Atom probe tomography data analysis procedure for precipitate and cluster identification in a Ti-Mo steel.

An atom probe tomography data analysis procedure for identification of particles in a Ti-Mo steel is presented. This procedure has been used to characterise both carbide precipitates (larger particles) and solute clusters (smaller particles), as reported in an accompanying Mater. Sci. Eng. A paper [1]. Particles were identified using the maximum separation method (cluster-finding algorithm) after resolving peak overlaps at several locations in the mass spectrum. The cluster-finding algorithm was applied to the data in a two-stage process to properly identify particles having a bimodal size distribution. Furthermore, possible misidentification of matrix atoms (mainly Fe) due to the local magnification effect (from the difference in field evaporation potential between the matrix and precipitates) has been resolved using an atomic density approach, comparing that measured experimentally using APT to the theoretical density of both the matrix and particles.

Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol.

INTRODUCTION: Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. METHODS AND ANALYSIS: A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. ETHICS AND DISSEMINATION: The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted.

Anodization parameters influencing the morphology and electrical properties of TiO2 nanotubes for living cell interfacing and investigations.

Nanotube structures have attracted tremendous attention in recent years in many applications. Among such nanotube structures, titania nanotubes (TiO2) have received paramount attention in the medical domain due to their unique properties, represented by high corrosion resistance, good mechanical properties, high specific surface area, as well as great cell proliferation, adhesion and mineralization. Although lot of research has been reported in developing optimized titanium nanotube structures for different medical applications, however there is a lack of unified literature source that could provide information about the key parameters and experimental conditions required to develop such optimized structure. This paper addresses this gap, by focussing on the fabrication of TiO2 nanotubes through anodization process on both pure titanium and titanium alloys substrates to exploit the biocompatibility and electrical conductivity aspects, critical factors for many medical applications from implants to in-vivo and in-vitro living cell studies. It is shown that the morphology of TiO2 directly impacts the biocompatibility aspects of the titanium in terms of cell proliferation, adhesion and mineralization. Similarly, TiO2 nanotube wall thickness of 30-40nm has shown to exhibit improved electrical behaviour, a critical factor in brain mapping and behaviour investigations if such nanotubes are employed as micro-nano-electrodes.

Note: electrochemical etching of silver tips in concentrated sulfuric acid.

Sharp metal tips have many uses, including in scanning probe microscopy. Silver is a particularly interesting metal for plasmonic enhancement, e.g., in tip-enhanced Raman spectroscopy, however few methods for the production of silver tips have been explored. A simple and reliable one step dc electrochemical method for the production of sharp silver tips in concentrated H2SO4 is presented. The optimal conditions are 10 V cell voltage and 99% sulfuric acid for tip radii below 100 nm. A LabView program was written to control the cut-off of the circuit to within a millisecond to avoid blunting the tips after drop-off.

Lymphedema in Canada: a qualitative study to help develop a clinical, research, and education strategy.

OBJECTIVE: The aim of this study was to gather data from Canadian stakeholders to help construct a national strategy and agenda for lymphedema management. METHODS: The Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema therapists, patient advocates, and others, used participatory action research and Open Space Technology to identify issues and build consensus at a national meeting of lymphedema stakeholders. Proceedings were videotaped and underwent content analysis. Existing Canadian documentation on lymphedema services was analyzed. Using those data sources, the Canadian Lymphedema Framework drafted a development strategy. RESULTS: Of 320 invited stakeholders (patients, therapists, physicians, industry representatives, and health policymakers), 108 participated in a day-long videotaped meeting discussing strategies to improve the management of lymphedema and related disorders in Canada. Participants identified barriers, challenges, and issues related to the need to raise awareness about lymphedema with patients, physicians, and the public. Five priority areas for development were articulated: education, standards, research, reimbursement and access to treatment, and advocacy. The main barrier to development was identified as the lack of clear responsibility within the health care system for lymphedema care. CONCLUSIONS: Data from stakeholders was obtained to solidly define priority areas for lymphedema development at a national level. The Canadian Lymphedema Framework has created a working plan, an advisory board, and working groups to implement the strategy.

Impact of hypoxia on the structure and function of benthic epifauna in Tolo Harbour, Hong Kong.

In Tolo Harbour, Hong Kong, where hypoxia occurs periodically, a large amount of benthic epifauna was found to be absent in the summer but become abundant again in the winter. This observation may indicate that some species are sensitive in detecting low dissolved oxygen (DO) levels and are able to escape from the harbour to more oxygenated, open waters when conditions deteriorate and return when DO levels are improved. Analysis of biological traits of these animals showed that 58% of the categories showed significant differences between the community structure in summer and winter. The significant biological traits of the few species, which remained in the harbour under the summer's hypoxic conditions suggested adaptation rather than opportunism to the low DO levels. Our data also showed that trawling can increase DO at the bottom and may benefit the less sensitive species that remained in the habitat during the summer.

Cytotoxicity of titanium and titanium alloying elements.

It is commonly accepted that titanium and the titanium alloying elements of tantalum, niobium, zirconium, molybdenum, tin, and silicon are biocompatible. However, our research in the development of new titanium alloys for biomedical applications indicated that some titanium alloys containing molybdenum, niobium, and silicon produced by powder metallurgy show a certain degree of cytotoxicity. We hypothesized that the cytotoxicity is linked to the ion release from the metals. To prove this hypothesis, we assessed the cytotoxicity of titanium and titanium alloying elements in both forms of powder and bulk, using osteoblast-like SaOS(2) cells. Results indicated that the metal powders of titanium, niobium, molybdenum, and silicon are cytotoxic, and the bulk metals of silicon and molybdenum also showed cytotoxicity. Meanwhile, we established that the safe ion concentrations (below which the ion concentration is non-toxic) are 8.5, 15.5, 172.0, and 37,000.0 microg/L for molybdenum, titanium, niobium, and silicon, respectively.

Effect of process control agent on the porous structure and mechanical properties of a biomedical Ti-Sn-Nb alloy produced by powder metallurgy.

The influence of different amounts and types of process control agent (PCA), i.e., stearic acid and ethylene bis-stearamide, on the porous structure and mechanical properties of a biomedical Ti-16Sn-4Nb (wt.%) alloy was investigated. Alloy synthesis was performed on elemental metal powders using high-energy ball milling for 5h. Results indicated that varying the PCA content during ball milling led to a drastic change in morphology and particle-size distribution of the ball-milled powders. Porous titanium alloy samples sintered from the powders ball milled with the addition of various amounts of PCA also revealed different pore morphology and porosity. The Vickers hardness of the sintered titanium alloy samples exhibited a considerable increase with increasing PCA content. Moreover, the addition of larger amounts of PCA in the powder mixture resulted in a significant increase in the elastic modulus and peak stress for the sintered porous titanium alloy samples under compression. It should also be mentioned that the addition of PCA introduced contamination (mainly carbon and oxygen) into the sintered porous product.

The reliability and accuracy of digital templating in total knee replacement.

We aimed to determine the reliability, accuracy and the clinical role of digital templating in the pre-operative work-up for total knee replacement. Initially a sample of ten pre-operative digital radiographs were templated by four independent observers to determine the inter- and intra-observer reliability of the process. Digital templating was then performed on the radiographs of 40 consecutive patients undergoing total knee replacement by a consultant surgeon not involved with the operation, who was blinded to the size of the implant inserted. The Press Fit Condylar Sigma Knee system was used in all the patients. The size of the implant as judged by templating was then compared to that of the size used. Good inter- and intra-observer agreement was demonstrated for both femoral and tibial templating. However, the correct size of the implant was predicted in only 48% of the femoral and 55% of the tibial components. Albeit reproducible, digital templating does not currently predict the correct size of component often enough to be of clinical benefit.

In vitro bioactivity evaluation of titanium and niobium metals with different surface morphologies.

Current orthopaedic biomaterials research mainly focuses on designing implants that could induce controlled, guided and rapid healing. In the present study, the surface morphologies of titanium (Ti) and niobium (Nb) metals were tailored to form nanoporous, nanoplate and nanofibre-like structures through adjustment of the temperature in the alkali-heat treatment. The in vitro bioactivity of these structures was then evaluated by soaking the treated samples in simulated body fluid (SBF). It was found that the morphology of the modified surface significantly influenced the apatite-inducing ability. The Ti surface with a nanofibre-like structure showed better apatite-inducing ability than the nanoporous or nanoplate surface structures. A thick dense apatite layer formed on the Ti surface with nanofibre-like structure after 1 week of soaking in SBF. It is expected that the nanofibre-like surface could achieve good apatite formation in vivo and subsequently enhance osteoblast cell adhesion and bone formation.

Titanium-nickel shape memory alloy foams for bone tissue engineering.

Titanium-nickel (TiNi) shape memory alloy (SMA) foams with an open-cell porous structure were fabricated by space-holder sintering process and characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. The mechanical properties and shape memory properties of the TiNi foam samples were investigated using compressive test. Results indicate that the plateau stresses and elastic moduli of the foams under compression decrease with the increase of their porosities. The plateau stresses and elastic moduli are measured to be from 1.9 to 38.3 MPa and from 30 to 860 MPa for the TiNi foam samples with porosities ranged from 71% to 87%, respectively. The mechanical properties of the TiNi alloy foams can be tailored to match those of bone. The TiNi alloy foams exhibit shape memory effect (SME), and it is found that the recoverable strain due to SME decreases with the increase of foam porosity.

The 'metacarpal cascade lines'; use in the diagnosis of dislocations of the carpometacarpal joints.

Dislocations of the carpometacarpal joints of the ring and little fingers are common and are frequently missed at presentation. We describe a radiographic observation which assists in the confirmation of the diagnosis.

Hydroxyapatite/titania sol-gel coatings on titanium-zirconium alloy for biomedical applications.

A simple sol-gel method was developed for hydroxyapatite/titania (HA/TiO(2)) coatings on non-toxic titanium-zirconium (TiZr) alloy for biomedical applications. The HA/TiO(2)-coated TiZr alloy displayed excellent bioactivity when soaked in a simulated body fluid (SBF) for an appropriate period. Differential scanning calorimetry, thermogravimetric analysis, X-ray diffraction and scanning electron microscopy-energy dispersive spectrometry were used to characterize the phase transformations and the surface structures and to assess the in vitro tests. The HA/TiO(2) layers were spin-coated on the surface of TiZr alloy at a speed of 3000rpm for 15s, followed by a heat treatment at 600 degrees C for 20min in an argon atmosphere sequentially. The TiO(2) layer exhibited a cracked surface and an anatase structure and the HA layer displayed a uniform dense structure. Both the TiO(2) and HA layers were 25microm thick, and the total thickness of the HA/TiO(2) coatings was 50microm. The TiZr alloy after the above HA/TiO(2) coatings displayed excellent bone-like apatite-forming ability when soaked in SBF and can be anticipated to be a promising load-bearing implant material.

Effect of stress on viral-bacterial synergy in bovine respiratory disease: novel mechanisms to regulate inflammation.

The severity of bovine respiratory infections has been linked to a variety of factors, including environmental and nutritional changes, transportation, and social reorganization of weaned calves. Fatal respiratory infections, however, usually occur when a primary viral infection compromises host defences and enhances the severity of a secondary bacterial infection. This viral-bacterial synergy can occur by a number of different mechanisms and disease challenge models have been developed to analyse host responses during these respiratory infections. A primary bovine herpesvirus-1 (BHV-1) respiratory infection followed by a secondary challenge with Mannheimia haemolytica results in fatal bovine respiratory disease (BRD) and host responses to these two pathogens have been studied extensively. We used this disease model to demonstrate that stress significantly altered the viral-bacterial synergy resulting in fatal BRD. Functional genomic analysis revealed that BHV-1 infection enhanced toll-like receptors (TLR) expression and increased pro-inflammatory responses which contribute to the severity of a Mannheimia haemolytica infection. TLRs play a critical role in detecting bacterial infections and inducing pro-inflammatory responses. It is difficult to understand, however, how stress-induced corticosteroids could enhance this form of viral-bacterial synergy. Nuclear translocation of the glucocorticoid receptor activates cell signalling pathways which inhibit both TLR signalling and pro-inflammatory responses. The apparent conundrum between stress-induced corticosteroids and enhanced BRD susceptibility is discussed in terms of present data and previous investigations of stress and respiratory disease.

Augmented hepatic interferon gamma expression and T-cell influx characterize acute hepatitis progressing to recovery and residual lifelong virus persistence in experimental adult woodchuck hepatitis virus infection.

Woodchucks infected with woodchuck hepatitis virus (WHV) have profiles of liver disease and age-dependent rates of progression to chronic hepatitis (CH) comparable with those seen in human hepatitis B. The mechanism of recovery from acute hepadnaviral infection or its evolution to chronicity remains unknown, although the liver immune responses are expected to play an important role. To determine the dynamics of intrahepatic cytokine expression and T-cell involvement, and to assess their value in predicting the outcome of acute hepatitis (AH) in the adult onset of WHV infection, we evaluated liver transcription of interferon gamma (IFN-gamma); tumor necrosis factor alpha (TNF-alpha); interleukins (IL)-2, -4, and -6; and the T-cell influx in relation to disease histologic severity and virus load in serial liver biopsies collected during the life span of experimentally infected woodchucks. Our results show that recovery from viral AH in adulthood is preceded by a significantly greater hepatic expression of IFN-gamma and CD3, an increased TNF-alpha transcription, lower hepatic WHV load, and a greater degree of liver inflammation than those in acute infection with CH outcome. Furthermore, we have learned that the elevated IFN-gamma, TNF-alpha, and CD3 expression in the liver endures for years not only in CH, but also, although to a lesser extent, in apparently completely resolved infection. This is consistent with our previous findings that residual WHV replication and remnant liver inflammation continue for life after recovery from AH. This study indicates that antiviral cytokines, in particular IFN-gamma, may play a central role in the long-term control of occult hepadnavirus persistence in the liver.

Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor.

BACKGROUND: Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC). The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index (BIS). METHODS: After premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl, 30 patients aged 20-65 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus dose; 25 microg x kg(-1) x min(-1)). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients received 4 mg/kg thiopental and 1 mg/kg rocuronium for tracheal intubation. After 10 min of a predetermined end-tidal sevoflurane concentration, BIS was measured. The ED50 of sevoflurane for each group was determined by up-down methodology based on BIS less than 50 (MAC(BIS50)). Plasma lidocaine concentrations were measured. RESULTS: The MAC(BIS50) of sevoflurane (0.59% end tidal) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (0.92%) or with intravenous lidocaine (1%; P < 0.0001). Plasma lidocaine concentrations in the intravenous lidocaine group (1.9 microg/ml) were similar to those in the epidural lidocaine group (2.0 microg/ml). CONCLUSIONS: Epidural anesthesia reduced by 34% the sevoflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocaine absorbtion, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for postoperative patient-controlled epidural analgesia.

UNLABELLED: Ropivacaine for patient-controlled epidural analgesia (PCEA) may facilitate postoperative patient mobilization because it causes less motor block than bupivacaine. Forty patients undergoing abdominal surgery were randomized in a double-blinded manner to the following: 0.05% bupivacaine/4 microg fentanyl, 0.1% bupivacaine/fentanyl, 0.05% ropivacaine/fentanyl, or 0.1% ropivacaine/fentanyl for standardized PCEA. We measured pain scores, side effects, and PCEA consumption for 42 h. Lower-extremity motor function was assessed with electromyography and isometric force dynamometry. Analgesia was equivalent among groups. Local anesthetic use was more in the 0.1% Ropivacaine and 0.1% Bupivacaine groups (77% increase, P = 0.001). Motor function decreased during PCEA (10%-35% decrease from preoperative, P < 0.001) and was equivalent among groups. Eight patients were transiently unable to ambulate. These patients used more local anesthetic (45 vs 33 mg mean, P < 0.05) with additional decrease in motor function (32%, P < 0.004) compared with ambulating patients. Other side effects were mild and equivalent among solutions. PCEA with bupivacaine/fentanyl and ropivacaine/fentanyl as 0.05% or 0.1% solutions appears clinically equipotent. Lower-extremity motor function decreases, but is unlikely to result in prolonged inability to ambulate. Use of a 0.05% solution may be advantageous to decrease local anesthetic use and prevent transient motor block. IMPLICATIONS: Patient-controlled epidural analgesia with bupivacaine/fentanyl and ropivacaine/fentanyl as either 0.05% or 0.1% solutions are clinically similar. Lower-extremity motor function will decrease with the use of any of these combinations, but is unlikely to result in the inability to walk.

Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair.

BACKGROUND AND OBJECTIVES: Femoral nerve block is effective in reducing postoperative pain after inpatient knee surgery. We studied its efficacy compared with standard analgesia following outpatient anterior cruciate ligament repair, including the duration of analgesia and the effect of different concentrations of bupivacaine. METHODS: After Institutional Review Board approval and informed consent, we prospectively randomized patients to receive, in a blinded fashion, either a sham block, a femoral nerve block with 25 mL 0.25% bupivacaine, or with 25 mL 0.5% bupivacaine after anterior cruciate ligament repair under epidural anesthesia. Verbal analog pain scores were evaluated by a blinded observer at 20 and 40 minutes after injection. Patients with pain >4 (out of 10) were assessed for the presence of a block and offered a supplemental block if no anesthesia was present at either evaluation. By prospective agreement, any study group with 6 failures was excluded from further recruitment. After discharge, patients recorded pain scores and analgesic consumption in a diary, and estimated the time at which they perceived that analgesia and sensory block from the femoral nerve block resolved, based on an increase in pain, sensation, and strength in the leg. RESULTS: In the sham block group, 6 of 12 patients reported inadequate analgesia in the postanesthesia care unit (4 at 20 minutes, 2 at 40 minutes; greater than other groups, P <.003) and were excluded from further study. Patients with sham blocks had higher pain scores 20 minutes after the block, and requested intravenous analgesia more often. Bupivacaine 0.25% and 0.5% provided 23.2 +/- 7 and 25.7 +/- 11 hours of analgesia, respectively. CONCLUSIONS: Femoral nerve block with 0.25% bupivacaine contributes significantly to multimodal postoperative analgesia in the immediate postoperative period following outpatient anterior cruciate ligament repair. Both doses of bupivacaine studied provided analgesia for the first night after surgery.