Bone cement implantation syndrome (BCIS) is poorly understood. It is an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty and may also be seen in the postoperative period in a milder form causing hypoxia and confusion. Hip arthroplasty is becoming more common in an ageing population. The older patient may have co-existing pathologies which can increase the likelihood of developing BCIS. This article reviews the definition, incidence, clinical features, risk factors, aetiology, pathophysiology, risk reduction, and management of BCIS. It is possible to identify high risk groups of patients in which avoidable morbidity and mortality may be minimized by surgical selection for uncemented arthroplasty. Invasive anaesthetic monitoring should be considered during cemented arthroplasty in high risk patients.
This paper presents a critical and reflexive account of using Q methodology in human geography. Q methodology has a long pedigree in psychological, political and sociological research, but is only recently beginning to be used by human geographers. We discuss, in particular, the parts of the process(es) of Q methodology that are often glossed over in the literature, through reflecting on our learning in using Q within a project examining the use and production of environmental science by NGOs. We conclude that Q may be a useful supplement to existing methods in human geography, as long as it is used creatively and reflexively and with full awareness of its interpretative dimensions.
In this paper we examine the role of nongovernmental organisations (NGOs) in debates about environmental science and knowledge, using empirical evidence from in-depth interviews with a range of NGOs involved in the waste debate in the United Kingdom. We discuss theoretical issues of scientific boundary-work and the construction of expertise and socially distributed knowledge, and then apply these to our empirical evidence. Our conclusions are that NGOs continue to subscribe to the notion of the preeminent authority of science in environmental debates, but also work partly in a more diverse, highly networked world of knowledge production which requires them to be pragmatic and versatile in how they legitimate knowledge from various sources. Hence, scientific knowledge is highly contingent in its authority, and dependent upon continual (re)negotiation.
Background Liraglutide is a glucagon-like peptide-1 (GLP-1) analogue currently approved for type 2 diabetes and obesity. Preclinical evidence in transgenic models of Alzheimer’s disease suggests that liraglutide exerts neuroprotective effects by reducing amyloid oligomers, normalising synaptic plasticity and cerebral glucose uptake, and increasing the proliferation of neuronal progenitor cells. The primary objective of the study is to evaluate the change in cerebral glucose metabolic rate after 12 months of treatment with liraglutide in participants with Alzheimer’s disease compared to those who are receiving placebo. Methods/design ELAD is a 12-month, multi-centre, randomised, double-blind, placebo-controlled, phase IIb trial of liraglutide in participants with mild Alzheimer’s dementia. A total of 206 participants will be randomised to receive either liraglutide or placebo as a daily injection for a year. The primary outcome will be the change in cerebral glucose metabolic rate in the cortical regions (hippocampus, medial temporal lobe, and posterior cingulate) from baseline to follow-up in the treatment group compared with the placebo group. The key secondary outcomes are the change from baseline to 12 months in z scores for clinical and cognitive measures (Alzheimer’s Disease Assessment Scale—Cognitive Subscale and Executive domain scores of the Neuropsychological Test Battery, Clinical Dementia Rating Sum of Boxes, and Alzheimer’s Disease Cooperative Study—Activities of Daily Living) and the incidence and severity of treatment-emergent adverse events or clinically important changes in safety assessments. Other secondary outcomes are 12-month change in magnetic resonance imaging volume, diffusion tensor imaging parameters, reduction in microglial activation in a subgroup of participants, reduction in tau formation and change in amyloid levels in a subgroup of participants measured by tau and amyloid imaging, and changes in composite scores using support machine vector analysis in the treatment group compared with the placebo group. Discussion Alzheimer’s disease is a leading cause of morbidity worldwide. As available treatments are only symptomatic, the search for disease-modifying therapies is a priority. If the ELAD trial is successful, liraglutide and GLP-1 analogues will represent an important class of compounds to be further evaluated in clinical trials for Alzheimer’s treatment. Trial registration ClinicalTrials.gov, NCT01843075 . Registration 30 April 2013. Electronic supplementary material The online version of this article (10.1186/s13063-019-3259-x) contains supplementary material, which is available to authorized users.
Nick Brown, then England's Minister for Agriculture, sent written advice about biosecurity to 85 000 livestock farmers. This action led to the first use of the term`biosecurity' in the House of Commons debating chamber on 9 April, as Brown outlined the latest measures being taken to combat the epidemic of foot and mouth disease (FMD) that only a month earlier he had erroneously announced was under control'. In fact, FMD, a viral disease of hoofed mammals, had spread through livestock to epidemic levels before it was even detected. The epidemic cost the UK »8 billion (much of this in sectors outside of agriculture) and gave rise to the slaughter of over 6 million animals in the largest-ever animal disease cull (for fuller accounts see Donaldson et al, 2002;. Whilst relatively confined to Great Britain (although The Netherlands and, to a lesser extent, Ireland and France were also affected) the crisis took place on a global stage. Control measures were dictated by the European Union, due to its status as a trade bloc under the World Trade Organization (WTO), as well as by WTO regulations themselves, and pictures of the hellish aftermath of slaughter and carcass disposal were broadcast round the world. The epidemic demonstrated that a modern state, with large resources and supposedly adequate contingency planning, could be overwhelmed by the multiplication of a simple virus. In the political debates, media coverage, and rapid policy making that accompanied the epidemic, biosecurity emerged as a government watchword, apparently central to the arsenal that eventually defeated FMD in September 2001.Biosecurity manifests variously around agriculture and animal disease, public health, (bio)terrorism, and the potential misuse of biotechnologies and bioscience research (compare Collier et al, 2004; Donaldson and Wood, 2004;Hinchliffe and Bingham, 2008). Viewed from a geographical perspective, biosecurity implies the maintenance of a spatial separation between categories of biological things: those which are
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