Crawley Hospital

INTRODUCTION: In 2008, the UK National Osteoporosis Guideline Group (NOGG) produced a guideline on the prevention and treatment of osteoporosis, with an update in 2013. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over. METHODS: Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. RESULTS: Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment, lifestyle measures and pharmacological interventions, duration and monitoring of bisphosphonate therapy, glucocorticoid-induced osteoporosis, osteoporosis in men, postfracture care and intervention thresholds. CONCLUSION: The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management.

We present an approach to understanding crystal packing via 'energy frameworks', that combines efficient calculation of accurate intermolecular interaction energies with a novel graphical representation of their magnitude. In this manner intriguing questions, such as why some crystals bend with an applied force while others break, and why one polymorph of a drug exhibits exceptional tabletability compared to others, can be addressed in terms of the anisotropy of the topology of pairwise intermolecular interaction energies. This approach is applied to a sample of organic molecular crystals with known bending, shearing and brittle behaviour, to illustrate its use in rationalising their mechanical behaviour at a molecular level.

ABSTRACT We have developed and implemented a robust and practical scheme for anisotropic 3D acoustic full-waveform inversion (FWI). We demonstrate this scheme on a field data set, applying it to a 4C ocean-bottom survey over the Tommeliten Alpha field in the North Sea. This shallow-water data set provides good azimuthal coverage to offsets of 7 km, with reduced coverage to a maximum offset of about 11 km. The reservoir lies at the crest of a high-velocity antiformal chalk section, overlain by about 3000 m of clastics within which a low-velocity gas cloud produces a seismic obscured area. We inverted only the hydrophone data, and we retained free-surface multiples and ghosts within the field data. We invert in six narrow frequency bands, in the range 3 to 6.5 Hz. At each iteration, we selected only a subset of sources, using a different subset at each iteration; this strategy is more efficient than inverting all the data every iteration. Our starting velocity model was obtained using standard PSDM model building including anisotropic reflection tomography, and contained epsilon values as high as 20%. The final FWI velocity model shows a network of shallow high-velocity channels that match similar features in the reflection data. Deeper in the section, the FWI velocity model reveals a sharper and more-intense low-velocity region associated with the gas cloud in which low-velocity fingers match the location of gas-filled faults visible in the reflection data. The resulting velocity model provides a better match to well logs, and better flattens common-image gathers, than does the starting model. Reverse-time migration, using the FWI velocity model, provides significant uplift to the migrated image, simplifying the planform of the reservoir section at depth. The workflows, inversion strategy, and algorithms that we have used have broad application to invert a wide-range of analogous data sets.

Novel species of fungi described in this study include those from various countries as follows: Australia : Apiognomonia lasiopetali on Lasiopetalum sp., Blastacervulus eucalyptorum on Eucalyptus adesmophloia , Bullanockia australis (incl. Bullanockia gen. nov.) on Kingia australis , Caliciopsis eucalypti on Eucalyptus marginata , Celerioriella petrophiles on Petrophile teretifolia , Coleophoma xanthosiae on Xanthosia rotundifolia , Coniothyrium hakeae on Hakea sp., Diatrypella banksiae on Banksia formosa , Disculoides corymbiae on Corymbia calophylla , Elsinoë eelemani on Melaleuca alternifolia , Elsinoë eucalyptigena on Eucalyptus kingsmillii , Elsinoë preissianae on Eucalyptus preissiana , Eucasphaeria rustici on Eucalyptus creta , Hyweljonesia queenslandica (incl. Hyweljonesia gen. nov.) on the cocoon of an unidentified microlepidoptera, Mycodiella eucalypti (incl. Mycodiella gen. nov.) on Eucalyptus diversicolor , Myrtapenidiella sporadicae on Eucalyptus sporadica , Neocrinula xanthorrhoeae (incl. Neocrinula gen. nov.) on Xanthorrhoea sp., Ophiocordyceps nooreniae on dead ant, Phaeosphaeriopsis agavacearum on Agave sp., Phlogicylindrium mokarei on Eucalyptus sp., Phyllosticta acaciigena on Acacia suaveolens , Pleurophoma acaciae on Acacia glaucoptera , Pyrenochaeta hakeae on Hakea sp., Readeriella lehmannii on Eucalyptus lehmannii , Saccharata banksiae on Banksia grandis , Saccharata daviesiae on Daviesia pachyphylla , Saccharata eucalyptorum on Eucalyptus bigalerita , Saccharata hakeae on Hakea baxteri , Saccharata hakeicola on Hakea victoria , Saccharata lambertiae on Lambertia ericifolia , Saccharata petrophiles on Petrophile sp., Saccharata petrophilicola on Petrophile fastigiata , Sphaerellopsis hakeae on Hakea sp., and Teichospora kingiae on Kingia australis . Brazil : Adautomilanezia caesalpiniae (incl. Adautomilanezia gen. nov.) on Caesalpina echinata , Arthrophiala arthrospora (incl. Arthrophiala gen. nov.) on Sagittaria montevidensis , Diaporthe caatingaensis (endophyte from Tacinga inamoena ), Geastrum ishikawae on sandy soil, Geastrum pusillipilosum on soil, Gymnopus pygmaeus on dead leaves and sticks, Inonotus hymenonitens on decayed angiosperm trunk, Pyricularia urashimae on Urochloa brizantha , and Synnemellisia aurantia on Passiflora edulis . Chile : Tubulicrinis australis on Lophosoria quadripinnata . France : Cercophora squamulosa from submerged wood, and Scedosporium cereisporum from fluids of a wastewater treatment plant. Hawaii : Beltraniella acaciae , Dactylaria acaciae , Rhexodenticula acaciae , Rubikia evansii and Torula acaciae (all on Acacia koa ). India : Lepidoderma echinosporum on dead semi-woody stems, and Rhodocybe rubrobrunnea from soil. Iran : Talaromyces kabodanensis from hypersaline soil. La Réunion : Neocordana musarum from leaves of Musa sp. Malaysia : Anungitea eucalyptigena on Eucalyptus grandis × pellita , Camptomeriphila leucaenae (incl. Camptomeriphila gen. nov.) on Leucaena leucocephala , Castanediella communis on Eucalyptus pellita , Eucalyptostroma eucalypti (incl. Eucalyptostroma gen. nov.) on Eucalyptus pellita , Melanconiella syzygii on Syzygium sp., Mycophilomyces periconiae (incl. Mycophilomyces gen. nov.) as hyperparasite on Periconia on leaves of Albizia falcataria , Synnemadiella eucalypti (incl. Synnemadiella gen. nov.) on Eucalyptus pellita , and Teichospora nephelii on Nephelium lappaceum . Mexico : Aspergillus bicephalus from soil. New Zealand : Aplosporella sophorae on Sophora microphylla , Libertasomyces platani on Platanus sp., Neothyronectria sophorae (incl. Neothyronectria gen. nov.) on Sophora microphylla , Parastagonospora phoenicicola on Phoenix canariensis , Phaeoacremonium pseudopanacis on Pseudopanax crassifolius , Phlyctema phoenicis on Phoenix canariensis , and Pseudoascochyta novae-zelandiae on Cordyline australis . Panama : Chalara panamensis from needle litter of Pinus cf. caribaea . South Africa : Exophiala eucalypti on leaves of Eucalyptus sp., Fantasmomyces hyalinus (incl. Fantasmomyces gen. nov.) on Acacia exuvialis , Paracladophialophora carceris (incl. Paracladophialophora gen. nov.) on Aloe sp., and Umthunziomyces hagahagensis (incl. Umthunziomyces gen. nov.) on Mimusops caffra . Spain : Clavaria griseobrunnea on bare ground in Pteridium aquilinum field, Cyathus ibericus on small fallen branches of Pinus halepensis , Gyroporus pseudolacteus in humus of Pinus pinaster , and Pseudoascochyta pratensis (incl. Pseudoascochyta gen. nov.) fromsoil. Thailand : Neoascochyta adenii on Adenium obesum , and Ochroconis capsici on Capsicum annuum . UK : Fusicolla melogrammae from dead stromata of Melogramma campylosporum on bark of Carpinus betulus . Uruguay : Myrmecridium pulvericola from house dust. USA : Neoscolecobasidium agapanthi (incl. Neoscolecobasidium gen. nov.) on Agapanthus sp., Polyscytalum purgamentum on leaf litter, Pseudopithomyces diversisporus from human

BACKGROUND: In addition to recurrent epileptic seizures, children with epilepsy can have coexisting cognitive and behavioral difficulties but the spectrum and prevalence of such difficulties are uncertain. METHODS: The Children with Epilepsy in Sussex Schools study is a prospective, community-based study involving school-aged children (5–15 years) with active epilepsy in a defined geographical area in the United Kingdom. Participants underwent comprehensive psychological assessment, including measures of cognition, behavior, and motor functioning. Consensus neurobehavioral diagnoses were made with respect to Diagnostic and Statistical Manual, Fourth Edition-Text Revision (DSM-IV-TR) criteria. RESULTS: A total of 85 children (74% of eligible population) were enrolled; 80% of children with active epilepsy had a DSM-IV-TR behavioral disorder and/or cognitive impairment (IQ ,85). Intellectual disability (ID) (IQ ,70) (40%), attention-deficit/hyperactivity disorder (ADHD) (33%), and autism spectrum disorder (ASD) (21%) were the most common neurobehavioral diagnoses. Of those who met criteria for a DSM-IV-TR behavioral disorder, only one-third had previously been diagnosed. Logistic regression revealed that seizures in the first 24 months compared with first seizures at 24 to 60 or 61+ months (odds ratio [OR] 13, 95% confidence interval 2.2–76.9; OR 21.3, 3.2–148.9) and polytherapy (OR 7.7, 1.6–36.3) were independently associated with ID and the presence of ID was associated with a diagnosis of ASD (OR 14.1, 2.3–87.1) after Bonferroni adjustment. Epilepsy-related factors did not independently predict the presence of behavioral disorders. CONCLUSIONS: Screening for neurobehavioral comorbidities should be an integral part of management in children with “active” epilepsy. There is a need for research to identify neurobiological mechanisms underpinning neurobehavioral impairments and studies to evaluate possible treatments.

Sulfoxides are capable of forming stable complexes with transition metals and there have been many comprehensive studies into their binding properties. However, the use of sulfoxides, particularly chiral sulfoxides, as ligands in transition metal catalysis is rather less well developed. This review aims to describe these catalytic studies and covers new developments that are showing very promising results and that have led to a renewed interest in this field.

ABSTRACT By adapting reverse time migration (RTM) and demigration as the migration and modeling operators to maximize the crosscorrelation between the simulated and the acquired seismic data, we introduced a new practical least-squares RTM (LSRTM) scheme and derived a steepest descent method in seeking the optimal image. Through synthetic and real data experiments, we determined that the proposed LSRTM provided high-quality images with balanced amplitudes, improved focusing, and enhanced resolution. The method was also capable of removing free surface ghosts caused by towed streamer acquisition, filling the structures and reducing crosstalk noise associated with simultaneous shooting.

The effect of citrated stored blood on coagulation was studied initially in a pilot study where 25 patients with acute severe gastrointestinal haemorrhage had their whole blood coagulation measured using the Biobridge Impedance Clotting Time (ICT). This demonstrated that there is a hypercoagulable response to haemorrhage which was partially reversed by blood transfusion. Similar changes were noted in Kaolin Cephalin Clotting Times (KCCT). A further 50 patients were then randomized to receive, during the 24 h after admission, either at least 2 units of blood or no blood transfusion unless the haemoglobin fell below 8 g/dl or they were shocked. In the transfused group nine patients re-bled compared with only one in the non-transfused group (P less than 0.01, chi 2 with Yates' correction). Early blood transfusion appears to reverse the hypercoagulable response to haemorrhage thereby encouraging re-bleeding and hence the need for an operation.

OBJECTIVES: To estimate fracture risk in patients receiving bariatric surgery versus matched controls. DESIGN: Population based, retrospective cohort study. SETTING: Use of records from the United Kingdom General Practice Research Database, now known as the Clinical Practice Research Datalink (from January 1987 to December 2010). PARTICIPANTS: Patients with a body mass index of at least 30, with a record of bariatric surgery (n=2079), and matched controls without a record (n=10,442). Each bariatric surgery patient was matched to up to six controls by age, sex, practice, year, and body mass index. Patients were followed from the date of bariatric surgery for the occurrence of any fracture. We used time dependent Cox regression to calculate relative rates of fracture, adjusted for disease and previous drug treatment, and time-interaction terms to evaluate fracture timing patterns. MAIN OUTCOME MEASURE: Relative rates of any, osteoporotic, and non-osteoporotic fractures. RESULTS: Mean follow-up time was 2.2 years. Overall, there was no significantly increased risk of fracture in patients who underwent bariatric surgery, compared with controls (8.8 v 8.2 per 1000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33). Bariatric surgery also did not affect risk of osteoporotic and non-osteoporotic fractures. However, we saw a trend towards an increased fracture risk after three to five years following surgery, as well as in patients who had a greater decrease in body mass index after surgery, but this was not significant. CONCLUSION: Bariatric surgery does not have a significant effect on the risk of fracture. For the first few years after surgery, these results are reassuring for patients undergoing such operations, but do not exclude a more protracted adverse influence on skeletal health in the longer term.

This paper describes a new technique for modeling and simulating the coherent returns from radar sea clutter, based on the compound K-distribution model for clutter amplitude statistics. Using observations of recorded Doppler spectra, a simple method is proposed for characterizing the temporal variations of the Doppler spectrum observed in a single-range cell. It is shown that simulations based on this model can reproduce the main statistical features observed in real measurements.

Osteoporosis is a common and debilitating condition associated with significant morbidity and mortality. The efficacy and safety of oral bisphosphonates for the treatment of osteoporosis are well established. However, patient adherence and persistence on treatment are suboptimal. This randomised open-label multi-centre study of 6-months' duration compared persistence on treatment in postmenopausal women with osteoporosis receiving either once-monthly ibandronate plus a patient support programme (PSP), or once-weekly alendronate. To avoid falsely elevated persistence rates often associated with clinical trials, the study was designed to reflect everyday clinical practice in the UK and follow-up visits were limited to be consistent with the primary care setting. Analysis of the primary endpoint showed that persistence was significantly higher in the ibandronate/PSP group compared with the alendronate group (p < 0.0001). The estimated proportion of patients persisting with treatment at 6 months was 56.6% (306/541) and 38.6% (198/513) in the ibandronate/PSP and alendronate groups, respectively. Therefore, compared with alendronate, there was a 47% relative improvement in the proportion of patients persisting with treatment in the ibandronate/PSP group. Secondary endpoint measurements of adherence (e.g. proportion of patients remaining on treatment at study end; proportion of patients discontinuing from the study) were also significantly different in favour of ibandronate plus patient support. In summary, the PERSIST study demonstrated that persistence on treatment was increased in patients receiving once-monthly ibandronate plus patient support compared with once-weekly alendronate. Increased persistence on bisphosphonate treatment is expected to improve patient outcomes and decrease the social and economic burden of osteoporosis.

Summary points:&#13;\n&#13;\nThe definition of street children varies, although much research distinguishes two groups: home based, who usually return home at night, and street based, who remain on the street and have no family support. &#13;\n&#13;\nLittle accurate information exists about the numbers of street children. &#13;\n&#13;\nStreet children are more prone to several physical problems, although most research has focused on adverse effects of sexual activity and drug misuse. &#13;\n&#13;\nSupport programmes have succeeded in returning children to their homes.&#13;\n&#13;\nDespite legislative changes, a vocal street children's movement, and adoption of advocacy strategies many street children continue to suffer violence and human rights abuses. &#13;\n&#13;\nMuch of society and the media remain to be convinced of the worth of street children.

BACKGROUND AND PURPOSE: There has been concern about carotid percutaneous transluminal angioplasty (PTA) carrying a greater risk of cerebral ischemia than carotid endarterectomy. We set out to compare cerebral hemodynamics and microembolization during carotid PTA and CEA. METHODS: We used transcranial Doppler to monitor the middle cerebral artery of 28 patients undergoing carotid PTA (n = 14) or carotid endarterectomy (CEA) with a shunt (n = 14). Each period during which the internal carotid artery was occluded by PTA balloon or by clamp when the shunt was not in place was timed. Individual periods were summated to give a total occlusion time. Ischemic time was defined as the period for which mean middle cerebral artery velocity fell to a third or less of baseline. Microembolic signals were counted during each procedure. RESULTS: CEA resulted in significantly longer individual and total occlusion time than PTA (mean individual occlusion time, seconds), CEA, 168 +/- 51; PTA, 20 +/- 7; P < .001; mean total occlusion time; CEA, 337 +/- 70; PTA, 26 +/- 10; P < .001. Ischemic time was also significantly longer during CEA than during PTA (CEA, 165 +/- 40; PTA, 17 +/- 5; P = .001). There were significantly more microembolic signals during PTA than during CEA (mean number of microembolic signals during CEA, 52 +/- 64; during PTA, 202 +/- 119; P = .001). There was no correlation between any of the parameters measured and periprocedural stroke, which occurred in one patient in each group. CONCLUSION: PTA results in less hemodynamic ischemia but more cerebral microembolism than CEA. In this small series, however, it is not possible to comment on the relations between ischemic time, microembolism, and stroke.

Sixty-three patients with liver disease were studied for the presence of the components of Sjögren's syndrome. The "sicca complex" (that is, patients without arthritis) was detected in 42% of patients with active chronic hepatitis, 72% with primary biliary cirrhosis, and 38% with cryptogenic cirrhosis. One patient with active chronic hepatitis and one with primary biliary cirrhosis had rheumatoid arthritis. No evidence of Sjögren's syndrome was detected in seven patients with alcoholic cirrhosis. It is suggested that the sicca complex and autoimmune liver disease may be part of a systemic disorder in which immunological mechanisms are concerned in the pathogenesis.

BACKGROUND: Restless legs syndrome (RLS) is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. METHODS: The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored task force consisting of experts and primary care practitioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. RESULTS: The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. CONCLUSION: The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here.

A novel technique for the fast and robust quantification of collagen architecture following scarring.

Tools for editing the genome and epigenome have revolutionised the field of molecular biology and represent a new frontier in targeted therapeutic intervention. Although efficiencies and specificities of genome editing technologies have improved with the development of TALEs and CRISPR platforms, intracellular delivery of these larger constructs still remains a challenge using existing delivery agents. Viral vectors, including lentiviruses and adeno-associated viruses, as well as some non-viral strategies, such as cationic polymers and liposomes, are limited by packaging capacity, poor delivery, toxicity, and immunogenicity. We report a highly controlled synthetic strategy to engineer a flexible dendritic polymer using click chemistry to overcome the aforementioned delivery challenges associated with genome engineering technologies. Using a systematic approach, we demonstrate that high transfection efficiencies and packaging capacity can be achieved using this non-viral delivery methodology to deliver zinc fingers, TALEs and CRISPR/dCas9 platforms.

This article presents an overview of the health implications of liquorice. Liquorice has beneficial applications in the medicinal and the confectionery sectors; the substance, therefore, is both widely available and commercially attractive. However, the ingestion of liquorice, and/or its active metabolites, can sometimes produce an acquired form of apparent mineralocorticoid excess (AME) syndrome, expressed as sodium retention, potassium loss and suppression of the renin-angiotensin-aldosterone system, in addition to clinical consequences such as raised blood pressure and oedema. Moreover, these metabolic changes, the mechanisms underlying which are highlighted in the accompanying text, are associated with a number of additional clinical symptoms. Considering the easy availability of liquorice itself and also of other products containing its active metabolites, it is quite possible that the health burden of liquorice-induced morbidity could be substantial. Healthcare practitioners need to be fully aware of the risks in view of a large number of reports in the literature concerning its toxicity.

Recovering methane (CH₄) <italic>via</italic> the injection of carbon dioxide (CO₂) into a CH₄-hydrate-bearing reservoir is a highly attractive mechanism for meeting the world's future energy demand, since it offers the prospect of carbon-neutral energy production.

Abstract The calibrated strain on the back face (the face opposite that from which the slot is machined) of compact tension (CT) and T-type wedge-opening-loading (WOL) specimens provides a method for measuring crack length when the load is known or for measuring load when the crack length is known. The method is simple, reliable, sensitive, and inexpensive. A good correlation was achieved between strain measurements on a CT specimen and values computed from a two-dimensional finite element analysis. The method has good potential for developing into a more sensitive crack length measurement technique than has previously been achieved. Calibration tables and graphs are reproduced that describe the relationship between crack length, back-face strain, and load for CT and T-type WOL specimens of any size and thickness and for any linear elastic material. The method has several advantages over the closely related crack opening displacement (COD) technique for some test situations and these are described. In particular, the back-face strain increases linearly with crack length for constant stress intensity conditions except for very deep cracks in CT specimens. The overall characteristics render the technique ideal for incorporation into computerized/automated crack growth testing. For constant back-face strain, the stress intensity was shown to decrease with increase in crack length for both CT and T-type WOL specimens. This decrease is more pronounced than for corresponding constant COD testing and this provides a good technique for obtaining threshold fatigue or stress corrosion conditions.