Mapping the movement for climate change and health in England: a descriptive review and theory of change analysis.

AIMS: There are a growing number of organisations working to address the connections between climate change and health. This article introduces the concept of 'theories of change' - the methodology by which organisations or movements hope to bring about social change - and applies it to the current climate change and health movement in England. Through movement mapping, the article describes and offers reflections on the climate change and health ecosystems in England. METHODS: Organisations working on climate change and health in England were identified and publicly available information was collated to map movement characteristics, target stakeholders and methodologies deployed, using an inductive, iterative approach. RESULTS: A total of 98 organisations working on health and climate change (and/or sustainability) were initially identified, of which 70 met the inclusion criteria. Most organisations target two or more stakeholders, with healthcare workers, management structures, and government being most commonly cited. Methodological approaches identified include Formal education programmes; Awareness-raising; Purchasing-procurement power; Advocacy; Financial; Media-messaging; Networking; Knowledge generation; and Policy making, of which education, awareness-raising, and advocacy are most commonly used. CONCLUSION: There is a tendency for climate change and health organisations in England to focus on individual level and sectoral change over system change. More could be made of the potential for the healthcare professions' voice and messaging for the wider climate movement. Given the rapid boom of climate change and health organisations in recent years, a mind-set shift that recognises different players as part of a cohesive ecosystem with better coordination and collaboration may reduce unnecessary work, and facilitate more cohesive outcomes.

Repair of calvarial defects in rats by prefabricated, degradable, long fibre composite implants.

We report results from an initial small animal study designed to provide information on the biocompatibility of a novel biodegradable composite designed for craniomaxillofacial reconstruction. Rat calvarium was chosen as a clinically analogous model, which allowed comparison between experimental groups (PCL alone, PCL/phosphate glass, or PCL/bioglass implants) and control groups (empty defects or bone grafted defects). All animals recovered well from surgery and no clinical complications were observed. Histological assessment indicated a lack of inflammatory response. The amount of new bone formation at the dural aspect of the implant was statistically significantly higher in the PCL/phosphate glass group than the other experimental groups. This study confirms, in a clinically analogous model, the promise of the novel PCL/phosphate glass composite material. Work is planned toward manufacturing scale up and clinical trials.

A review of the design process for implantable orthopedic medical devices.

The design process for medical devices is highly regulated to ensure the safety of patients. This paper will present a review of the design process for implantable orthopedic medical devices. It will cover the main stages of feasibility, design reviews, design, design verification, manufacture, design validation, design transfer and design changes.

Cells react to nanoscale order and symmetry in their surroundings.

Mammalian cells react to microstructured surfaces, but there is little information on the reactions to nanostructured surfaces, and such as have been tested are poorly ordered or random in their structure. We now report that ordered surface arrays (orthogonal or hexagonal) of nanopits in polycaprolactone or polymethylmethacrylate have marked effects in reducing cell adhesion compared with less regular arrays or planar surfaces. The pits had diameters of 35, 75, and 120 nm, respectively, with pitch between the pits of 100, 200, and 300 nm, respectively. The cells appear to be able to distinguish between different symmetries of array. We suggest that interfacial forces may be organized by the nanostructures to affect the cells in the same way as they affect liquid crystal orientations.

A comparison of the torsional performance of stainless steel and titanium alloy tibial intramedullary nails: a clinically relevant approach.

In recent years there has been a tendency to design and manufacture intramedullary nails from titanium alloy rather than from stainless steel. The aim of this project was to compare the torsional performance of one manufacturers standard stainless steel and titanium alloy tibial intramedullary nails, using their distal locking screw holes and dedicated cross screws to secure each nail distally. A custom built test rig and materials testing machine were used to determine the torsional rigidity of the nails. Theory was used to calculate the torsional rigidity of the central parts of each nail. From the mechanical testing, the mean torsional rigidity of the titanium alloy nail system was 40.9 N m2 while that of the stainless steel nail system was 34.6 N m2, for all distal interlocking screw positions tested. Based on theoretical calculations the torsional rigidity of the central part of the nail was 83 N m2 for the stainless steel nail and 66 N m2 for the titanium alloy nail. This study shows the importance of using the distal locking screw holes and dedicated cross screws to secure intramedullary nails during mechanical testing so that clinically relevant results are obtained about the whole nail system and not just the nail.

A longitudinal study of the cultivable subgingival anaerobic bacteria isolated from sheep during the development of broken mouth periodontitis.

In a longitudinal bacteriological study of the cultivable subgingival anaerobic flora isolated from developing broken mouth periodontitis in sheep, samples were taken from five sheep on each of three farms on seven occasions over a period of 2.5 years. Ten different bacterial genera were isolated regularly but with fluctuating frequencies. Bacteroides and Fusobacterium organisms accounted for nearly 70% of the isolates. The Bacteroides and Fusobacterium isolates studied in detail from one farm were identified to species level. The fusobacteria comprised F. nucleatum-like organisms (68.6%). F. necrophorum (29.6%) and F. naviforme (1.8%). The Bacteroides spp. were divided into 11 main groups and included black-pigmented species similar to B. asaccharolyticus and B. gingivalis. On the farm studied in detail, the sheep could be allocated to two groups according to progression of periodontal disease. Most of the B. gingivalis-like isolates were from sheep with actively progressing disease, indicating that this organism may play a role in periodontal destruction in sheep.

Preliminary study of the anaerobic bacteria isolated from subgingival plaque from sheep.

A preliminary study was made to determine the genera of cultivable anaerobic bacteria which could be isolated from subgingival plaque of sheep. Samples were taken from 10 sheep on farms with a known record of broken mouth periodontitis. For assessment of the sampling technique, samples were also taken from freshly exposed tooth roots in killed sheep. The bacteria isolated on several selective and non-selective media were identified to genus level by a combination of Gram reaction, colony morphology and gas chromatographic analysis of volatile and non-volatile fatty acid metabolic end products. At least 10 different genera were isolated and these findings are discussed in relation to the bacteriology of human periodontitis and recent studies of sheep broken mouth periodontitis.

Development of periodontal disease in a single flock of sheep: clinical signs, morphology of subgingival plaque and influence of antimicrobial agents.

The clinical development of broken mouth over a single reproductive year and the effect of two broad spectrum antibacterial agents upon it was followed in 72 Scottish Blackface ewes aged between two and three years. Using a number of dental health indices especially developed for the purpose, the amount of gingivitis, tooth movement, gum recession and pocketing were quantified and graphed for both the whole population and each group in the drug trial. All clinical features except movement fluctuated significantly with time, the fluctuations often being associated with nutritional or other environmental factors. Despite the extended use of large doses of two antimicrobial agents no significant reduction in the amount of clinical gingivitis or pocketing was evident.

Skeletal and blood biochemical characteristics of sheep during growth and breeding: a comparison of flocks with and without broken mouth.

Two-hundred female Scottish Blackface sheep ranging in age from 3 months to 5 1/2 years were used to investigate the relationships between blood biochemical characteristics, skeletal metabolism and dental health on 5 farms, 3 with broken mouth and 2 with no incidence of the disease. Skeletal growth to 6 months of age was faster in lambs from control flocks than in lambs from affected farms although growth thereafter was slower in the control group. A generally lower protein intake on control farms may account for this reduced growth rate. In general, adult dimensions of bones were attained between 14 and 30 months of age but age of maturation varied between bones; tibial endochondral growth ended after 14 to 21 months while the rib still showed evidence of endochondral growth at 70 months of age. This growth was episodic, being maximal during lactation and possible causes are discussed. There was no significant differences in calcium or phosphorus status between control and affected populations, an inadequate phosphorus intake during pregnancy was common to both groups. Lower serum magnesium concentration in affected than in control sheep was a consistent finding and is discussed.

Effects in sheep of high dietary levels of vitamin D3 as measured by circulating concentrations of some vitamin D metabolites and skeletal examination.

Housed non-pregnant ewes were given diets supplemented with five, 10, 20, 40 and 80 times the Agricultural Research Council's recommended requirement for vitamin D for 16 weeks. The effects on vitamin D status were assessed by measuring 25-hydroxylated vitamin D metabolites (25-OHD) in plasma at intervals. After 16 weeks, animals on the lowest and two highest vitamin D intakes were killed for histological examination of selected soft tissues and bones. Circulating concentrations of 25-OHD increased with intake and time during the experiment. However the increases were not proportional to intake and only when intakes exceeded 20 times the recommended requirement were concentrations greater than those seen in summer in grazing sheep. There was some evidence for the production of an additional vitamin D metabolite in animals on high vitamin D intakes. No abnormalities were detected in any of the tissues examined histologically.

Dental disease in hill sheep: an abattoir survey.

Heads from 478 aged sheep of a predominantly hill breed population were examined in detail for evidence of dental disease, using both soft and hard tissue measurements around incisor and cheek teeth. Almost 60 per cent of this population (all over 2 1/2 years of age and with a mean age between 7 and 8 years) had either loose or missing teeth. Malalignment of cheek teeth and/or incisors was also common. Pocketing was seen in 87 per cent of the population, and was significantly correlated with tooth looseness. There was also a significant relationship between incisor and specific cheek tooth pocket depths. Whilst local alveolar bone loss was found, it was not a reflection of more general skeletal deterioration. The survey confirms the high incidence of broken mouth in the national flock and shows that wherever incisor problems occur there is a likelihood that cheek tooth disease is also present, a relationship not readily appreciated clinically.

A method for the measurement of the gingival sulcus of sheep.

A method for measuring and comparing the depths of the gingival sulcus of sheep in the incisor region at necropsy is described. The method was devised to assess and compare dental health in groups of sheep with and without premature loss of incisor teeth (broken mouth). The technique involves the use of paper spills in combination with dental plaster models.

The role of colostrum in glomerulonephritis of Finnish Landrace lambs: effect of cross-fostering newly born Finnish Landrace and Cheviot lambs.

Newly-born Finnish Landrace and Cheviot lambs were cross-fostered to determine the role of colostrum in the development of mesangiocapillary glomerulonephritis of the Finnish Landrace breed. Severe glomerulonephritis occurred in four Finnish Landrace lambs reared by their own dams. One of six siblings of affected lambs, all reared by Cheviot foster mothers, developed a milder focal form of the disease. No glomerulonephritis occurred in three Cheviot lambs reared by Finnish Landrace foster mothers whose own naturally reared lambs died of the disease. An artificially reared colostrum-free Finnish Landrace lamb became severely affected, though its naturally reared sibling had no renal disease in sequential biopsies. It is concluded that colostrum has no primary role in the development of the disease.