Effect of milk flow rate switch-point settings on cow comfort and milking duration.

Automatic cluster removers (ACR) operate by ceasing vacuum to the cluster and detaching the milking unit from the udder by means of a retracting cord once the milk flow has decreased to a predefined level (i.e., the milk flow rate switch-point). There is a large body of literature on this topic indicating that increasing the flow rate switch-point (e.g., from 0.2 kg/min to 0.8 kg/min at the udder level) is effective in reducing milking duration while having little effect on milk yield or milk somatic cell count (SCC). However, despite these findings many farms still use a switch-point of 0.2 kg/min because it is believed that emptying the udder completely at each milking is a prerequisite for good dairy cow management, especially in relation to maintaining a low milk SCC. However, there may be additional undocumented benefits in terms of cow comfort to increasing the milk flow rate switch-point, because the low milk flow period at the end of milking is a high-risk time for inducing teat-barrel congestion. The objective of this study was to quantify the effect of 4 milk flow rate switch-point settings on cow comfort, milking duration, and milk yield. In this study, we applied 4 treatments consisting of different milk flow rate switch-points to cows in a crossover design in a spring calving grass based dairy herd in Ireland. The treatments were (1) MFR0.2, where the cluster was removed at a milk flow rate of 0.2 kg/min; (2) MFR0.4, where the cluster was removed at 0.4 kg/min; (3) MFR0.6, where the cluster was removed at 0.6 kg/min, and (4) MFR0.8, where the cluster was removed at 0.8 kg/min. Milking parameters were recorded by the parlor software and leg movements (i.e., kicks or steps) during milking were recorded with an accelerometer. These data were used as a proxy for cow comfort during milking. The results of this study showed significant differences in cow comfort across treatments, as indicated by cow stepping during milking, for a.m. milkings, but these differences were not detected for p.m. milkings, possibly because a.m. milkings were longer than p.m. milkings due to a 16:8 h milking interval on the research farm. Differences tended to distinguish the 2 lower-flow switch-point settings with greater leg movement against the 2 higher-flow switch-point settings with less leg movement during milking. The effect of treatment (milk flow rate switch-point) on daily milking duration was significant. The milk duration for MFR0.8 was 89 s (14%) shorter than MFR0.2. There was no significant effect of treatment on SCC in this study.

Effect of milk flow-rate switch-point settings on milking duration and udder health throughout lactation.

The objective of this study was to quantify the effects of different milk flow-rate switch-point settings on milking duration, somatic cell count (SCC), strip milk, teat condition, and milk yield in a grass-based system in a long-term experiment. Much work has already been conducted providing strong support for significant reduction in milking duration without effects on yield through increasing the flow-rate switch-point at which vacuum to the milking cluster ceases and the cluster is removed from the cow by means of a retracting cord. However, in practice many farms have not adopted this labor-saving technology on the basis that it may increase milk SCC. Recent research on commercial Irish dairy herds identified the contagious mastitis-causing pathogen Staphylococcus. aureus as the most prevalent pathogen detected. Staph. aureus could have a cyclical shedding pattern which would inhibit detection at certain time points. Therefore, to reliably assess the effect of milk flow-rate switch-points on SCC, a long-term study was required, consisting of multiple observations on cow-level SCC. The present study filled this gap in knowledge by informing on any effect that ceasing milking at different flow rates may have on milking duration and SCC levels, particularly with regard to spring calving grass-based systems. Four treatments, consisting of milk flow-rate switch-points increasing from 0.2 kg/min to 0.8 kg/min in steps of 0.2 kg/min, were deployed for 31 wk to cows at the Teagasc Research Centre at Moorepark, Ireland. The effect of treatment on daily milking duration was significant. The milking duration for a milk flow-rate switch-point of 0.8 kg/min was 95 s (14%) shorter than for 0.2 kg/min. We did not find a significant effect of increasing the milk flow-rate switch-point from 0.2 to 0.8 kg/min on milk yield or SCC in this long-term study. We did find a significant effect of week of experiment on milk SCC, whereby the SCC of the cows on the experiment increased similarly among treatment groups as lactation progressed. A significant reduction in dead time (time from cluster attachment to reach a milk flow rate of 0.2 kg/min) was also noted as the milk flow-rate switch-point increased. On average, reductions in dead time contributed 12% to the overall reductions in milking duration. Similarly, reductions in low flow time (time from a flow rate of 0.2 kg/min to cluster detachment at the end of milking) contributed 26% to the overall reductions in milking duration. Reductions in dead time and low flow time played a greater role in reducing p.m. milking duration rather than a.m. milking duration due to the milking interval practiced on the research farm.

Effect of mechanical premilking stimulation on milking duration in late lactation.

This study documents the effect of mechanical prestimulation on the milking duration of pasture-based cows in late lactation to better harness increased capacity of automation in the milk harvesting process. Premilking stimulation, provided via manual or mechanical means, has been shown to promote the milk letdown reflex and assist in achieving quick, comfortable, and complete milk removal from the udder. The literature is lacking knowledge on the effect of mechanical premilking stimulation on milking duration, especially in late lactation and in pasture-based systems, and many pasture-based farms do not practice a full premilking routine because of a lack of labor availability. The current study addresses this gap in knowledge. In this study, we tested 2 treatments: (1) the No Stim treatment used normal farm milking settings with no premilking preparation and (2) the Stim treatment used 60 s of mechanical premilking stimulation, with a rate of 120 cycles per minute and a pulsator ratio of 30:70 on cluster attachment. Once the 60 s of stimulation had elapsed, normal milking settings resumed for the remainder of the milking. Sixty cows were enrolled in the study, which ran for 20 d. The effect of treatment on a.m. milking duration was significant, a.m. milking duration for Stim was 12 s shorter than that of No Stim. The effect of treatment on p.m. milk duration was not significant. Treatment had no effect on a.m./p.m. milk yields, average milk flowrates or peak milk flowrates. Significant differences emerged between treatments on a.m. and p.m. dead time (time from cluster attachment to reach a milk flowrate of 0.2 kg/min). The a.m. and p.m. dead times were 6 s shorter for Stim compared with No Stim. The time taken to achieve peak milk flowrate (time to peak) at morning milking was 7 s shorter for Stim compared with No Stim, and treatment yielded no significant effects on time to peak at p.m. milkings. Treatment also had no significant effect on log10 somatic cell count. Although the percentage of congested teat-ends and teat-barrels was numerically lower for Stim versus No Stim, no statistical differences were detected across these measures. Based on the results of the study, we found merit in applying 60 s of mechanical pre-stimulation at a.m. milking from a milking duration perspective. However, the strategy was not as successful for the p.m. milking. Analysis of the milk flowrate profiles recorded during the study suggest potential utility in employing different machine settings for various milkings based on anticipated yield and level of udder fill.

Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020.

OBJECTIVES: The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN: The study design is monitoring and evaluation of a national public health protection programme. METHODS: All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS: Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS: The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.

The cross-national epidemiology of specific phobia in the World Mental Health Surveys.

BACKGROUND: Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. METHOD: Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. RESULTS: The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. CONCLUSIONS: Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.

Cobalt hydroxide nanoflakes and their application as supercapacitors and oxygen evolution catalysts.

Finding alternative routes to access and store energy has become a major issue recently. Transition metal oxides have shown promising behaviour as catalysts and supercapacitors. Recently, liquid exfoliation of bulk metal oxides appears to be an effective route which provides access to two-dimensional (2D) nano-flakes, the size of which can be easily selected. These 2D materials exhibit excellent electrochemical charge storage and catalytic activity for the oxygen evolution reaction. In this study, various sized selected cobalt hydroxide nano-flake materials are fabricated by this time efficient and highly reproducible process. Subsquently, the electrochemical properties of the standard size Co(OH)2 nanoflakes were investigated. The oxide modified electrodes were prepared by spraying the metal oxide flake suspension onto a porous conductive support electrode foam, either glassy carbon or nickel. The cobalt hydroxide/nickel foam system was found to have an overpotential value at 10 mA cm-2 in 1 M NaOH as low as 280 mV and an associated redox capacitance exhibiting numerical values up to 1500 F g-1, thereby making it a viable dual use electrode.

Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury.

STUDY DESIGN: Longitudinal cohort design. OBJECTIVES: First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time. SETTING: Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS). METHODS: People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics. RESULTS: Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (ρ=0.692), and reduced anxiety (ρ=-0.522), depression (ρ=-0.643) and pain (ρ=-0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point. CONCLUSIONS: EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.

Craniosynostosis and risk factors related to thyroid dysfunction.

Thyroid disease is a common problem among women of reproductive age but often goes undiagnosed. Maternal thyroid disease has been associated with increased risk of craniosynostosis. We hypothesized that known risk factors for thyroid disease would be associated with risk of craniosynostosis among women not diagnosed with thyroid disease. Analyses included mothers of 1,067 cases and 8,494 population-based controls who were interviewed for the National Birth Defects Prevention Study. We used multivariable logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). After excluding women with diagnosed thyroid disease, younger maternal age (AOR 0.7, 95% CI 0.6-0.9, for <25 years versus 25-29), black or other race-ethnicity (AOR 0.3, 95% CI 0.2-0.4 and AOR 0.6, 95% CI 0.4-0.8, respectively, relative to non-Hispanic whites), fertility medications or procedures (AOR 1.5, 95% CI 1.2-2.0), and alcohol consumption (AOR 0.8, 95% CI 0.7-0.9) were associated with risk of craniosynostosis, based on confidence intervals that excluded 1.0. These associations with craniosynostosis are consistent with the direction of their association with thyroid dysfunction (i.e., younger age, black race-ethnicity and alcohol consumption are associated with reduced risk and fertility problems are associated with increased risk of thyroid disease). This study thus provides support for the hypothesis that risk factors associated with thyroid dysfunction are also associated with risk of craniosynostosis. Improved understanding of the potential association between maternal thyroid function and craniosynostosis among offspring is important given that craniosynostosis carries significant morbidity and that thyroid disease is under-diagnosed and potentially modifiable.

A systematic, genome-wide, phenotype-driven mutagenesis programme for gene function studies in the mouse.

As the human genome project approaches completion, the challenge for mammalian geneticists is to develop approaches for the systematic determination of mammalian gene function. Mouse mutagenesis will be a key element of studies of gene function. Phenotype-driven approaches using the chemical mutagen ethylnitrosourea (ENU) represent a potentially efficient route for the generation of large numbers of mutant mice that can be screened for novel phenotypes. The advantage of this approach is that, in assessing gene function, no a priori assumptions are made about the genes involved in any pathway. Phenotype-driven mutagenesis is thus an effective method for the identification of novel genes and pathways. We have undertaken a genome-wide, phenotype-driven screen for dominant mutations in the mouse. We generated and screened over 26,000 mice, and recovered some 500 new mouse mutants. Our work, along with the programme reported in the accompanying paper, has led to a substantial increase in the mouse mutant resource and represents a first step towards systematic studies of gene function in mammalian genetics.

Insensitivity to Suffering: Psychopathic Traits and Perception of Others' Pain.

Despite growing evidence that psychopathy entails reduced emotional processing, the relationship between psychopathic traits and third-person pain perception is poorly understood. This study directly examined perception of others' pain in a sample of male and female students (N = 105) who completed the Self-Report Psychopathy scale (SRP-III) and the Toronto Empathy Questionnaire (TEQ). Participants watched a video of 60 one-second clips of other people experiencing pain. Following each clip, participants rated the perceived level of pain intensity and pain unpleasantness. Psychopathic traits were unrelated to response bias, suggesting that individuals high in psychopathic traits were no more or less likely to impute pain to others. However, higher levels of psychopathic traits, particularly callous affect and antisocial behavior, were associated with a decreased ability to discriminate others' pain. Sensitivity and response bias were unrelated to TEQ scores. These findings provide novel insights into the influence of psychopathic traits on emotional processing.

A randomised placebo-controlled trial of the effectiveness of early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (EMERGE): study protocol.

BACKGROUND: Pregnancies affected by gestational diabetes mellitus (GDM) are associated with an increased risk of adverse maternal and foetal outcomes. Current treatments for GDM involve initial medical nutritional therapy (MNT) and exercise and pharmacotherapy in those with persistent hyperglycaemia. Insulin is considered first-line pharmacotherapy but is associated with hypoglycaemia, excessive gestational weight gain (GWG) and an increased caesarean delivery rate. Metformin is safe in selected groups of women with GDM but is not first-line therapy in many guidelines due to a lack of long-term data on efficacy. The EMERGE trial will evaluate the effectiveness of early initiation of metformin in GDM. METHODS: EMERGE is a phase III, superiority, parallel, 1:1 randomised, double-blind, placebo-controlled trial comparing the effectiveness of metformin versus placebo initiated by 28 weeks (+6 days) plus usual care. Women aged 18-50 years will be recruited. Women with established diabetes, multiple pregnancies, known major congenital malformation or small for gestational age (<10th centile), intolerance or contraindication to the use of metformin, shock or sepsis, current gestational hypertension or pre-eclampsia, significant gastrointestinal problems, congestive heart failure, severe mental illness or galactose intolerance are excluded. INTERVENTION: Immediate introduction of metformin or placebo in addition to MNT and usual care. Metformin is initiated at 500mg/day and titrated to a maximum dose of 2500mg over 10 days. Women are followed up at 4 and 12 weeks post-partum to assess maternal and neonatal outcomes. The composite primary outcome measure is initiation of insulin or fasting blood glucose ≥ 5.1 mmol/L at gestational weeks 32 or 38. The secondary outcomes are the time to insulin initiation and insulin dose required; maternal morbidity at delivery; mode and time of delivery; postpartum glucose status; insulin resistance; postpartum body mass index (BMI); gestational weight gain; infant birth weight; neonatal height and head circumference at delivery; neonatal morbidities (neonatal care unit admission, respiratory distress, jaundice, congenital anomalies, Apgar score); neonatal hypoglycaemia; cost-effectiveness; treatment acceptability and quality of life determined by the EQ5D-5L scale. DISCUSSION: The EMERGE trial will determine the effectiveness and safety of early and routine use of metformin in GDM. TRIAL REGISTRATION: EudraCT Number 2016-001644-19l; NCT NCT02980276 . Registered on 6 June 2017.

Site specific increase in heterogeneity of trabecular bone tissue mineral during oestrogen deficiency.

Although osteoporosis reduces overall bone mass causing bone fragility, recent studies report that the remaining bone tissue is significantly stiffer. Preliminary studies indicate that alterations in bone tissue mineral content might explain these changes, albeit that other studies report conflicting observations. The objective of this study is to quantify whether the distribution of bone tissue mineral is altered during oestrogen deficiency. Individual trabeculae were harvested from the proximal femur of 7 ovariectomised sheep (OVX), sacrificed 12 months post-surgery, and 5 age-matched controls. Mineral content (wt% Ca) was determined using a quantitative backscattered scanning electron microscopy imaging approach. Mineral heterogeneity within individual trabeculae was compared by calculating the full width at half maximum (FWHM) of mineral density distributions. Mean calcium content, the spatial distribution of mineral within trabeculae and the inter-trabecular variation between regions of proximal femora were also compared. Oestrogen deficiency increased mineral heterogeneity within individual trabeculae compared to healthy controls, as measured by FWHM (3.57 ± 0.68 vs. 3.17 ± 0.36 wt% Ca, p = 0.04). In particular mineral variability increased between superficial and deep regions of trabeculae of OVX animals (p = 0.04). Interestingly, mineralisation variability between greater and lesser trochanters (i.e. intertrochanteric fracture line) was increased in OVX compared to CON, as indicated by a greater % difference in the standard deviation of trabecular mineral content (77.11 ± 11.70 vs. 45.64 ± 23.70 %, p = 0.03). Such changes are undetectable by evaluating the mean mineral content of bone tissue, but may contribute to changes in bone mechanical strength following osteoporotic bone loss.

A latent class analysis of psychosis-like experiences in the New Zealand Mental Health Survey.

OBJECTIVE: To describe the underlying structure of psychosis-like experiences in the New Zealand Mental Health Survey. METHOD: A nationwide survey of household residents aged 16+ years was undertaken (n = 7435), using the Composite International Diagnostic Interview (3.0), including a six question lifetime screener for psychosis. Participants were grouped in three ways: by the number of 'symptoms' (occurring when not dreaming, half-asleep or under the influences of drugs) and by latent classes derived from binary responses (no/yes) or ordinal responses (never/sub-threshold/few times/many times). RESULTS: Psychosis-like events were not uncommon (7.3%; 95% CIs 6.5-8.1), particularly experiences of visual (5.3%; 95% CIs 4.7-6.0) or auditory hallucinations (2.8%; 95% CIs 2.3-3.3). Both latent class analyses indicated a 'normal' class, a 'hallucinatory class' and a 'psychotic' class. The lifetime probability of anxiety, mood or substance disorders and the lifetime probability of seeking help for mental health problems increased from 'normal' to 'hallucinatory' to 'psychotic' classes and with the 'symptom' count. CONCLUSION: The presence of sub-threshold events and variation in the number of times a 'symptom' is experienced suggest a psychosis continuum. However, the latent classes labelled 'hallucinatory' and 'psychotic' differ markedly in symptomatology, which suggests some form of discrete clustering.

Experimental validation of a finite element model of the proximal femur using digital image correlation and a composite bone model.

Computational biomechanical models are useful tools for supporting orthopedic implant design and surgical decision making, but because they are a simplification of the clinical scenario they must be carefully validated to ensure that they are still representative. The goal of this study was to assess the validity of the generation process of a structural finite element model of the proximal femur employing the digital image correlation (DIC) strain measurement technique. A finite element analysis model of the proximal femur subjected to gait loading was generated from a CT scan of an analog composite femur, and its predicted mechanical behavior was compared with an experimental model. Whereas previous studies have employed strain gauging to obtain discreet point data for validation, in this study DIC was used for full field quantified comparison of the predicted and experimentally measured strains. The strain predicted by the computational model was in good agreement with experimental measurements, with R(2) correlation values from 0.83 to 0.92 between the simulation and the tests. The sensitivity and repeatability of the strain measurements were comparable to or better than values reported in the literature for other DIC tests on tissue specimens. The experimental-model correlation was in the same range as values obtained from strain gauging, but the DIC technique produced more detailed, full field data and is potentially easier to use. As such, the findings supported the validity of the model generation process, giving greater confidence in the model's predictions, and digital image correlation was demonstrated as a useful tool for the validation of biomechanical models.

Pre-clinical evaluation of ceramic femoral head resurfacing prostheses using computational models and mechanical testing.

Ceramic-on-ceramic hip resurfacing can potentially offer the bone-conserving advantages of resurfacing while eliminating metal ion release. Thin-walled ceramic resurfacing heads are conceivable following developments in the strength and reliability of ceramic materials, but verification of new designs is required. The present study aimed to develop a mechanical pre-clinical analysis verification process for ceramic resurfacing heads, using the DeltaSurf prosthesis design as a case study. Finite element analysis of a range of in vivo scenarios was used to design a series of physiologically representative mechanical tests, which were conducted to verify the strength of the prosthesis. Tests were designed to simulate ideal and worst-case in vivo loading and support, or to allow comparison with a clinically successful metallic device. In tests simulating ideal loading and support, the prosthesis sustained a minimum load of 39 kN before fracture, and survived 10 000 000 fatigue cycles of 0.534 kN to 5.34 kN. In worst-case tests representing a complete lack of superior femoral head bone support or pure cantilever loading of the prosthesis stem, the design demonstrated strength comparable to that of the equivalent metal device. The developed mechanical verification test programme represents an improvement in the state of the art where international test standards refer largely to total hip replacement prostheses. The case study's novel prosthesis design performed with considerable safety margins compared with extreme in vivo loads, providing evidence that the proposed ceramic resurfacing heads should have sufficient strength to perform safely in vivo. Similar verification tests should be designed and conducted for novel ceramic prosthesis designs in the future, leading the way to clinical evaluation.

Population-based epidemiology of Staphylococcus aureus bloodstream infection in Canterbury, New Zealand.

BACKGROUND: Few contemporary reports describe population-based incidence of Staphylcoccus aureus bloodstream infection (SABSI). AIM: To describe longitudinal incidence of SABSI in a region of New Zealand with low MRSA prevalence. METHODS: Blood cultures growing S. aureus were identified from hospital laboratories between 1 July 1998 and 30 June 2006. Record linkage was used to combine information from local and national databases into a single patient event record. Information from the New Zealand census was used to determine regional incidence of disease. An address-based measure of deprivation was used to analyse the relationship between incidence and socioeconomic status. Morbidity data were not collected. RESULTS: 779 patients with SABSI were identified (482/779 (62%) male, 297/779 (38%) female). The crude incidence of S. aureus bacteraemia varied between 18.5-27.3/100 000 per annum. Three of 779 isolates (0.4%) were MRSA. Two hundred and seventy-seven of 776 (36%) patients with complete records had hospital-acquired SABSI. One hundred and forty-one of 778 patients (18%) died within 30 days and 235/778 (30%) died within a year. Proportional hazards survival models significantly associated age, male sex and more than 14 days of hospitalization in the year prior to index culture with adverse outcome. Higher socioeconomic status was associated with lower rates of SABSI (adjusted rate ratio 0.74, 95% confidence interval: 0.56-0.98, P= 0.007 after adjustment for age and sex, and comparing the highest and lowest deprivation quintiles). CONCLUSION: Population factors significantly influence SABSI incidence and survival. Further research is required to determine whether these have the potential to invalidate inter-hospital comparison of SABSI incidence as a measure of health-care quality.

A review of probabilistic analysis in orthopaedic biomechanics.

Probabilistic analysis methods are being increasingly applied in the orthopaedics and biomechanics literature to account for uncertainty and variability in subject geometries, properties of various structures, kinematics and joint loading, as well as uncertainty in implant alignment. As a complement to experiments, finite element modelling, and statistical analysis, probabilistic analysis provides a method of characterizing the potential impact of variability in parameters on performance. This paper presents an overview of probabilistic analysis and a review of biomechanics literature utilizing probabilistic methods in structural reliability, kinematics, joint mechanics, musculoskeletal modelling, and patient-specific representations. The aim of this review paper is to demonstrate the wide range of applications of probabilistic methods and to aid researchers and clinicians in better understanding probabilistic analyses.

Performance of the resurfaced hip. Part 1: the influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck.

Hip resurfacing is an established treatment for osteoarthritis in young active patients. Failure modes include femoral neck fracture and prosthesis loosening, which may be associated with medium-term bone adaptation, including femoral neck narrowing and densification around the prosthesis stem. Finite element modelling was used to indicate the effects of prosthesis sizing and positioning on the bone remodelling and fracture strength under a range of normal and traumatic loads, with the aim of understanding these failure modes better. The simulations predicted increased superior femoral neck stress shielding in young patients with small prostheses, which required shortening of the femoral neck to give an acceptable implant-bone interface. However, with a larger prosthesis, natural femoral head centre recreation in the implanted state was possible; therefore stress shielding was restricted to the prosthesis interior, and its extent was less sensitive to prosthesis orientation. With valgus orientation, the implanted neck strength was, at worst, within 3 per cent of its intact strength. The study suggests that femoral neck narrowing may be linked to a reduction in the horizontal femoral offset, occurring if the prosthesis is excessively undersized. As such, hip resurfacing should aim to reproduce the natural femoral head centre, and, for valgus prosthesis orientation, to avoid femoral neck fracture.