Identifying the capabilities most important for veterinary employability using a modified Delphi process.

BACKGROUND: In the veterinary profession, employability has been defined as 'a set of personal and professional capabilities that enable a veterinarian to gain employment, contribute meaningfully to the profession, and develop a career pathway that achieves satisfaction and success'. This study was part of a multinational collaborative research project aiming to define the capabilities most important for employability in the veterinary context (www.VetSet2Go.edu.au). METHODS: The project gathered empirical evidence from multiple stakeholders including employees, employers, clients, team members, academics and professional bodies. These perspectives needed to be brought together as a cohesive body of evidence. We used a modified Delphi process, whereby a panel of experts were asked to reach consensus on the capabilities most important for veterinary employability, after considering the evidence from the sub-projects. RESULTS: The Delphi panel reached rapid consensus upon 21 of an initial 47 capabilities, including effective communication with clients and colleagues, teamwork, technical knowledge and skills, resilience and well-being, adaptability, emotional intelligence, workflow management and empathy and compassion. CONCLUSION: Of note for veterinary educators are those attitudinal items identified by this Delphi process as important to employability but potentially underemphasised in existing competency frameworks, such as accepts responsibility, keen to learn, diligence (high standard of care) and self-awareness.

Resilience of veterinarians at different career stages: The role of self-efficacy, coping strategies and personal resources for resilience in veterinary practice.

BACKGROUND: The aim of this study was to determine the effect of demographic and psychological factors on resilience in new graduate-, mid- and late-career veterinarians working in Australia. METHOD: An online cross-sectional survey of 800 veterinarians collected demographic and descriptive data in two stages from late 2015 to 2017, such as gender, average hours worked per week, type and region of practice and intention to leave veterinary medicine. Psychological factors were measured utilising the Brief Resilience Scale, the Veterinary Resilience Scale-Personal Resources, the Brief COPE and General Self-Efficacy measures. RESULTS: Using a full-factorial univariate General Linear Model, no significant difference in general resilience was evident between the three career-stage groups (p > 0.05). However, higher self-efficacy, higher personal resources for resilience in veterinary practice, and lower problem-focused, higher emotion-focused and lower dysfunctional coping strategies were related to higher resilience. In the model for mid- and late-career veterinarians, a weak positive relationship existed between higher average hours worked per week and higher resilience, while intention to leave veterinary practice was also related to lower resilience in mid- and late-career veterinarians. CONCLUSION: This study supports the value of personal resources, rather than career stage, gender or region of work, as influential in developing veterinarian resilience.

Extreme bilateral polydactyly in a wild-caught western grey kangaroo.

Polydactyly is a congenital malformation resulting from an autosomal dominant mutation manifesting as supernumerary digits of the hands or feet. It is most commonly reported in humans and domestic mammals, though there have also been isolated examples across a range of wild vertebrate species. Here we report a case of extremely unusual bilateral preaxial polydactyly on the pectoral limbs of a male western grey kangaroo (Macropus fuliginosus) from the South West region of Western Australia, in which two supernumerary digits were present on each manus. A supernumerary digit I on each manus was rudimentary in morphology without extrinsic muscular connections. However, supernumerary digit II present on each manus had fully developed extrinsic and intrinsic muscular connections, suggesting that these digits possessed normal function in flexion and extension. An alternative hypothesis is that the two supernumerary digits are both representatives of the most radial digit I, though this would then require the true digit I to have taken on the appearance of digit II by acquiring an additional phalanx and modified muscular attachments. The carpal bones exhibited a number of subtle differences in morphology when compared to normal pentadactyl individuals. The presence of a distal, rather than proximal, epiphysis on the first metacarpal was unexpected but further investigation suggested that this characteristic is perhaps more variable (in this species at least) than has been previously recognized. This case provides an unusual example to be considered within the broader context of limb development.

Development and validation of a contextualised measure of resilience in veterinary practice: the Veterinary Resilience Scale-Personal Resources (VRS-PR).

BACKGROUND: This article reports on the development and validation of a contextualised measure of personal resources for resilience in veterinary practice. METHODS: Exploratory factor analysis and structural equation modelling were used to evaluate data from two surveys of veterinary practitioners. RESULTS: Exploratory factor analysis of the first survey (n=300) revealed six items comprising the Veterinary Resilience Scale-Personal Resources (VRS-PR). These items focused on flexibility, adaptability, optimism, building strengths, enjoying challenges, and maintaining motivation and enthusiasm at work. Structural equation modelling using the second survey (n=744) confirmed the factor structure of the VRS-PR and established convergent validity with an established measure of general resilience, the Brief Resilience Scale. Examination of the mean and standard deviation of the combined survey data enabled scores on the VRS-PR to be provisionally classified into 'low', 'moderate' and 'high' (reported by approximately 13%, 72% and 15% of respondents, respectively). Respondents also reported results spanning 'low', 'moderate' and 'high' classifications for the Brief Resilience Scale (approximately 34%, 57% and 9%, respectively). CONCLUSION: The VRS-PR may be used to evaluate the extent to which respondents draw upon the personal resources captured in the scale and identify areas for improvement.

An Exploration of the Career Motivations Stated by Early-Career Veterinarians in Australia.

Despite the critical influence of motivation on education and work outcomes, little is known about the motivations driving people to become and remain veterinarians. This qualitative study explored the career motivations stated by Australian veterinary graduates (n = 43) using a free-response Ten Statements Test (TST) at graduation, with follow-up interviews 6-8 months later (n = 10). TST responses were coded using an alternate inductive-deductive approach that tested their fit against existing theories of motivation. Results showed that the stated motivations were predominantly oriented to perceived value, rather than self-beliefs such as expectancy of success. About a quarter of the statements were animal-related, principally themed around intrinsic animal orientation (e.g., I like animals) or extrinsic animal-related purpose (e.g., I want to help animals). However, many non-animal themes also emerged, including both intrinsic (e.g., love of learning, challenge/problem solving, variety, social relatedness) and extrinsic (e.g., helping people, social contribution, career opportunity) motivations. Interview data revealed a motivational narrative of early formative influences, with some interviewees describing a later transition toward more people- or goal-oriented motivations. This exploratory study, outlining a broad taxonomy of veterinary career motivations and their alignment to self-determination theory in particular, may provide a useful framework for exploring career motivations in veterinary education.

Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care.

INTRODUCTION: Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care. MATERIALS AND METHODS: A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost. RESULTS: A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour. CONCLUSIONS: Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.

Beyond Competence: Why We Should Talk About Employability in Veterinary Education.

The purpose of this article is to explore employability as a complement to competency in defining the overarching objectives of veterinary education. Although the working usage of the term competency has evolved and stretched in recent years, and contemporary competence frameworks have expanded to better reflect the range of capabilities required of a veterinary professional, the potential remains for the dominance of competency-led discourse to obscure the aim of producing not only competent but also successful and satisfied veterinarians. Expanding the educational mission to include employability may provide this broader focus, by stretching the end point, scope, and scale of veterinary education into the crucial transition-to-practice period, and beyond. In this article we review available evidence from multiple stakeholder perspectives and argue that employability expands the focus beyond servicing the needs of the public to better integrate and balance the needs of all the stakeholders in veterinary education, including the graduates themselves. By refocusing the goal of veterinary education to include the richer end point of success, turning the attention to employability could enhance current attribute frameworks and result in veterinarians who not only better meet the needs of those they serve but are also better prepared to experience fulfilling and satisfying careers. Finally, we suggest one educational approach may be to conceptualize competency, professionalism, and employability as overlapping dimensions of the successful veterinary professional.

The fibular meniscus of the kangaroo as an adaptation against external tibial rotation during saltatorial locomotion.

The kangaroo knee is, as in other species, a complex diarthrodial joint dependent on interacting osseous, cartilaginous and ligamentous components for its stability. While principal load bearing occurs through the femorotibial articulation, additional lateral articulations involving the fibula and lateral fabella also contribute to the functional arrangement. Several fibrocartilage and ligamentous structures in this joint remain unexplained or have been misunderstood in previous studies. In this study, we review the existing literature on the structure of the kangaroo 'knee' before providing a new description of the gross anatomical and histological structures. In particular, we present strong evidence that the previously described 'femorofibular disc' is best described as a fibular meniscus on the basis of its gross and histological anatomy. Further, we found it to be joined by a distinct tendinous tract connecting one belly of the m. gastrocnemius with the lateral meniscus, via a hyaline cartilage cornu of the enlarged lateral fabella. The complex of ligaments connecting the fibular meniscus to the surrounding connective tissues and muscles appears to provide a strong resistance to external rotation of the tibia, via the restriction of independent movement of the proximal fibula. We suggest this may be an adaptation to resist the rotational torque applied across the joint during bipedal saltatory locomotion in kangaroos.

The Impact of a Brief Embedded Mindfulness-Based Program for Veterinary Students.

Veterinary medical students, like other university students, are likely to experience elevated levels of stress, anxiety, and depression over the course of their studies. Mindfulness-based interventions have previously been effective for university students in reducing stress, depression, and anxiety. In this study, a mindfulness-based intervention was embedded in a core (compulsory) unit of a veterinary science course, in part with the aim of improving student well-being. Preliminary results suggest that, despite the mindfulness intervention, overall symptoms of stress, depression, and anxiety among participants (n=64) increased between the start and end of the semester. However, further analysis showed that most of this longitudinal increase was attributable to individuals who scored above the normal range (i.e., at least mild level of symptoms) in one or more measures at the beginning of the semester. Within this subset, individuals who regularly engaged in mindfulness practice once a week or more throughout the semester reported significantly lower depression and anxiety symptoms than those who practiced less than once a week (i.e., who had long periods without practice). Results suggest that engaging regularly in mindfulness practice potentially acted as a protective factor for students already experiencing at least a mild range of symptoms of anxiety and depression at the beginning of the semester. While not all veterinary students may derive significant benefit immediately, providing access to an embedded mindfulness program early in their program may facilitate the development of adaptive coping mechanisms, which may be engaged to increase resilience across their academic and professional life.

Finding the Balance: Uncovering Resilience in the Veterinary Literature.

Resilience is an issue of emerging importance in veterinary education and research, as in other professional contexts. The aim of this study was to perform an appraisal of how resilience is portrayed in the contemporary (1995-present) research and education literature around veterinary mental health, and to attempt a provisional synthesis informing a conception of resilience in the veterinary context. Qualitative analysis of the literature (59 sources included) revealed a dominant emphasis on mental health problems, particularly stress, which outweighs and potentially obscures complementary approaches to well-being and resilience. We found the construct of resilience underdeveloped in the veterinary literature and in need of further research, but provide a preliminary synthesis of key themes emerging from the current literature (emotional competence, motivation, personal resources, social support, organizational culture, life balance, and well-being strategies). We advocate for greater balance between complementary perspectives in veterinary mental health education and research, and propose that an increasing focus on resilience (here endorsed as a dynamic and multi-dimensional process involving personal and contextual resources, strategies, and outcomes) will help to address this balance.

Which professional (non-technical) competencies are most important to the success of graduate veterinarians? A Best Evidence Medical Education (BEME) systematic review: BEME Guide No. 38.

BACKGROUND: Despite the growing prominence of professional (non-technical) competencies in veterinary education, the evidence to support their importance to veterinary graduates is unclear. AIM: To summarize current evidence within the veterinary literature for the importance of professional competencies to graduate success. METHODS: A systematic search of electronic databases was conducted (CAB Abstracts, Web of Science, PubMed, PsycINFO, ERIC, Australian and British Education Index, Dissertations & Theses) from 1988 to 2015 and limited to the veterinary discipline (veterinar* term required). Evidence was sought from consensus-based competence frameworks, surveys of stakeholder perceptions, and empirical evidence linked to relevant outcomes (e.g. employability, client satisfaction or compliance). Data extraction was completed by two independent reviewers and included a quality assessment of each source. RESULTS: Fifty-two sources were included in the review, providing evidence from expert frameworks (10 sources), stakeholder perceptions (30 sources, including one from the previous category), and empirical research (13 sources). Communication skills were the only competency to be well-supported by all three categories of evidence. Other competencies supported by multiple sources of empirical evidence include empathy, relationship-centered care, self-efficacy, and business skills. Other competencies perceived to be relatively more important included awareness of limitations, professional values, critical thinking, collaboration, and resilience. CONCLUSIONS: This review has highlighted the comparatively weak body of evidence supporting the importance of professional competencies for veterinary graduate success, with the exception of communication skills. However we stress this is more indicative of the scarcity of high-quality veterinary-based education research in the field, than of the true priority of these competencies.

The Life of Meaning: A Model of the Positive Contributions to Well-Being from Veterinary Work.

We present a veterinary model of work-derived well-being, and argue that educators should not only present a (potentially self-fulfilling) stress management model of future wellness, but also balance this with a positive psychology-based approach depicting a veterinary career as a richly generative source of satisfaction and fulfillment. A review of known sources of satisfaction for veterinarians finds them to be based mostly in meaningful purpose, relationships, and personal growth. This positions veterinary well-being within the tradition of eudaimonia, an ancient concept of achieving one's best possible self, and a term increasingly employed to describe well-being derived from living a life that is engaging, meaningful, and deeply fulfilling. The theory of eudaimonia for workplace well-being should inform development of personal resources that foster resilience in undergraduate and graduate veterinarians.

The synthesis, characterisation and in vivo study of a bioceramic for potential tissue regeneration applications.

Hydroxyapatite (HAP) is a biocompatible ceramic that is currently used in a number of current biomedical applications. Recently, nanometre scale forms of HAP have attracted considerable interest due to their close similarity to the inorganic mineral component of the bone matrix found in humans. In this study ultrafine nanometre scale HAP powders were prepared via a wet precipitation method under the influence of ultrasonic irradiation. The resulting powders were compacted and sintered to form a series of ceramic pellets with a sponge-like structure with varying density and porosity. The crystalline structure, size and morphology of the powders and the porous ceramic pellets were investigated using advanced characterization techniques. The pellets demonstrated good biocompatibility, including mixed cell colonisation and matrix deposition, in vivo following surgical implantation into sheep M. latissimus dorsi.

Vascular foramina of the metacarpophalangeal sesamoid bones of Greyhounds and their relationship to sesamoid disease.

OBJECTIVE: To apply a novel technique and use the number and size (diameter and mean area) of vascular foramina to estimate potential blood supply in the metacarpophalangeal bones of dogs. ANIMALS: 28 Greyhounds. PROCEDURES: The forelimb sesamoid bones of 23 dogs were obtained after dogs were euthanized. Bones were isolated and examined by scanning electron microscopy. The number, diameter, and area of vascular foramina were determined by image analysis. Arterial distribution was assessed by use of resin injection in the sesamoid bones of 5 additional dogs. RESULTS: Sesamoids 2 and 7 had significantly fewer foramina (mean +/- SE, 38.9+/-2.5) and lower total foramen area (0.55+/-0.04 mm(2)), compared with values for other sesamoids (70.4+/-3.3 foramina and 1.43+/-0.06 mm(2), respectively). Mean area and diameter of foramina of sesamoids 2 and 7 were also smaller in some regions. Comparison of the foramen distribution in dogs with sesamoid disease and clinically normal dogs revealed that for sesamoids 2 and 7, intact sesamoids from dogs with sesamoid disease had a significantly lower total foramen area (20 sesamoids from 9 dogs, 0.45+/-0.04 mm(2)), compared with sesamoids in clinically normal dogs (59 sesamoids from 14 dogs, 0.58+/-0.03 mm(2)). However, for sesamoids other than 2 and 7, dogs with sesamoid disease had a significantly greater foramen area. CONCLUSIONS AND CLINICAL RELEVANCE: The restriction of vascular foramina in sesamoids 2 and 7 appeared to mirror the disease distribution and disease risk for specific dogs.

Biodistribution and clearance of intra-articular liposomes in a large animal model using a radiographic marker.

The intra-articular (IA) route of administration in treating arthritis has potential for targeting drug delivery to affected tissues, thereby minimising the attendant side-effects of systemically administered drugs. The ultra-structure of the synovium however facilitates rapid drug efflux from the joint; effectively the IA route is equivalent to other non-IV parenteral routes with regards absorption and redistribution into the systemic circulation. The aim of this study was to extend the drug residence time within the knee joint by using a liposome formulation. DPPC-based liposomes were prepared with the radio contrast agent iohexol as a drug marker. 8 sheep had their right knees injected IA with iohexol liposomes and the contralateral joints with either free iohexol or empty liposomes. Joints were radiographed at multiple time points up to 16 days post-injection. Iohexol-mediated radiopacity was quantified by densitometer. Sheep were sacrificed at the end of the study for microscopy of synovial tissues. Good visualization of iohexol-mediated radiopacity with fine anatomical definition was possible throughout the experiment. Also evident on the films was extra-articular radiopacity with liposomes tracking along muscle facial planes. Cellular and tissue localization with light microscopy was possible through use of frozen sections and because of the large liposome size. Residence of encapsulated iohexol within the knee joint was greatly prolonged. Liposomal iohexol declined bi-exponentially with a terminal elimination half-life of 134 hours. In contrast, free iohexol was undetectable at 3 hours post-injection.

Deep dissection: motivating students beyond rote learning in veterinary anatomy.

The profusion of descriptive, factual information in veterinary anatomy inevitably creates pressure on students to employ surface learning approaches and "rote learning." This phenomenon may contribute to negative perceptions of the relevance of anatomy as a discipline. Thus, encouraging deep learning outcomes will not only lead to greater satisfaction for both instructors and learners but may have the added effect of raising the profile of and respect for the discipline. Consideration of the literature reveals the broad scope of interventions required to motivate students to go beyond rote learning. While many of these are common to all disciplines (e.g., promoting active learning, making higher-order goals explicit, reducing content in favor of concepts, aligning assessment with outcomes), other factors are peculiar to anatomy, such as the benefits of incorporating clinical tidbits, "living anatomy," the anatomy museum, and dissection classes into a "learning context" that fosters deep approaches. Surprisingly, the 10 interventions discussed focus more on factors contributing to student perceptions of the course than on drastic changes to the anatomy course itself. This is because many traditional anatomy practices, such as dissection and museum-based classes, are eminently compatible with active, student-centered learning strategies and the adoption of deep learning approaches by veterinary students. Thus the key to encouraging, for example, dissection for deep learning ("deep dissection") lies more in student motivation, personal engagement, curriculum structure, and "learning context" than in the nature of the learning activity itself.

Proteoglycan 4 downregulation in a sheep meniscectomy model of early osteoarthritis.

Osteoarthritis is a disease of multifactorial aetiology characterised by progressive breakdown of articular cartilage. In the early stages of the disease, changes become apparent in the superficial zone of articular cartilage, including fibrillation and fissuring. Normally, a monolayer of lubricating molecules is adsorbed on the surface of cartilage and contributes to the minimal friction and wear properties of synovial joints. Proteoglycan 4 is the lubricating glycoprotein believed to be primarily responsible for this boundary lubrication. Here we have used an established ovine meniscectomy model of osteoarthritis, in which typical degenerative changes are observed in the operated knee joints at three months after surgery, to evaluate alterations in proteoglycan 4 expression and localisation in the early phases of the disease. In normal control joints, proteoglycan 4 was immunolocalised in the superficial zone of cartilage, particularly in those regions of the knee joint covered by a meniscus. After the onset of early osteoarthritis, we demonstrated a loss of cellular proteoglycan 4 immunostaining in degenerative articular cartilage, accompanied by a significant (p < 0.01) decrease in corresponding mRNA levels. Early loss of proteoglycan 4 from the cartilage surface in association with a decrease in its expression by superficial-zone chondrocytes might have a role in the pathogenesis of osteoarthritis.

Post-mortem water uptake by sheep lenses left in situ.

PURPOSE: Human lenses are generally obtained from eye bank eyes, which have been stored in the cold for extended periods. It is not known what effect the storage has on the lens. In this study, we examine the effects of post mortem time on the weights of sheep lenses left in the eye. METHODS: Lenses were removed from 299 ex vivo sheep eyes (200-day-old), which had been kept on ice for various times up to 76 h. Wet and dry weights were then determined. In addition, wet and dry weights were obtained from 147,414-day-old and 149,660-day-old lenses removed within one hour of death. RESULTS: After about 30 h in the eye, lens wet weights started to increase. By 76 h, the water content had increased by 25%. CONCLUSIONS: Uptake of water by lenses while stored in the eye at low temperature can significantly alter lens properties. It is suggested that caution is needed when interpreting data obtained with lenses from eye bank eyes unless it can be demonstrated that there has been no water uptake.

Regional assessment of articular cartilage gene expression and small proteoglycan metabolism in an animal model of osteoarthritis.

Osteoarthritis (OA), the commonest form of arthritis and a major cause of morbidity, is characterized by progressive degeneration of the articular cartilage. Along with increased production and activation of degradative enzymes, altered synthesis of cartilage matrix molecules and growth factors by resident chondrocytes is believed to play a central role in this pathological process. We used an ovine meniscectomy model of OA to evaluate changes in chondrocyte expression of types I, II and III collagen; aggrecan; the small leucine-rich proteoglycans (SLRPs) biglycan, decorin, lumican and fibromodulin; transforming growth factor-beta; and connective tissue growth factor. Changes were evaluated separately in the medial and lateral tibial plateaux, and were confirmed for selected molecules using immunohistochemistry and Western blotting. Significant changes in mRNA levels were confined to the lateral compartment, where active cartilage degeneration was observed. In this region there was significant upregulation in expession of types I, II and III collagen, aggrecan, biglycan and lumican, concomitant with downregulation of decorin and connective tissue growth factor. The increases in type I and III collagen mRNA were accompanied by increased immunostaining for these proteins in cartilage. The upregulated lumican expression in degenerative cartilage was associated with increased lumican core protein deficient in keratan sulphate side-chains. Furthermore, there was evidence of significant fragmentation of SLRPs in both normal and arthritic tissue, with specific catabolites of biglycan and fibromodulin identified only in the cartilage from meniscectomized joints. This study highlights the focal nature of the degenerative changes that occur in OA cartilage and suggests that altered synthesis and proteolysis of SLRPs may play an important role in cartilage destruction in arthritis.

The nitric oxide donor glyceryl trinitrate increases subchondral bone sclerosis and cartilage degeneration following ovine meniscectomy.

AIM: To examine the effect of glyceryl trinitrate (GTN), a nitric oxide (NO) donor compound, on the concurrent progression of cartilage and subchondral bone changes in an ovine meniscectomy model of osteoarthritis (OA). METHODS: Bilateral lateral meniscectomy (MX) was performed on 12 ewes to induce OA. Six were treated with topical GTN (0.7mg/kg twice weekly) (MX+GTN). Six other sheep formed non-operated controls (NOC). After sacrifice at six months, the subchondral bone density (BMD) of the lateral and medial femoral condyles (LFC, MFC) and tibial plateau (LTP, MTP) was assessed by DEXA. Dynamic biomechanical testing was performed across the MTP and LTP. Histological sections from each region were scored qualitatively and the thickness of the subchondral bone plate (SCB) was determined by image analysis. RESULTS: MX+GTN displayed significantly greater SCB thickness relative to MX in the LFC (mean increase +88% and +42%, respectively) and the MFC. SCB BMD was 10-12% greater in MX+GTN relative to MX in the LFC, LTP and MTP. MX+GTN sheep also showed greater increases in some histopathology variables, greater central erosion of the LTP, and changes in dynamic stiffness (decreased) and phase lag (increased) in the outer zone of the LTP. CONCLUSIONS: Treatment with GTN significantly increased subchondral bone thickness and density during subchondral remodelling following meniscectomy. In addition, it slightly but significantly worsened degeneration of cartilage structure and function. These results suggest that clinical use of GTN may accelerate both cartilage degeneration and subchondral bone sclerosis if used in the presence of OA, and demonstrate that NO has the potential be an important mediator of the subchondral bone changes seen in OA.