An evaluation of Fracture Liaison Services in the detection and management of osteoporotic fragility fractures: A narrative review.

OBJECTIVES: To evaluate the current evidence for whether Fracture Liaison Services are being utilised effectively in the UK to aid in the prevention of fragility fractures. KEY FINDINGS: Radiological under-reporting and non-standardised assessment of fragility fractures still persist, with low numbers of patients undergoing a risk assessment and treatment for secondary prevention of fracture. In order to improve care for these patients, the reporting of vertebral fractures must be improved and standardised in order to identify patients at increased risk of secondary fragility fractures. Fracture Liaison Services determine the need for anti-resorptive therapy for the prevention of future fragility fractures. Targeted treatment of at-risk patient groups has been shown to reduce the risk of further fracture. CONCLUSION: Fracture Liaison Services have been shown to be cost effective, while reducing the risk of secondary fractures, but they are not currently offered by all NHS providers.

The making of a nutrition professional: the Association for Nutrition register.

OBJECTIVE: Nutritionists in the UK are at the start of an exciting time of professional development. The establishment of the Association for Nutrition in 2010 has presented an opportunity to review, revitalize and expand the UK Voluntary Register of Nutritionists. In the UK and elsewhere, there is a need for a specialist register of nutritionists with title protection as a public safeguard. DESIGN: The new structure will base professional registration on demonstration of knowledge and application in five core competencies. Initially, there will be five specialist areas: animal; public health; nutritional scientist; food; sports and exercise. The wording and requirements linking the specialist areas to the competencies have been carefully defined by leading individuals currently on the existing register in these specialist areas. These have been evaluated by a random sample of existing registrants to check for accuracy of definitions and examples. Other work aims to establish a clear quality assurance framework in nutrition for workers in the health and social care sectors (UK Public Health Skills and Career Framework Levels 1-4) who contribute to nutrition activity, such as community food workers, nutrition assistants and pharmacists. Students, co-professional affiliates and senior fellows will also find a place in the new Association. The title 'nutritionist' is not currently legally protected in the UK and it is used freely to cover a range of unregulated practice. CONCLUSIONS: The establishment of a professional register to protect the public and to provide a clear identity for nutritionists is a vital step forward.

Three-dimensional hierarchical structures for fog harvesting.

Conventional fog-harvesting mechanisms are effectively pseudo-2D surface phenomena in terms of water droplet-plant interactions. In the case of the Cotula fallax plant, a unique hierarchical 3D arrangement formed by its leaves and the fine hairs covering them has been found to underpin the collection and retention of water droplets on the foliage for extended periods of time. The mechanisms of water capture and release as a function of the surface 3D structure and chemistry have been identified. Of particular note is that water is retained throughout the entirety of the plant and held within the foliage itself (rather than in localized regions). Individual plant hairs form matlike structures capable of supporting water droplets; these hairs wrap around water droplets in a 3D fashion to secure them via a fine nanoscale groove structure that prevents them from easily falling to the ground.

Kinetic control of monomer sequence distribution in living anionic copolymerisation.

Sequence control in synthetic polymers is a subject that is sparsely reported with little research in the field of sequence control in chain growth polymerisation. We report herein preliminary investigations into anionic copolymerisation of diphenylethylene (DPE) and its derivatives with styrene. DPE is a monomer that will only copolymerise and can form alternating copolymers. However, by introducing electron donating or withdrawing substituents onto the phenyl rings of DPE it is possible to prepare new range of (alternating) copolymers and with careful choice of monomer combination and conditions, the kinetically controlled (simultaneous) copolymerisation of three or more monomers results in copolymers with a greater degree of monomer sequence control.

Inhibition of HIV-1 infectivity by low molecular weight heparin. Results of in vitro studies and a pilot clinical trial in patients with advanced AIDS.

Several sulfated polysaccharides have been shown to have anti-HIV activity in vitro. However, many of these compounds are not suited for use in vivo because they present an increased risk of bleeding or cannot be administered chronically. We tested the anti-HIV effects of low molecular weight heparin (LMW-heparin) (Enoxaparin) in vitro using a model system of HIV infectivity because LMW-heparin can be given to patients on a long-term basis with little risk. In vitro, LMW-heparin was shown to inhibit HIV-1 production from a T cell lymphoma line (H9) and phytohemagglutinin-stimulated lymphoblasts. Inhibition of infectivity was dose dependent at concentrations achievable in vivo. We then performed a pilot clinical trial in 13 patients with advanced AIDS of 6 months of chronic, self-administered Enoxaparin given in standard prophylactic doses. CD4 counts appeared to stabilize or increase in most patients during the first 3 months of treatment, then remained stable or declined after 6 months. There was no appreciable change in serum p24 levels. There was no evidence of drug toxicity and no bleeding episodes. These findings demonstrate that a commercially available, relatively non-toxic form of LMW-heparin is a potent inhibitor of HIV-1 production in cultured cells and that it is feasible to treat patients with AIDS with LMW-heparin on a long-term basis. Definitive clinical trials of LMW-heparins and related compounds as experimental anti-viral agents in patients with HIV infection are indicated.

Mycobacterium avium complex infection in AIDS: clinical features, treatment, and prevention.

Infection with Mycobacterium avium complex (MAC) may cause a serious disseminated bacterial infection in up to 40% of patients with advanced HIV infection. Disseminated MAC has a negative impact on quality of life and contributes significantly to morbidity and mortality. Prompt diagnosis and aggressive treatment can diminish those effects. Disseminated disease can be prevented in many patients with the use of rifabutin prophylaxis. Nurses play an important role in evaluating symptoms and educating patients about the prevention and treatment of disseminated MAC.