RESUMO
Mountains are the water towers of the world, supplying a substantial part of both natural and anthropogenic water demands1,2. They are highly sensitive and prone to climate change3,4, yet their importance and vulnerability have not been quantified at the global scale. Here we present a global water tower index (WTI), which ranks all water towers in terms of their water-supplying role and the downstream dependence of ecosystems and society. For each water tower, we assess its vulnerability related to water stress, governance, hydropolitical tension and future climatic and socio-economic changes. We conclude that the most important (highest WTI) water towers are also among the most vulnerable, and that climatic and socio-economic changes will affect them profoundly. This could negatively impact 1.9 billion people living in (0.3 billion) or directly downstream of (1.6 billion) mountainous areas. Immediate action is required to safeguard the future of the world's most important and vulnerable water towers.
Assuntos
Abastecimento de Água , Altitude , Conservação dos Recursos Naturais , Humanos , Fatores Socioeconômicos , ÁguaRESUMO
We present results from Compton imaging of gamma-ray sources using an instrument constructed from thin silicon scattering detectors and CsI(Tl) absorbing detectors. We have successfully imaged single and double point sources for several common radioactive isotopes ((137)Cs, (60)Co, (22)Na, (54)Mn). The measured angular resolution is 11.6( composite function) FWHM at 662keV. In parallel with the hardware effort, a GEANT4-based simulation code was developed. Comparisons between real and simulated data are discussed.
Assuntos
Césio , Raios gama , Iodetos , Silício , Espectrometria gama/instrumentação , Desenho de Equipamento , Monitoramento de Radiação/instrumentaçãoRESUMO
We studied the effect of the surface finish of the stem on the transfer of load in the proximal femur in a sheep model of cemented hip arthroplasty. Strain-gauge analysis and corresponding finite-element (FE) analysis were performed to assess the effect of friction and creep at the cement-stem interface. No difference was seen between the matt and polished stems. FE analysis showed that the effects of cement creep and friction at the stem-cement interface on femoral strain were small compared with the effect of inserting a cemented stem.
Assuntos
Cimentos Ósseos , Fêmur/fisiopatologia , Prótese de Quadril/efeitos adversos , Osseointegração , Animais , Fenômenos Biomecânicos , Força Compressiva , Análise de Falha de Equipamento , Análise de Elementos Finitos , Teste de Materiais , Desenho de Prótese , Falha de Prótese , Distribuição Aleatória , Ovinos , Propriedades de Superfície , Análise de Sobrevida , Resistência à Tração , Fatores de Tempo , Suporte de CargaRESUMO
The Unispacer knee system is a cobalt-chrome self-centring tibial hemiarthroplasty device for use in the treatment of isolated medial compartment osteoarthritis of the knee. The indications for use are similar to those for high tibial osteotomy, but insertion does not require bone cuts or component fixation, and does not compromise future knee replacement surgery. A prospective study of a consecutive series of 18 patients treated with the Unispacer between June 2003 and August 2004 was carried out to determine the early clinical results of this device. The mean age of the patients was 49 years (40 to 57). A total of eight patients (44%) required revision within two years. In two patients revision to a larger spacer was required, and in six conversion to either a unicompartmental or total knee replacement was needed. At the most recent review 12 patients (66.7%) had a Unispacer remaining in situ. The mean modified visual analogue score for these patients at a mean follow-up of 19 months (12 to 26) was 3.0 (0 to 11.5). The mean pain level was 30% that of the mean pre-operative level of 10. The early clinical results using this device have been disappointing. This study demonstrates that use of the Unispacer in isolated medial compartment osteoarthritis is associated with a high rate of revision surgery and provides unpredictable relief of pain.
Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Desenho de Prótese/normas , Radiografia , Amplitude de Movimento Articular/fisiologia , Reoperação , Resultado do TratamentoRESUMO
The plain films and arthrograms performed on 42 painful cemented hip arthroplasties in 40 patients were reviewed and the radiological findings compared to the surgical assessment of component stability. All radiography, which included Judet views in the plain films, was reviewed without knowledge of the surgical findings and without comparison with previous studies. Criteria for the detection of loosening of cemented femoral and acetabular components were predetermined. The accuracy of plain film assessment of acetabular component stability was increased significantly (p less than 0.05) by including oblique views in the plain film assessment. The accuracy of assessment of acetabular component stability on plain films was 88%, on arthrography 90% and, with both studies combined, was 98%. Femoral component stability was assessed accurately on 90% of plain films and 90% of arthrograms, and this was not improved by combining the studies. The difficulty of detecting low grade infections is discussed with results of pseudocapsule aspiration.
Assuntos
Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor , Falha de Prótese , RadiografiaRESUMO
Primary infra-inguinal arterial reconstructions were reviewed for primary patency and outcome of thrombosis in 144 patients. Distal anastomoses in these patients were to the popliteal artery and were above the knee in 63, below the knee in 53 and at the tibial level in 28. The treatment used was: polytetrafluoroethylene (PTFE) in 33 cases, PTFE with an interposition vein cuff in 29 cases, autogenous saphenous vein (ASV) in situ in 47 cases, and reversed technique in 26 cases. Life table analysis showed a 59% overall primary patency at 3 years. Patency rates of above knee anastomoses (65%) and below knee (61%) were statistically different from the tibial anastomoses (42%, P = 0.005). In both above and below knee popliteal anastomoses there was a statistically significant difference in the patency of ASV and the PTFE/vein cuff technique (P = 0.0006) but there was no difference between ASV and PTFE. There was no difference in patency rates for the various types of grafts with tibial anastomoses. Data were analysed at 3 years, taking into account the variables of smoking, diabetes or indications for surgery respectively and no difference was found in patency. The number and calibre of the run-off vessels did not influence patency significantly, hence anastomosis to any good quality vessel regardless of run-off is recommended. The poor results with the interposition vein cuff technique are unexplained but this study suggests that the technique should be reserved for anastomoses below the popliteal artery.
Assuntos
Prótese Vascular , Artéria Femoral/cirurgia , Artéria Poplítea/cirurgia , Grau de Desobstrução Vascular , Adulto , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Claudicação Intermitente/cirurgia , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Estudos Retrospectivos , Veia Safena/transplante , Artérias da Tíbia/cirurgia , Resultado do TratamentoRESUMO
The macroscopic, radiographic, and histologic features of the prosthesis-cement and cementbone interfaces and adjacent bone were studied in 21 cemented hemiarthroplasties in sheep that had lived until sacrifice at 9 months. The features were compared with those immediately after implantation of the stem in the contralateral femur. The femoral stem was a double taper that was either polished collarless, matte collarless, or matte collared. There was no prosthesis to cement debonding or cement to bone radiolucent line immediately after implantation, and there was excellent interdigitation at the cement-bone interface. After 9 months there was no evidence of prosthesis to cement debonding and no stem with definite loosening. At 9 months after implantation there was evidence of bone remodeling with new bone filling what were presumed to be gaps at the cement-bone interface from immediately after implantation. Radiolucent lines at the cement-bone interface were found to represent trabeculation of the cortical bone rather than the presence of a complete fibrous interface, which was not seen. There was no difference between stem types. Sheep have been shown to be useful in a model of cemented hip arthroplasty and, although no differences were seen between stem types at 9 months after implantation, long term differences cannot be excluded.