Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis.

PURPOSE: Planned interim analysis of GENESIS; a prospective pilot study investigating the role of genicular artery embolization (GAE) in patients with mild to moderate osteoarthritis of the knee using permanent microspheres. METHODS: Thirty-eight patients, median age = 60 (45-83), attended for GAE using 100-300 µm permanent microspheres. All patients had mild to moderate knee OA, resistant to conservative treatments over 6 months. Knee MRI was performed at baseline, and 12 months, enabling semi-quantitative analysis using Whole-Organ Magnetic Resonance Imaging Score (WORMS). Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS) (0-100 mm) were completed at baseline, 6 weeks, 3 months (n = 32), and 1-year (n = 16). Adverse events were recorded prospectively. RESULTS: Technical success of accessing and embolizing the target genicular arteries was 84%. Six patients were not embolized: four due to a presumed risk of non-target embolization, and two due to a lack of hyperaemic target. Mean VAS improved from 60 (SD = 20, 95% CI 53-66) at baseline to 36 (SD = 24, 95% CI 28-44) at 3 months (p < 0.001) and 45 (SD = 30, 95% CI 30-60) at 1-year (p < 0.05). All KOOS subscales showed a significant improvement at 6-weeks, 3-months, and 1-year follow-up, except function in daily living, which reached borderline significance (p = 0.06) at 1-year. Four patients experienced mild self-limiting skin discoloration over the embolized territory. One patient experienced a small self-limiting groin haematoma. WORMS scores at 1-year follow-up showed significant improvement in synovitis (p < 0.05). There were no cases of osteonecrosis. CONCLUSION: GAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.

Charging for port reception facilities in North Sea ports: putting theory into practice.

The aim of this paper is to evaluate the charging systems for the use of port reception facilities for waste oil, and to examine the potential impact of the charging elements of the new (late 2000) EU Directive on port reception facilities for ship-generated waste and cargo residues. Experience to date with alternative models for charging is considered. Conclusions are drawn about the effectiveness of the EU Directive as a means of controlling pollution in the North Sea and producing a 'level playing field' between ports.

A review of the science behind drinking water standards for copper.

Copper is an essential element, being a vital component in several enzyme systems. Some intake, therefore, is necessary for human health. At high intakes, however, it can have toxic effects. This paper uses a quality audit framework to review the strength of the science underlying the setting of standards for copper in drinking water intended for human consumption. The two copper standards examined are the revised EU drinking water directive (98/83/EC) of 2 mg/l, based on WHO guidelines, and the USEPA treatment technique action level of 1.3 mg/l. Examination of these standards reveals that neither has a firm scientific basis, accordingly both are difficult to justify from a scientific standpoint, a situation that is worrying in both health and policy terms.

Uncertainties in risk assessment for the determination of drinking water pollutant concentrations: Cryptosporidium case study.

There is a growing acknowledgement of the need to recognise uncertainties in the estimation of waterborne risks. In this paper, the strength of the science available to characterise Cryptosporidium risks in drinking water is investigated, in particular the determination of oocyst concentrations at various points in the chain of water supply. A recently developed scientific quality audit framework is used as a tool to guide this investigation. The framework systematically reveals the relatively greater strength of the science for the "upstream" elements (estimation of concentrations in environmental reservoirs) than for the "downstream" elements (concentrations in distribution). It is the downstream elements that have greater bearing on human health and public policy issues. It is noted that the adoption of new monitoring Regulations is likely to prompt action to strengthen knowledge of these downstream elements in the future.