The study team were advised by the independent oversight committees to stop trial recruitment and the delivery of trial therapy due to a difference in the number of reported hospitalisations between the treatment and control group.Because of concerns over potential worry or distress for participants resulting from the trial changes, implementation was carefully monitored throughout. Discussions with participants were documented and feedback recorded whenever this was given. Feedback has been reviewed to identify learning points and enable reflection on the processes used in the trial and during implementation of the trial changes.Specific feedback was received and documented from 37 participants from all trial stages. A number of recurring themes were identified. Among the most frequently reported were the view that an initial increase in distress was expected when engaging in psychological therapies, concern over lack of alternative treatment options, alternative interpretations of the findings and insights into both the processes by which therapy was delivered in the trial and the way in which the trial changes were implemented.Feedback from participants provided useful insights and there are lessons to be learned for researchers and clinicians. Involving service users in a collaborative dialogue regarding the safety issues identified and the options for the trial may have been fruitful. There is scope for alternative understandings of safety issues in trials of psychological interventions in mental health and discussions about what constitutes safety in this context are warranted. Insights from service users should inform conceptualisations of safety in future psychotherapy trials.


Cardiopulmonary bypass for aortic dissection repair is most frequently established via the peripheral arteries. Central cannulation in the context of aortic dissection was first described in 1998.In this situation, access to the descending aorta can be gained via the Seldinger technique and the wire carefully passed retrograde towards the aortic valve. Cannulation of the true lumen can be confirmed by transoesophageal echocardiography with the wire floating freely by the aortic valve. Once the position of the wire in the true lumen is confirmed, a cannula can be placed over the wire.Extensive dissection of the aorta with concurrent contraindications for peripheral cannulation poses a particular problem for cannulation since it can be difficult to ensure cannulation of the true lumen. In these cases, the technique described above with proximal passing of the wire and confirmation of its position in the true lumen by transoesophageal ultrasonography can be a useful method.


Following the publication of this article, the authors have been unable to confirm the presence of the zeolin gene within the transgenic cassava plants in several subsequent studies. This raises concerns about the validity of the results reported in the article.Additionally, the Committee on Research Integrity at Donald Danforth Plant Science Center has carried out an institutional investigation which revealed that significant amounts of data and supporting documentation that were claimed to be produced by the first author could not be found. Given that the validity of the results could not be verified, and in line with the recommendation issued by the corresponding author's institution, the authors retract the article.The authors apologize to the readers.


It is my great pleasure to be able to introduce the research topic on Time and Causality. The topic had been hosted simultaneously on Frontiers in Perception Science and Frontiers in Cognitive Science. Doing so acknowledged that the human experiences of Time and Causality mutually constrain each other, and attracted high-quality submissions from a wide range of authors who might previously not have published in the same outlet.The majority of research on Time and Causality in previous decades investigated how temporal information constrains causal inference  relate to causality-induced shifts in time perception.


Understanding etiology and molecular pathogenesis of rheumatoid arthritis is key to the development of precise prevention and curative therapy for this disease. Recent progress on how genes and environment interact in causing immune reactions that may induce arthritis in humans as well as in mice, have provided a conceptual basis for the development of new prevention and treatment strategies which need to be different for different subsets of RA. In order to bring this emerging knowledge to the level where basic and clinical academic science can collaborate with industry for rapid development of the potential new therapies, there is a need for closer collaboration between basic and clinical scientists from many centers, and for increased collaboration between industry and academia in translational medicine.In Europe, both the EU-funded framework programs and the EU and industry funded Innovative Medicine Initiative (IMI) funder programs in rheumatology are geared to accomplishing these goals. This presentation will be concerned both with the scientific basis of these programs and with a descriptions of the challenges and potential promises that these new collaborative programs offer to rheumatology.


Mutations within the gene encoding for the chloride ion channel CFTR results in cystic fibrosis, the most common autosomal recessive genetic disease in the Caucasian population. CFTR regulates absorption and secretion mechanisms across intestinal and airway mucosae. Although the intestinal phenotype can be clinically handled, chronic infection and inflammation of the lungs of CF patients remains the principal cause of morbidity and mortality. The aim of this Research Topic is to provide to the readers the most recent information available on “Strategies to circumvent the CFTR defect in cystic fibrosis.” The Research Topic is divided in three mains parts: the first part describes the CFTR structure, processing and regulation of the normal and mutant ion channels. Anna Patrick and Philip Thomas  review the molecular interactions leading to the complex folding process of the CFTR protein and how essential steps are disrupted in CFTR mutants. Soo Jung Kim and William Skach  detail the timing and coordination of specific folding steps of the native CFTR in and across the ER membrane. Colleen Weiler and Mitchell Drumm  broaden our views with genetic studies that have identified variant genes implicated in the clinical manifestations of CF. The second part of the Special topics discusses the molecular targets to rescue CFTR processing. Rebecca Chanoux and Ronald Rubenstein describe the current knowledge of the network of cellular chaperones that facilitate the folding and trafficking of CFTR to the plasma membrane. Then, a series of papers by the groups of Teresinha Leal  and John Hanrahan  report interesting observations regarding the potential of several inhibitors in correcting the CF phenotype at the level of ion transport and inflammation. Luigi Maiuri and collaborators  propose to target the intracellular environment in order to reestablish functional autophagy in CF epithelial cells. The third chapter is dedicated to new molecules that have already been developed or in development and able to rescue CFTR channel function by targeting mutant CFTR at the mRNA  and/or at the protein  levels. Finally, the Special Topic is concluded by an in-depth review by Christine Bear and collaborators . Importantly, the gaps in our knowledge regarding the mechanism of action of existing correctors, the unmet need to discover compounds which restore proper CFTR structure and function in CF affected tissues and new strategies for therapy development are discussed. We are convinced that we achieved a very interesting Special Topics thanks to the outstanding contributions of all authors. We are especially grateful to the authors for having believed in this project and accepted to share their knowledge. All the manuscripts have been peer-reviewed and we would like to thank the experts for helping us to reach an issue of high standard.


The UK has a world leading reputation for clinical research. However this position is being undermined by an overly complex regulatory and governance environment that has had a very negative effect on undertaking clinical trials in an efficient way. The European Clinical Trials Directive (EUCTD) was implemented into UK law in May 2004 and was intended to provide greater protection to patients and volunteers participating in clinical trials and increase the quality of trial conduct. At the same time the Research Governance Framework (RGF) was introduced into the NHS. Increasingly the research community has viewed implementation of both the EUCTD and RGF as being disproportionate and ‘gold plated’.In 2010 the Academy of Medical Sciences was invited by Government to review the regulation and governance of health research and make recommendations to improve current processes. Despite recent attempts to improve parts of the regulation pathway, the review identified that significant challenges remain, including: delays and duplication in obtaining NHS research permissions; a lack of proportionality in the regulation of clinical trials; and a healthcare culture that fails to fully support the value and benefits of health research. The Academy’s report recommended the creation of a new health regulator to rationalise the regulation and governance of health research; steps to streamline the approval of research studies by NHS Trusts; and changes to improve the UK environment for clinical trials.Since the publication of the Academy’s report a number of positive changes have been made. The 2011 Plan for Growth outlined a package of government measures to foster growth in the healthcare and life sciences and took forward a number of recommendations from the Academy report, including establishment of a new Health Research Authority to streamline regulation and improve the cost effectiveness of clinical trials, and making future funding by the National Institute for Health Research to NHS Trusts conditional on meeting benchmarks. The Government has created a new duty for clinical commissioning groups to promote research innovation and for the NHS Commissioning Board to ensure provision of treatment costs for patients who are taking part in research. The MHRA are introducing a risk based approach to management of clinical trials based on the marketing status of an investigational medicinal produce and the standard medical care that would facilitate a proportionate approach to trial activities. The ongoing review of the EUCTD may offer a further opportunity to reduce the regulatory burden on academic trials.The above changes are welcome and should result in reductions in the time to obtain approvals and permissions for clinical trials and some reduction in trial management costs. However it remains to be seen whether the health research regulatory agency will have sufficient authority to achieve more efficient working between regulators, researchers and the NHS to maintain the UKs historical position as a world leader in designing and delivering high quality clinical trials.


The aim of the poster presentation is to draw attention to syphilis and is relevance within the 20A literature review inspired the production of the poster. The purpose of the poster is to inform other podiatrists about the various signs, stages. symptoms and manifestations of syphilis. The poster covers many aspects which are relevant to the profession; it highlights the neurological, dermatological and wound presentations, as well as the subsequent management and diagnosis.The poster has been designed to inform peers, with the aim to bring syphilis and its complications to the forefront with regards to the recent increase in the condition thus highlighting its relevance to the lower limb and podiatry.


Independent data monitoring committee is responsible for review of the ongoing safety of participants and the validity and integrity of data in clinical trials and for making recommendations to the sponsor whether the trial should continue as planned, be modified or be terminated because of safety concern, futility of the trial, or treatment benefit. Use of DMCs by government and industry sponsors has been growing steadily ever since the announcement by the US National Institutes of Health in 1998 and by the Food and Drug Administration in 2001 of policy and guidelines for data and safety monitoring.Since a statistical analysis plan serves as a benchmark for the final analysis and the final report for regulatory filing, it needs to be explicit about its contents including the specific statistical analyses to be used. An interim analysis plan, however, serves as a benchmark for the ongoing review of the safety and efficacy data by the DMC and therefore it cannot be codified as in an SAP as it needs to be flexible to address any concerns raised by the DMC during the trial and to evolve with the emerging issues in the monitoring of the study. More importantly it needs to summarize and present the interim safety and efficacy data in the most succinct way to facilitate the review of the ongoing risk-benefit of the trial and to help the DMC members comprehend the contents of the report in the most efficient way.Industry and contract research organization practices continue to be less than desirable in that there is a tendency to consider the interim analysis plan and resulting interim reports merely as a subset of the statistical analysis plan and the final report. This presentation will offer some thoughts on how the interim report should be prepared for DMC review and to improve the contents of the interim report.


Is there any rationale or even requirement for yet another journal devoted to Minimal Access Surgery (MAS)? MAS is snowballing with the volume and speed of an avalanche and is already well served by excellent, established Journals whose monthly contribution to MAS is so diverse and extensive, that any surgeon would be hard-pressed to go through all that is already being written on this subject. Why then the need for this Journal of Minimal Access Surgery?The Asia-Pacific region is a vast ocean of humanity, which after decades is reaching for its economic and political potential. In similar vein surgery in this vast area is taking giant steps forward and these steps are best seen in the phenomenal growth of MAS When the first hesitant steps of laparoscopic surgery were taken in India in early 1990, the first in the developing world, “surgical activists” came down heavily on proponents of this patient-friendly surgery on grounds that it was “inappropriate” for poor countries, was a surrender to the West, would distort the values of surgeons in India and bring into question the ethics of those who promote this surgery.13 The pheThe flame of MAS was first lit in the developed world. The U.S. and countries in Europe have greatly helped nurture and spread the growth of MAS in poor countries by spreading education and funding equipment in the early years. Perhaps more, these countries have set a bench-mark in standards for self-appraisal and evaluation, in the quality of their surgical literature and in the leadership and thrust their two major Societies, the Society of American Gastrointestinal Endoscopic Surgeons [SAGES] and later the European Association for Endoscopic Surgery [EAES] have had on the growth and quality of MAS world wide. It is the anticipation of the JMAS that these countries will continue their support to the developing world as also to JMAS with their quality articles, input and suggestions, an anticipation well reflected by the composition of this Editorial Board.However, the raison d’etre of this Journal is primarily to give scientific expression to the work done in this region as also other developing countries as also in Latin America and Africa. It is a sad fact that perhaps as a result of the pressure of the large volume of day to day work, or a lack of appreciation of their own quality and results the vast majority of surgeons here do not give structured, statistically significant expression to their surgical work. Just as fifteen years back we accepted the challenge to spread MAS in our part of the world, we now urge the vast army of surgeons active in MAS in all developing countries to give substance and expression to our extensive patient load and experience, share our cost-saving expertise, our innumberable innovations born out of stark necessity, our problems and solutions, and by encouraging more and more hesitant colleagues, help spread our mission to all corners.One reads in MAS literature articles devoted to successful outcomes and positive evaluation of procedures. Rarely does one read of mishaps or complications, these are so conveniently swept under the carpet. Usually these unfortunate situations are isolated cases but if reported would very possibly be of greater practical and educational value than many of the success stories. It is the the intent of this Journal to publish as many such reports / papers and give total encouragement to those brave and positively motivated surgeons who have the courage and integrity to share their problem cases.The world is fast becoming smaller and countries and continents rapidly coming closer. The International Federation Of Societies Of Endoscopic Surgeons (IFSES), a Federation of ten large Socieites of endoscopic surgeons which work in unision to supplement each other and help improve the quality and spread of MAS has four of its Member Societies in the Asia Pacific Region – the Japan Society for Endoscopic Surgery [JSES], the Society of Endoscopic and Laparoscopic Surgeons of Asia [ELSA], the Chinese Society for Laparo-Endoscopic Surgery [CSLES], the Indian Association of Gastrointestinal Endo-Surgeons[IAGES], and two in Latin America the Federation Latinoamericana de Cirugia[FELAC], the Association Latinoamaericana de Cirujanos Endoscopistas [ALACE]. The IAGES stretches out in support and co-operation to all these Societies, welcomes their contributions to JMAS. Most of these Societies have had and continue to have the support of the two major Societies of the developed world, the Society of American Gastrointestinal Endoscopic Surgeons and European Association for Endoscopic Surgery in their bid to narrow the gap between the priviledged and the deprived.The Editorial Board is fully aware of the hurdles and problems it faces in establishing and indexing this Journal. On the other hand this Editorial Board stands committed to its conviction that this Journal will be an important vehicle in improving the quality and spread of MAS in this region. In this cause we confidently anticipate the total support not only of the entire surgical community in the Asia-Pacific region but from all over the world. If success is defined not so much by the position reached, as by the determination to overcome obstacles while trying to succeed, this Journal has charted its road-map in the correct direction.


Urinary incontinence (UI) is a common condition in women which can be caused by the weakening or dysfunction of pelvic floor muscles as a result of ageing, pregnancy or obesity. Prevalence of UI is higher in women than that of diabetes, depression and hypertension but rates are difficult to establish because there is evidence of a reluctance to seek help and assumptions that symptoms are normal and untreatable. Women can become increasingly depressed and isolated. The first line of treatment for UI is pelvic floor muscle training (PFMT) and effectiveness has been shown in over 50 randomised controlled trials. However, there are gaps in research about motivation and adherence to exercise. Research about mobile participatory healthcare has identified the role of technology in addressing problems with adherence. There has been an increase in the use of smart phones to access the internet and in the number of health related applications but there is a lack of research about how individuals interact with this new technology and a lack of understanding about effectiveness of different elements of the technology. Mobile phone apps have been developed to support women in PFMT. The approaches used to promote exercise include; improving incontinence symptoms, strengthening muscles after pregnancy and increasing sexual sensation. The apps have features such as; reminders, counts and graphs to show progress, and timers for contractions. Research will be undertaken in Moray, North East Scotland to increase understanding of the experience of community dwelling women in using apps for PFMT. This study forms part of doctoral research which will also include an explanatory randomised controlled trial and post-trial interviews.The study aims to increase understanding of the motivation and adherence of women in undertaking PFMT. The attitudes and views of health professionals and community dwelling women toward mobile phone apps for PFMT will be investigated. Design elements of at least three apps will be reviewed in terms of their potential usefulness in promoting and prompting behaviour change and in the development of exercise habit formation. The acceptability of apps to support PFMT and the different approaches used will also be examined.Focus groups will be conducted with health professionals and community dwelling women from Moray, North East Scotland. The health professionals will be asked to review the quality of health information and to consider implications for potential use by patients. The community dwelling women will be asked for their views on usability and acceptability and for their responses to the different elements and approaches of the apps. The groups will include; mothers of young children, perimenopausal women and older women to represent different age groups.Data from focus groups around attitudes to, and acceptability of, PFMT apps will be presented at the Congress.Results from this study will increase understanding about motivation for PFMT and the role of apps in encouraging women to exercise to prevent and improve incontinence symptoms and will be used to design future research.


Intentional and accidental poisoning or overdose is a serious concern in Iran. There are some reasons for this, first of which, is that Iran has the highest rate of opium addiction in the world. Also, there are no efficient rules and enough surveillance on selling the pharmaceutical drugs in the pharmacies in Iran and nearly all medications are available to the lay people as over the counter medications. So, there are so many poisoned patients admitted to the Iranian hospitals every year.Treatment of the poisoned patients in Iran has been growing within the recent decades and there are some referral poison hospitals in each part of Iran. Although in many countries these patients refer to general hospitals and are managed by general or emergency medicine physicians under the supervision of the clinical toxicologists, in Iran the patients' falimies prefer to bring them to the tertiary poison hospitals and the physicians prefer to refer them to these centers because of the legal problems they generally encounter while managing these patients . In TehrEvery day, there are lots of requests from the extremely ill poisoned patients being in the long queue to be admitted to these centers from general hospitals. However, even with the 24-hour efforts of the medical and paramedical staff of these centers, it is not possible to respond to all of these requests mainly due to the limitations in the hospital beds. This is while the staff in emergency departments (EDs) of these centers generally have to admit the patients referring to them at the first step (including those who can out-patiently be managed) to their wards to overcome the overcrowdedness of their EDs.On the other hand, the matter of outpatient treatment of the poisoned patients is a known entity worldwide that has been suggested to be safe and effective in many cases of poisoning even with ethanol, opioid, and carbon monoxide -13. In sThe authors declare that they have no competing interests.NZ gave the idea and did bibliography and drafted the article. OM completed/edited/revised the article. Both authors read and approved the final manuscript.


Quality health system is not only an ideological way of delivering health service in many a country but involves the practical systems and institutions to deliver. Over the last two decades issues to do with quality of health care has been phenomenally on the increase with the population demanding quality health care from those who deliver them.The purpose of this study therefore was to do a baseline analysis of the existence of quality health care initiatives in selected hospitals in Kumasi, Ashanti Region as a field site for Ghana.Ghana like many other countries in the West African subregion has implemented quality health care over this period of time. The study was supported by RIPAQS and the West Africa Health Organization (WAHO), with additional support from the Governments of member states of the ECOWAS.The study was carried out over a period of June to July, 2012, involving face to face administration of questionnaires that were pretested in selected hospitals in Ghana after an initial pilot in Abidjan the Ivorian capital. 359 different categories of health staff from six purposively selected health facilities were sampled for the study.Findings reveal that quality health systems have been implemented largely in many of the health facilities in Ghana over the years. Many of the indicators of quality health care assessed covering areas such as operational, technical and institutional dimensions have been fully implemented. Only a few of the indicators had either been partially implemented or non-existent. A few were either under discussion or had no idea of actions in place. There appeared to be a general loss of vigour and zest for sustained quality healthcare to be implemented within the selected health facilities. Factors that are thought to be impeding the process has to do mainly with lack of funding, lack of communication and in some instances institutional leadership have prevented in many instances the implementation and role out of such plans.The study recommends the implementation of a sustained strategy for implementing quality health care in particular all the initiatives that are in the draft stage. The renewed call for managers of quality health systems within local health budget management centres must be encouraged.None declared


Previous studies have shown that gender or seniority of applicants can be linked to success in obtaining research funding, but we found little evidence about other features of successful applications for trials funding. The aim of this study was to investigate the association between items or features in a funding application and success when considered by a research funding board. This knowledge will be useful to potential applicants to the HTA programme and to other programmes, and to funding boards of this and other research programmes. The work was not intended to set ideal standards for applications, rather to extend knowledge of current practice and to explore what may be learnt from this.We undertook a retrospective cohort study using applications to the NIHR HTA programme. The sample comprised 296 outline proposals for primary research, submitted to the commissioning board of the HTA programme between January 2006 and December 2009. Proposals to the commissioned work stream were selected as these proposals addressed issues which the HTA programme already deemed to be important, hence the priority of the research question was not considered as one of the selection criteria for success or failure.The dependent variables were characteristics of the applications (or teams) selected a priori by a panel of experts drawn from the board and informed by existing literature. They included characteristics relating to the principal investigator, the team and the bid. The outcomes were success or failure at short-listing and in obtaining research funding.Data were analysed using uni-variate and multivariate analysis and conditional logistic regression modelling.Results of the analysis indicated that the characteristics most strongly associated with success were: whether the proposal met the specifications of the commissioning brief; multi-disciplinarity of the team; experience of writing and critiquing research bids; and whether or not a pilot or feasibility study had been conducted. The gender of the chief investigator and proposed trial costs were not significantly associated with success or failure.The association between meeting the commissioning brief and success is in line with expectations and is reassuring regarding the decision making processes of the board. It suggests to applicants that deviating from the brief is risky. The relative success of multi-disciplinary teams and those including a statistician, a health economist or another methodologist were also anticipated by the experts. This offers evidence to applicants of the preferred make-up of teams. Further research in other funding streams or organisations would be useful.


For the first time 10 national and multinational Trauma Associations plus health professionals from more than 40 countries will get together to confer on the science and status of trauma in the world in the 21st century.The World Trauma Congress is a success even before its official opening next August 22Trauma is medicine practiced by teams/groups of health professionals. The field of trauma extends from injury prevention to trauma systems, from pre-hospital care to rehabilitation with lots in between including several hospital-based professionals . As trauma evolves and the necessity to become more structured and organized is recognized by countries across the world, the importance of local Trauma Associations has been rediscovered. In turn, as the local/national Trauma Associations become stronger and more relevant to their communities and countries, they also see the value of participating in multinational Associations. This process has resulted in the resurgence of the Panamerican Trauma Society in the Americas, the creation in Europe of the European Society for Trauma and Emergency Surgery (ESTES) and the proliferation of international education programs by the American College of Surgeons Committee on Trauma. Now in 2012, these national and multinational associations will gather under the umbrella of the first World Trauma Congress.The goal of having a truly World Trauma Congress that represents all the aspirations of all Trauma Associations of the world will only be partially fulfilled in August. But the meeting shows that the trauma world is capable of getting together, sharing knowledge and working together to improve trauma care everywhere.One of the highlights of the World Trauma Congress is 2 separate scientific Journal supplements. All participants of the World Trauma Congress were invited to submit full manuscripts to these supplements and 11 were selected by peer-reviewed process for the present supplement. These manuscripts address many of the most important topics in trauma in the world today such as deaths due to motorcycle crashes. While rich countries appear primarily concerned about fossil fuel cost to move their large fleet and its ecological impact, developing nations are experiencing epidemic proportions of death related to the growing numbers of small and economical motorcycles [The background for the first 2 studies contrasts with that of two other manuscripts that analyze the utility of robots and telemedicine in medical education and exchange of trauma knowledge ,4. EducaThis supplement also selected high caliber experimental research and novel diagnostic methods and therapies. Dr Rezende  reports Finally two manuscripts focus on the “growing pains” experienced by developing countries as they try to implement complex and costly trauma systems. Dr Gonsaga and collaborators  comparedIt is with this hope that we see the World Trauma Congress. Despite many barriers, national and multinational Trauma Associations from around the world are getting stronger, are increasing their participation in health policies and are becoming more influent. And these associations and their members are also recognizing the importance of collaborating and they will get together in August 2012 with the goal of ending trauma in the world. A goal we are proud to be part of.The authors declare that they have no competing interests.


The School of Medicine and Medical Science in University College Dublin has developed an innovative educational module that aims to increase awareness of rare diseases among medical students.A significant challenge faced by families and patients affected by rare diseases is the general lack of awareness among medical professionals of the sheer number of rare diseases that exist and the sometimes devastating impact a rare disease can have on all aspects of a person’s life. Many doctors believe that they are unlikely to come across a rare disease in their professional careers and simply do not realise that We have developed an elective module with contributions from patient organisations, clinicians, academic staff, research scientists and pharmaceutical industry. The module is offered to undergraduate medical students in the final year of their pre-clinical training. The module was designated a grade neutral module which makes no impact on the student’s overall grade that academic year. The method of assessment had to reflect the overall aim of the module, which was to increase awareness of rare diseases among medical students and not examine the level of scientific knowledge of a host of rare disorders. Assessment of the module had two distinct components. The first was a reflective learning journal that had to be completed by the student at regular intervals during the semester. Students also had to prepare an information pamphlet suitable for a medical professional detailing genetic basis, symptoms and treatment of the disorder chosen, as well as resources for further information.Feedback from the module has been extremely positive. All contributors were very enthusiastic about the module and very keen to be involved. Feedback from the students was exceptionally complimentary. Many students commended the multidisciplinary approach taken. The highlights of the module were the talks given either directly by the patients themselves, or by representatives of patient support organisations. These accounted for approximately 30% of the lectures. There is no doubt that these sessions proved both inspirational and memorable for the students. Entries to the reflective journal described how the module and in particular the experiences described by the patients prompted many students to research particular disorders in more depth and made a lasting impact on them. The feedback from the module has been overwhelmingly positive and shows the advantage of using a multidisciplinary approach where the student can hear directly from the patient, learn about the importance of research and advances in treatment of rare disorders and identify resources that will be useful in their future professional careers.


The Fogarty International Center at NIH has the mission of supporting training and research in global health with a focus on problems in low and middle income countries. Our programs provide research opportunities in both infectious and chronic diseases that link investigators and institutions in the United States with groups in the developing world. The value of these long term investments is evident by their ability to support cutting edge research while training local investigators to develop independent streams of funding and support. The presentation will provide examples of our activities that might have application within the network of the Institut Pasteur.


The Journal, Chief Editor and the Authors wish to retract the Original Research article cited above in its entirety. Based on information reported after publication, this article was found to have images that were inappropriately manipulated . The authors and the journal regret the errors and regret any inconvenience to the readers of Frontiers in Plant Science.


When we discuss various modalities of treatment, our aim is to measure the benefits. This benefit is usually defined as the years of saved life or increase the life expectancy in dreadful conditions. But life is not only the quantity. We know that the quality is even more important, but quantification of this outcome is not easy . There hRule of culture, values, concerns and expectations from life in different cultures and even different stages of life should not be ignored when one consider the quality of life , 4. For The indication of liver transplantation has important effect on quality of life after transplantation. Those suffering from chronic liver disease were usually in grave condition for months even years before transplantation with frequent hospitalization and low quality of life. Their improvement after transplantation is very promising and they usually enjoy a high quality of life specially in the first years after transplantation . ThereafMental health of patients before and after liver transplantation also affects quality of life and should be considered in evaluation of post liver transplantation quality of life .In my experience the patients’ physician relationship has a major effect on quality of life specially in chronic medical conditions .The health providers and in special the responsible physicians can help the patient to cope with the complications and can make their expectations more realistic even before transplantations. All of these have major effects on quality of life. This aspect is usually not well addressed in current instruments including the one proposed by Tayebi and her colleagues. We should say that this aspect is also very difficult to measure. One way might be to compare quality of life of patients between centers. Those centers with better quality of life may have reached this not only with higher experience in medical care and lower rates of medical complications but also with more professionalism and better psychological support of their patients.Sexual life might not be as important for elderly but this affects the life of middle age and younger recipients deeply. This special issue needs to be well addressed . The cosAuthors correctly pointed to the limitation of their study in having nonrandom samples. Extrapolation of their data to different patents from different backgrounds of diseases and cultures should be done with caution. We look forward for further prospective studies on this important issue in recipients of liver transplantation to have a better understanding of different dimensions of quality of life.


Febrile neutropenia (FN) is one of the most serious complications of chemotherapy. Recent advances in its management have included prevention with prophylactic antibiotics and growth factors, improvement in the management of the septic patient and the development of risk stratification systems aiming to identify those patients at high risk of complications and allowing clinicians to tailor therapy appropriately. However, despite these, FN remains the cause of significant morbidity and mortality, with healthcare resource implications (Two studies published in this issue have addressed the concept of risk stratification in FN, and both the articles provide information, that if developed further, may be used to inform decisions in the management of patients in the future (The ability to identify patients at low risk of complications has led to the development of less-intensive treatment strategies for these patients involving oral antibiotics and/or early discharge/treatment at home. Several studies (−3 and stomatitis grade 2 or more.This is an interesting finding and there are certainly plausible reasons why each of these findings could predispose patients to the development of complications. However, it should be remembered that this analysis was based on a relatively small number of cases that had already undergone a pragmatic risk stratification that is different to the widely adopted MASCC scoring system. Clearly these markers require validation in prospective studies if they are to become useful determinants of risk of complication and it is therefore currently unclear what role they will have in the management of FN. Perhaps consideration should be given to investigating them further, either in tandem with the MASCC criteria or applying them to patients assessed as low risk by MASCC. In this way they may have the potential to improve the sensitivity of the MASCC index and current practice.It now appears clear that risk stratification allows identification of a proportion of patients who are at low risk of complications and that some of these patients can be managed safely as outpatients. A recent study in this journal by It can be seen that the use of risk stratification in FN continues to evolve and these papers provide useful and insightful information.


Sir,We thank Our study, Given the potential impact of the ICI and the dynamic nature of web-based resources, it will be important to address the different ways in which HPs and patients perceive ICI. It is also important to focus on the maintenance of the quality of ICI rather than just assessing its quality. Several other issues such as inequalities of internet access will also need to be considered if ICI is to be integrated meaningfully with traditional consultation models.


During the past decade, however, increasingly onerous  regulation and related bureaucracy have made clinical trials much more difficult and costly to conduct. The impact of these large increases in costs and effort is that many existing and novel interventions are not being evaluated, or the trials that are conducted are smaller and less informative than they might otherwise be. The negative effect of these obstacles on the emergence of reliable evidence about the safety and efficacy of treatments affects the care of people not just in developed countries but also in developing countries where resources are more limited and the burden of disease is large. Hence, there is an urgent need for major changes to procedures for the initiation, conduct, monitoring and safety reporting of clinical trials such that they are more proportionate to the risks of doing a trial compared with the risks of not doing it. Unless radical improvements are now made to the regulatory environment, the huge potential of clinical trials to assess the safety and efficacy of new and existing treatments and, thereby, to produce substantial improvements in health care and public health will not be fulfilled.Since their introduction in the middle of the 20


The Royal Brisbane and Women's Hospital Eating Disorder Unit is a Room: State wide public specialist service providing high quality support and intervention to adults requiring an inpatient admission to treat eating disorders.Family members and carers play a significant role in providing support for their loved one both in the community and during inpatient admissions. A gap in service delivery was noted in the provision of support to families and carers during the inpatient admission. The identification of a nominated family worker  was developed to ensure that families and carers were able to access support and assistance in a timely manner.In conjunction with this an information booklet was produced to be given to families on admission of their loved ones as a way of providing detailed, up to date information to better assist and improve the support family members received.The information booklet was developed in conjunction with consumers, a paid carer representative and other eating disorder professionals.Care in Inpatient and Community Settings stream of the 2013 ANZAED Conference.This abstract was presented in the


Response latency in spiking activity is frequently investigated and often defined in different ways. In this study it is the time period from the stimulus application to the change in the neural firing rate evoked by the stimulation. While methods of latency estimation were proposed mostly for excitatory response  in ch as in ). Two tyEither the probability density function of the forward recurrence time or its Laplace transform is derived for a given model and is then employed in several methods of latency estimation. Moment estimators and maximum-likelihood estimators are applications of generally known estimation methods. Another method uses the Laplace transform of the probability density function of the forward recurrence time. And the last proposed method is semiparametric and its idea is to compare the theoretical cumulative distribution function of the forward recurrence time derived for the model in absence of stimulation to the empirical distribution function obtained from data.


This paper addresses the problem of identifying the parameters involved in the formation of spatial patterns in nonlinear two dimensional systems. To this aim, we perform numerical experiments on a prototypical model generating morphogenetic Turing patterns, by changing both the spatial frequency and shape of the patterns. The features of the patterns and their relationship with the model parameters are characterized by means of the Generalized Recurrence Quantification measures. We show that the recurrence measures Determinism and Recurrence Entropy, as well as the distribution of the line lengths, allow for a full characterization of the patterns in terms of power law decay with respect to the parameters involved in the determination of their spatial frequency and shape. A comparison with the standard two dimensional Fourier transform is performed and the results show a better performance of the recurrence indicators in identifying a reliable connection with the spatial frequency of the patterns. Finally, in order to evaluate the robustness of the estimation of the power low decay, extensive simulations have been performed by adding different levels of noise to the patterns. Morphogenesis is the mechanism for which spatial structures and patterns form spontaneously in biological and biochemical systems. This phenomenon can be explained by assuming that at least two species, an activator and an inhibitor, are interacting in a spatial domain subject to reaction and diffusion processes of different intensities In order to find innovative methodologies for identifying and modelling patterned data arising from biological and biochemical reaction-diffusion processes, we observe that the main feature of such data is the presence of regular structures involving typical patterns  This work addresses the problem of identifying a correlation between the structure of patterns and model parameters in a prototypical model showing Turing pattern formation. Two numerical experiments are performed by varying the parameters controlling the shape and spatial frequency of the patterns, respectively. Our aim is to establish a functional relationship between the recurrence indicators and the model parameters by means of GRPs and GRQA. We will show that the functional form of the GRQA measures strictly depends on one of the model parameters. The relationship can be used to identify suitable values of the parameters responsible for the generation of patterns, which can be a hard task in experiment design and practical applications. Moreover, this relationship is shown to be robust with respect to noise levels lower than Two numerical experiments have been performed by varying the parameters In the first experiment, we set In the second experiment, the diffusion coefficient In the following we report the evolution of the recurrence indicators The comparison of ings see  that thiWe then performed an additional experiment by continuously varying In the second experiment we fix the spatial frequency of the patterns by maintaining The methods based on time recurrences have been shown to be robust with respect to noise and measurement errors In order to test and eventually find a similar robustness for methods based on spatial recurrences, the spot patterns analyzed in experiment 1 have been corrupted by noise with increasing intensity. Moreover, it is worth noticing that between noise levels of This paper addressed the problem of analyzing morphogenetic patterns emerging from nonlinear systems through physical mechanisms leading to Turing instabilities. The analysis is performed by using a set of recurrence indicators and, in particular, by means of the Generalized Recurrence Plots and Generalized Recurrence Quantification Analysis.The results clearly show that the method carries out important insights about the structure of patterns and the evolution of such structures under different parametric conditions. Specifically, the main result concerns with the clear identification of the mathematical relationship between the parameter Furthermore, our results will help the experimental scientist in identifying unknown parameters by using the information provided by the recurrence measures. Furthermore, when dealing with experiments where a strong sensitivity to the spatial frequency is present, the proposed method exploits the spatial recurrence properties for retrieving reliable information about the patterns. The obtained results have also been validated by adding noise to the patterns. In this case we found that the power low relationship between the Determinism and the parameter Future developments will be devoted to the application of the proposed methodology for the parametric identification of experimental systems, such as bacterial growth and reaction diffusion systems performed in micro-emulsions.In 1952 Turing In this section we provide only basic notions on recurrence methods for spatial data , accounts for recurrences between the d-dimensional state vectors and presents a linear manifold of dimension In the case of a We now consider spatially distributed systems at a certain (fixed) time of their evolution. In the particular case of Each black dot in the GRP represents a spatial recurrence between two pixels, and every pixel is identified by its coordinates A visual inspection of the four dimensional RP is possible only by projections in three or two dimensions. Although this is possible Click here for additional data file.


The Funding Statement is incorrect. The Funding Statement should read: "This work was financed by internal funding of Hematech, Inc., which no longer exists and no longer has financial interest in the work. Hematech has transferred all of its business to Sanford Applied Biosciences, LLC. There are no current external funding sources for this study. Financial interest in this work is currently owned by Sanford Applied Biosciences who did have a role in the decision to publish as well as the preparation of the manuscript. While it is considered beneficial to the interests of Sanford Applied Biosciences to publish this work, this consideration played no role in the study design, data collection and analysis and preparation of the manuscript. This is evidenced by the inclusion of now independent authors with no affiliation to Sanford Applied Biosciences."


AbstractCodes of nomenclature. These terms are intended to help those engaged in naming across organism groups, and are the result of the work of the International Committee on Bionomenclature, whose aim is to promote harmonisation and communication amongst those naming life on Earth.A set of terms recommended for use in facilitating communication in biological nomenclature is presented as a table showing broadly equivalent terms used in the traditional  As a part of this meeting it reviewed the status of communication between and change in the various international sets of rules that biologists follow when naming organisms – the Codes of nomenclature. The group exchanged updates on the status of the Codes (see Codes of nomenclature) and discussed how to enhance inter-community communication with the aim of bringing together those concerned with naming life on Earth.The International Committee on Bionomenclature  has meant that the communities working on the various indices for a variety of organism groups are not only working in their own domains, but are increasingly developing technological solutions to enable more efficient retrieval of names of all organisms, along with information pertaining to their first publication. As groups focused on the nomenclature of various organisms work more closely together, efficient communication becomes ever more important. Recent changes in the rules governing the naming of prokaryotes  significantly and have the potential to cause confusion. It is based on the table of equivalence of technical terms arising from discussions on harmonisation of nomenclature  and that BioCode . These e


Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty) and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of manuscripts. The physicist Richard Feynman argued, during his commencement address at the California Institute of Technology in 1974, that utter honesty must be a cornerstone of scientific integrity. He cautioned researchers from fooling themselves by saying: "We've learned from experience that the truth will come out. Other experimenters will repeat your experiment and find out whether you were wrong or right. Nature's phenomena will agree or they'll disagree with your theory. And, although you may gain some temporary fame and excitement, you will not gain a good reputation as a scientist if you haven't tried to be very careful in this kind of work." if you are doing an experiment, you should report everything that you think might make it invalid - not only what you think is right about it: other causes that could possibly explain your results; and things you thought of that you've eliminated by some other experiment, and how they worked - to make sure the other fellow can tell they have been eliminated."


The economic and social impact of food allergy affects many sectors of society.There are associated costs to individuals,their carers and their households,potentially over a lifetime. In the health sector resourses are required for diagnosis,support and education.The entire food chain is affected through extra costs,food regulations and moral obligations.Also the employment sector is affected in terms of lost productivity. There is currently a lack of information and clear methodology for assessing the economic and social cost of food allergy to the individual and to society.Hardest to quantify are the costs associated with quality of life factors such as health,financial security,standard of living, family and friends and general well-being.The Europrevall Project attempts to address these issues and acknowledges that further work in this area is required. It is possible to ilustrate the the social and economic impact of food allergy from the perspective of the individual and their families and carers through an examination of the issues regularly brought to the attention of patient support groups.These may not be easily quantifiable but are nonetheless very real.These impacts can be alleviated by ensuring that individuals and families receive the services they need and through improved understanding,awareness and training. Undoubtedly more research is needed in this area.Patient groups need to continue to support people coping with these challenges and to ensure that the requirement for education and training across the public and private sectors is recognised.


There has been limited research on how systematic reviews are used within the design of new trials. Here we report an investigation of how systematic reviews have informed the planning and design of a cohort of randomised trials.Documentation from the application process for all randomised trials funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme between 2006 and 2008 were obtained. Data were extracted on references to systematic reviews and how reviews had been used in the planning and design of the trial.Documentation was available for 48 of the 50 randomised trials funded by NIHR HTA during this period. The main areas in which systematic reviews were used were in the selection or definition of an outcome to be measured in the trial , the sample size calculation , the duration of follow up  and the approach to describing adverse events .Systematic reviews were referenced in most funded applications, with just over half having used the review to inform the design. Although there is an expectation from funders that applicants will use a systematic review to justify the need for a new trial, there seems to be little expectation regarding further use of a review in the planning and design of the trial. Guidelines for applicants and funders should be developed to promote the use of systematic reviews in the planning and design of randomised trials.


Laparoscopic appendicectomy is one of the most common surgical procedures and is often performed out of hours. Securing the base of the appendix may be achieved either by stapling or by use of a pre-formed endoloop.An endoloop is created extracorporeally using a Roeder knot in a standard fashion.The advantage of passing the standing end through the fenestration as shown is that the knot is always easily retrieved should the forceps and standing end become misaligned during the pushing process. The technique is equally applicable to loops created extracorporeally and used in a lasso fashion for pedicle ligation  and for The self-created endoloops are reliable, safe and cost effective.


We are grateful to Prof Bongani MayosiInterestingly we have, since our publication, encountered a case of Brugada syndrome in our practice, although we are yet to report the case. We therefore agree that many of the myocardial diseases reported from the rest of the world probably also exist here in Africa.The current problem however is how to define and classify the cardiomyopathies. One of us (AF) was part of the group that first proposed the name cardiomyopathy for this group of diseases.In our view, subsequent attempts at classifying these disorders of the myocardium have disregarded this basic principle and have labelled virtually all diseases of the myocardium as cardiomyopathy. Such assumptions have made classification of the diseases more complex and difficult to use in routine clinical practice. They also ignore geographic differences in the causation and presentation of the diseases, especially in Africa where the problem of the cardiomyopathies is most profound.We do not think that the current European Society of Cardiology classification is suitable for clinicians working in Africa.Our classification was designed to trigger a debate in Africa towards this end and in so doing we have continued to maintain that basic philosophy of calling every disorder of the myocardium by the disease that caused the disorder. We have through that avoided the unending controversies surrounding the definition of cardiomyopathy and have attempted to bring all the disorders of the myocardium under one classification. We agree that the Pan-African Society of Cardiology (PASCAR) should take further steps to either adopt or modify this classification to suit the clinical realities of Africa.


As we are entering a new era of genomics and as sequencing and system-level approaches are boosting life science and human disease research, the journal Current Genomics will continue to provide the community with comprehensive reviews of last developments in the field. Current Genomics values openness, originality and high scientific standard and it will be the 2013 goal of the journal and its editorial board to keep working along these lines together with an expanding community of contributors and readers.


Following an investigation at the University of Pavia, it has been established that Lisa Mapelli made a substantial contribution to the work reported in this study and that her contribution fulfills the requirements for authorship for the article. This Correction is issued to reflect her contribution and include Dr Mapelli as second author of the article, the author list should therefore be revised as follows:Federico Brandalise, Lisa Mapelli, Urs Gerber, Paola RossiDr Mapelli contributed to the collection and analysis of data and the processing of the figures and has no competing interests.


There are increasing reports of declining malaria prevalence in a number of African countries. This presents a new set of challenges for accurate identification and enumeration of the parasite burden. This is not solely related to generating estimates of malaria with sufficient precision  but to the realisation that these measures constitute an important component of surveillance. Pro-and reactive surveillance will be required to maintain the gains that have been made by control programmes by better targeting of resources to areas of sustained transmission which are likely constitute the reservoirs for infection. Surveillance is also an integral component of elimination campaigns.To facilitate surveillance and monitoring, new tools for the detection of infection and exposure to infection will be needed. Molecular amplification assays such as PCR or LAMP will allow identification of sub-microscopic infections that are likely to be the reservoir of infection at low transmission. Serological measures detect antibodies to malaria parasites that reflect exposure to infection and can be performed on large sample numbers. It is likely that these methodologies will need to be used both in conjunction to capture as many likely infections as possible but also separately as the scale and sensitivity of screening change.This presentation will provide further rationale for integrating these approaches, show current examples of their utility in low endemicity settings and discuss options for subsequent development of this approach.


There is limited access to published research in the field of Ayurveda. Researchers find themselves groping in the dark to make an assessment of prior research work. A narrative review of prior research by screening published research papers will lay the foundation for identifying strengths and gaps in the evidence base that is available to vouchsafe the safety and efficacy of Ayurvedic interventions. It will also facilitate systematic reviews and meta analyses in the future.More than 700 research journals on Ayurveda were accessed through electronic databases like Pubmed and DHARA and many journals were also hand search to compile nearly 8000 citations on Ayurvedic research. The research papers were screened and classified on the basis of the nature of submission, the research approach, quality of research, study design, disease conditions, formulations, interventions and species used.A summarized and classified overview of prior research on Ayurveda could be sketched on the basis of the comprehensive analysis. Issues in quality of research and research design could be identified as well as the good and bad practices in research publication. The key diseases for which evidence is available for recipes and clinical interventions in Ayurveda could also be identified with an understanding of the level of evidence and the research gaps.Nearly half of the published research papers on Ayurveda are review papers. The majority of original research work is in the area of preclinical studies and drug standardization. Clinical research work is comparatively less and there is scarcity of research designs and studies that address Ayurveda as a whole system. However, clinical trials outnumber case studies and case reports. An analysis of the preclinical and clinical work done in the field of Ayurveda gives important leads to identify priorities for future research on Ayurveda.


The authors wish to amend the incorrect reference to a paper in the Discussion section. The authors state: "We were incorrect to state  that Brown and Horn [18] showed that the proportion of sites within the IMM responsive to an audiovisual imprinting stimulus increased with imprinting. Their paper makes no assertion about the effects of imprinting on neuronal responsiveness to an audiovisual imprinting stimulus. That paper could not, therefore, have "led to the assumption that imprinting similarly affects responsiveness to the audiovisual imprinting stimulus and its visual component." We were incorrect to make this assertion and to refer to it in the Conclusions. In light of these errors, for which we apologize, the third paragraph of the Discussion and the relevant part of the Conclusions should be disregarded."


To the Editor: The updated estimates of foodborne illness in the United States reported by Scallan et al. probably overestimate the occurrence of illness caused by unspecified agents because they did not account for the apparent sensitivity of the population survey to the occurrence of norovirus . No other known agents were correlated with the population survey rates, and the total numbers of outbreaks were inversely correlated with the population survey data.The strength of the correlation between norovirus outbreaks and survey results suggests that the population survey is sensitive to norovirus activity and that norovirus may account for much of what is considered to be unspecified. The fact that the highest observed population rate was ≈50% greater than the lowest rate suggests that annual variation in norovirus activity may account for a considerable proportion of what otherwise seems to be unspecified. More thorough and timely investigation and reporting of outbreaks could facilitate the development of models to evaluate the number of illnesses and update them annually. To the Editor: The report by Scallan et al. provides a valuable update regarding estimated annual illnesses, hospitalizations, and deaths caused by recognized foodborne pathogens, most of which cause diarrheal disease, in the United States  and probability distributions. The fraction of acute gastroenteritis estimated to be attributable to norovirus was wide (6%–26%), so it probably encompassed year-to-year variations in incidence. Not only is norovirus estimated to be the most common known cause of foodborne illness, but it is the illness for which we have the least surveillance information. Better data for norovirus are needed. Studies to examine the association between norovirus activity and reported rates of acute gastroenteritis of unknown cause could be useful. Although the most recent FoodNet survey of gastroenteritis was conducted in 2006, more surveys await funding.


Progress of the IUPAC InChI/InChIKey project continues to move ahead quote well. Use of the algorithm has increased over the past year to the point that numerous publications use and refer to InChI. The Markush and Polymer/Mixtures IUPAC InChI working groups have completed their initial work and/or are moving ahead at a good pace. Publicity for the project is good and has resulted in considerable increase in the usage of the InChI algorithm. The Trust web site is now available to the public and is updated regularly. Even CAS now allows for an InChI string to be used as input for a SciFinder search. Extensions to the project’s current capabilities are being developed by a number of expert, experienced individuals and groups from various areas of chemistry. This presentation will describe the current technical state of the InChI algorithm and how the InChI Trust is working to assure the continued support and delivery of the InChI algorithm.


The competing interests for this manuscript were missing. They should read "Lun Yang is an employee of GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America and was previously employed by the Shanghai Jiao Tong University. This work was completed during his employment there and thus has no interest conflict with this company. The opinions and information in this article do not necessarily reflect the views and policies of the GlaxoSmithKline."


The interest in the relationship between articular cartilage and the structural and functional properties of peri-articular bone relates to the intimate contact that exists between these tissues in diarthrodial joints. Much of the interest and continuing controversy regarding the relationship between these tissues dates back to the original suggestion by Radin and Rose that alterations in the mechanical properties of subchondral bone could adversely affect the functional state of chondrocytes and the integrity of the overlying cartilage. They hypothesized that the deterioration in articular cartilage associated with the osteoarthritic process was secondary to an initial increase in subchondral bone stiffness induced by repetitive mechanical loading. Numerous approaches have been used to establish that the changes in periarticular bone occur very early in the development of OA. Although chondrocytes also have the capacity to modulate their functional state in response to loading, the capacity of these cells to repair and modify their surrounding extracellular matrix is relatively limited in comparison to the adjacent subchondral bone. This differential adaptive capacity likely underlies the more rapid appearance of detectable skeletal changes in OA in comparison to the articular cartilage. Given the intimate mechanical and biological interaction between the articular cartilage and subchondral bone it is likely that alterations in the composition and/or structural organization of either tissue will modulate the properties and function of the other joint component. An additional factor that affects the interaction between these tissues is the gradual expansion of the zone of calcified cartilage and advancement of the tidemark that occurs with aging and progression of OA and contributes to overall thinning of the articular cartilage. The precise mechanisms involved in this process have not been definitively established and could include the release of pro-angiogenic factors from chondrocytes in the deep zones of the articular cartilage that have undergone hypertrophy and/or the influences of microcracks that have initiated focal remodeling in the calcified cartilage in an attempt to repair the microdamage. In addition, this process markedly increases the mechanical stresses in the deep zones of the cartilage matrix, which likely contributes to the acceleration in OA cartilage deterioration. In summary, there is the need for further studies to define the pathophysiological mechanisms involved in the interaction between subchondral bone and articular cartilage and for applying this information to the development of therapeutic interventions to improve the outcomes in patients with OA.


The presentation will provide an overview of the role and scope of practise of forensic podiatry. This is a new and innovative area of practice, often involving footwear and as such, the presentation fits in with these conference themes.A document has been prepared by an international committee on forensic podiatry defining the role and scope of practise of this new discipline for the first time. This document will be presented and explained. The presentation will explain how the role and scope of forensic podiatry came to be defined and will cover the definition of forensic podiatry, the level of education expected and the tasks performed by forensic podiatrists. In view of the potential for confusion where forensic investigations involve multiple disciplines, the presentation will also consider areas in which forensic podiatrists would not become involved.As a very new area of practise, the paper will provide a timely opportunity to enhance delegates understanding of forensic podiatry and how this fits in with the wider forensic world.To understand how to approach this field. To help delegates understand how to avoid the pitfalls and dangers of working in forensic podiatry.