• Dame Maria Matilda Ogilvie Gordon, A Britisher and a woman at that (1864-1939)

      Burek, Cynthia V. (Earth Science Teachers' Association, 2005)
      This article discusses the life and work of Dame Maria Matilda Ogilvie Gordon (1864-1939).
    • Death by effectiveness: exercise as medicine caught in the efficacy trap!

      Beedie, Chris; Mann, Steven; Jimenez, Alfonso; Kennedy, Lynne; Lane, Andrew M.; Domone, Sarah; Wilson, Stephen; Whyte, Greg; Aberystwyth University; ukactive Research Institute; Universidad Europea; University of Chester; University of Wolverhampton; Liverpool John Moores University (BMJ Publishing Group, 12/02/2015)
      Sport and Exercise Medicine (SEM) has had a good run. For a while it was the low-cost magic bullet. With efficacy demonstrated in study after study, the conclusion was clear: ‘Exercise is Medicine’, a potential public health panacea. Sadly, the early promise waned. While we continue to be bombarded by original research and reviews extoling the efficacy of exercise, there is an apparent dearth of evidence of its effectiveness. This fact is highlighted in 2014 reports from the UK Government1 and Public Health England.2
    • Decision making for refusals of treatment—a framework to consider

      Jones, Steven; Monteith, Paul; Williams, Barry (Journal of Paramedic Practice, 02/05/2014)
      Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.
    • Delivering public health through primary care: The role of CAB services

      Thurston, Miranda; Caiels, James; University of Chester (2005)
    • Delivery and engagement in public health nutrition: The use of ethnographic fiction to examine the socio-cultural experiences of food and health among mothers of young children in Skelmersdale, Lancashire

      Ellahi, Basma; Cox, Peter; Gregg, Rebecca A. (University of Liverpool (University of Chester), 2013-04)
      Encouraging good nutrition is particularly important in the early years of life for the development of appropriate food habits and healthy adults in later life. These are governed by many contending and conflicting influences. Objective: This research examines the food choice influences for mothers of young children in Skelmersdale, West Lancashire (UK). Participants were recruited from a large community food intervention (clients) and were compared with those not involved in the initiative (non-clients). This enabled the reflection of the broader socio-cultural experiences of food and the influence of “structure” and “agency” on food choices. The research adopted a phenomenological approach using ethnographic recording techniques (interview and observation). The research findings are presented as ethnographic fictions. These short fictional stories provide a “thick” description of the participant’s lifeworld. They locate these choices in the person and the place. A hierarchy of food choice influences emerged from the data, with three main findings. Most prominently, the influence of individual capacity on the food choices made. Secondly, the influence of place, town planning and the geography of an area on food choices. Thirdly, the influence of gender, relationships and social networks. Central to the thesis of this research is the use of ethnographic fiction to enable a better understanding of the complexity involved in food choice and community development approaches to nutritional change. The use of ethnographic fiction conveyed a better understanding of people and of the role and impact of an intervention upon the wider processes involved in food choice. Ethnographic fiction was used here for the first time in public health nutrition to explain the complex picture of food choice for mothers of young children in Skelmersdale, and to convey new insight on food choice and the complexity of food choice influence.
    • Detection of irradiated food by immunoassay - development and optimization of an ELISA for dihydrothymidine in irradiated prawns

      Tyreman, Anne L.; Bonwick, Graham A.; Smith, Christopher J.; Coleman, Robert C.; Beaumont, Paul C.; Williams, John H. H.; University of Chester ; University of Chester ; University of Chester ; University of Chester ; Homerton College, Cambridge ; University of Chester (Blackwell, 12/11/2013)
      This article discribes the development and use of a competitive enzyme-linked immuno-sorbent assay (ELISA) to detect prawns which have been irradiated.
    • Determination of Iron (III) Reducing Antioxidant Capacity for Manuka Honey and Comparison with ABTS and Other Methods

      Yusof, Hasif I. M.; Owusu-Apenten, Richard K.; Nigam, Poonam S.; Universiti Kebangsaan Malaysia Medical Centre; Ulster University; University of Chester (SCIENCEDOMAIN International, 11/06/2018)
      Aims: Applying multiple assays with trolox as the sole reference compound is a recent AOAC proposal to improve the reliability of total antioxidant capacity determinations. The aim of this study was to evaluate, iron (III) reducing antioxidant capacity (iRAC) for Manuka honey samples and comparisons with ABTS and other well-known assays. Study Design: In-vitro, laboratory-based study. Place and Duration of Study: School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK; September 2015-May 2016. Methodology: Manuka honey rated Unique Manuka Factor (UMF) 5+, 10+, 15+, 18+ and a nonrated (NR) sample were analysed using five assays for total antioxidant capacity namely, iRAC, ABTS, DPPH, FRAP, and Folin assays. Values for total antioxidant capacity were normalized as Trolox Equivalent Antioxidant capacity (TEAC) for comparison within and between assays. Results: The TAC were correlated for all methods (R2 = 0.83-0.99) and also correlated with the total phenols content. Actual TEAC value for a given honey ranged by 21-70-fold depending on the assay method with the following general order of increase; DPPH < FRAP (pH 3.6) < iRAC (pH 7.0) <ABTS (pH7) < Folin (pH ~11). The trends in TAC values are discussed alongside of TEAC values for 50 food items and some challenges for comparing different antioxidant methods are highlighted. Conclusion: Total antioxidant capacity of Manuka honey changes in a regular manner probably affected by assay pH. The findings are important for attempts to standardize antioxidant methods as currently applied to foods, beverages and dietary supplements. Further research is recommended to examine the effect of normalizing antioxidant methods for solvent composition and pH.
    • Developing children: developmental discourses underpinning physical education at three Scottish preschool settings

      McEvilly, Nollaig; Atencio, Matthew; Verheul, Martine; University of Chester; California State University; The University of Edinburgh (Taylor & Francis, 20/11/2015)
      This paper reports on one aspect of a study that investigated the place and meaning of ‘physical education’ to practitioners and children at three preschool settings in Scotland. We employed a poststructural type of discourse analysis to examine the developmental discourses the 14 participating practitioners drew on when talking about ‘physical education’ at preschools, during semi-structured interviews. Three main discourses around the notion of developmentalism were identified during analysis of the adults’ interview data: (1) preschool children learn and develop through play; (2) preschool children should have choices and freedom; and (3) sometimes more structured activities are needed. The practitioners were heavily invested in developmental ‘truths’ about how preschool children learn and develop. They were in agreement that play is a vital element of preschool education, and that, consequently, children should be provided with opportunities for exploration and making choices. However, they also talked about sometimes ‘needing’ to restrict children’s freedom and provide more adult-led activities. Our findings illustrate the strength of developmental discourses at the three settings. We suggest that preschool practitioners, as well as policy-makers and researchers, should critically reflect on the effects of taken-for-granted developmental discourses, and move beyond thinking in terms of binaries such as ‘physical education versus play’ or ‘structure versus freedom’.
    • The development and effectiveness of perceptual training programme for coaches and judges in gymnastics

      Lafferty, Moira E.; Page, Jennifer L. (University of Liverpool (University of Chester), 2009-03)
      This thesis investigated the development and effectiveness of a perceptual training programmes for coaches and judges in gymnastics. Study one examined the variability of visual search for coaches and judges when viewing handspring vaults. The study found that there were no significant differences between the mean number of fixations, fixation duration and number of areas fixated across two time-points four weeks apart. In addtion, the natural range of variation of the number of fixations, fixation duration and number of area fixated was found to be 9/7%, 5.7% and 14.2% (expressed as coefficient of variation). Study two examined differences between expert and novice gymnastics coaches' and judges' visual search. Analysis of gaze behaviour showed that experts make significantly more fixations of significantly longer duration to significantly fewer areas than novies. There was no significant difference between the outcome juddgements made by the expert and novice coaches and judges. These findings suggest that visual search may be a contributing factor to expert performance in judgement formation. Study three explored the visual search pattern and knowledge used by expert coaches and judges when making decisions. Data were gathered through the used of eye-tracking and semi-structered interviews. Analyses established that experts tend to fixate on the torso and shoulders of gymnasts throughout the vault, and that there are three to four specific areas which are explored during each phase of a vault. Study four examined the effectiveness of a perceptual training programme for a perceptual traning and control group. Fixation number, fixation duration, number of areas fixated and outcome judgement were recorded at baseline, immediently after the programme and four weeks after it had been withdrawn. 2 (control vs. perceputal training) x 3 (intervention phase) ANOVA's with repeated measures showed that the perceptual training group produced significantly less error at the retention stage for number of fixations (F (2,6) = 12.57, p = 0.01, effect size n2 = .81), at the post-test for fixation duration (F (2,6) = 7.49, p = 0.02, effect size n2 = .71). However post-hoc analyses could not detect the difference for number of areas fixated. In study five, four participants that took part in the experiental condition watched a perceptual training DVD twice a week for six weeks. The case study data showed that the expert and novices who watched the perceptual training DVD made changes to their visual search variables and judgements and therefore became more analogous to the experts from study three to baseline to the post-test. However, only the novices retained the beneficial effects of the intervention. To conclude, this programme of research examinaed the development and effectiveness of a perceptual training programee for coaches' and judges' in gymnastics. This thesis suggests that a perceptual training programme based on the visual search and declarative knowledge of expert coaches and judges is effective at altering visual search and enhancing decision making for noveice coaches and judges. This research programme therefore promotes the use of perceptual training programmes for novice coaches and judges in sport.
    • The development of a facial expression scale using footrot and mastitis as models of pain in sheep

      McLennan, Krista M.; Rebelo, Carlos J.; Corke, Murray J.; Holmes, Mark A.; Leach, Matthew C.; Constantino-Casas, Fernando; University of Chester; University of Cambridge; Newcastle University (Elsevier, 19/01/2016)
      Management of pain in sheep is limited by the challenges of recognising and accurately quantifying 35 pain in this species. The use of facial expression scoring to assess pain is a well-utilised, practical tool 36 in both humans and non-human animals. The objective of this study was to develop a standardised 37 facial expression pain scale for adult sheep, that could be used reliably and accurately to detect pain 38 associated with naturally occurring painful diseases, such as footrot and mastitis. We also investigated 39 whether the scale could be reliably and accurately utilised by observers after training, enabling the 40 development of an on-farm pain assessment tool. The Sheep Pain Facial Expression Scale (SPFES) 41 was able to correctly identify sheep suffering from disease with a high degree of accuracy (AUC; 42 Footrot: 0.81, Mastitis: 0.80). Diseased sheep scored higher on the scale than controls on the day of 43 disease identification (P<0.05) and diseased sheep showed changes in their facial expression after 44 treatment (P<0.001). The abnormal facial expressions of diseased sheep reduced over time, and at 45 recovery were in line with control sheep. Control sheep did not change their facial expression over 46 time. Five scorers who were trained to use the developed scale also assessed the facial expressions of 47 sheep. The scorers were blind to treatment and session. Scorers reliably (ICC: 0.86) and accurately (α 48 = 0.86) identified changes in the facial expression of sheep with footrot over time (P<0.05), and 49 scored control sheep consistently low over time. The SPFES offers a reliable and effective method of 50 assessing pain in sheep after minimal training.
    • The development of a novel rugby league match simulation protocol

      Twist, Craig; Nicholas, Ceri; Lamb, Kevin L.; Sykes, Dave (University of Liverpool (University of Chester)University of Chester, 2011-12)
      The effectiveness of recovery interventions following prolonged multiple sprint team sports matches has rarely been studied despite the potential for exercise-induced muscle damage to adversely affect training in the days following games. The lack of research related to this topic is probably owing to the wide variability that exists in the movement demands of players between matches and the impact that this has on the subsequent rate and magnitude of recovery which makes it difficult to detect meaningful differences when conducting research with small sample sizes. Therefore, the purpose of this thesis was to develop a rugby league-specific match simulation protocol that replicates the movement demands, physiological responses and subsequent recovery from matches in order to study the effectiveness of recovery interventions. Hence, two time-motion analysis studies were conducted using a semi-automated image recognition system to inform the development of the rugby league match simulation protocol (RLMSP). Whilst mean total distance covered over the duration of the match was 8,503 m, ball in play and stoppage work-to-rest ratios were 1:6.9 and 1:87.4, respectively, for all players. Furthermore, a significant decline in high and very high intensity running locomotive rates were observed between the initial and final 20 min periods of the match. Thus a RLMSP was devised to replicate the overall movement demands, intra-match fatigue and recovery from a senior elite rugby league match. Not only was there a low level of variability in the movement demands during the RLMSP over consecutive trials, but with the exception of creatine kinase, the rate and magnitude of recovery following the RLMSP was similar to that that has been published following competitive matches. Therefore, the RLMSP devised in this thesis may be a more appropriate research tool for assessing the effectiveness of recovery interventions following match related exercise than following actual match play.
    • The development of a reliable amateur boxing performance analysis template

      Thomson, Edward; Lamb, Kevin L.; Nicholas, Ceri; University of Chester (Taylor & Francis, 02/11/2012)
      The aim of this study was to devise a valid performance analysis system for the assessment of the movement characteristics associated with competitive amateur boxing and assess its reliability using analysts of varying experience of the sport and performance analysis. Key performance indicators to characterise the demands of an amateur contest (offensive, defensive and feinting) were developed and notated using a computerised notational analysis system. Data were subjected to intra- and inter-observer reliability assessment using median sign tests and calculating the proportion of agreement within predetermined limits of error. For all performance indicators, intra-observer reliability revealed non-significant differences between observations (P > 0.05) and high agreement was established (80-100%) regardless of whether exact or the reference value of ±1 was applied. Inter-observer reliability was less impressive for both analysts (amateur boxer and experienced analyst), with the proportion of agreement ranging from 33-100%. Nonetheless, there was no systematic bias between observations for any indicator (P > 0.05), and the proportion of agreement within the reference range (±1) was 100%. A reliable performance analysis template has been developed for the assessment of amateur boxing performance and is available for use by researchers, coaches and athletes to classify and quantify the movement characteristics of amateur boxing.
    • The development of an amateur boxing simulation protocol

      Thomson, Edward (University of Chester, 2015)
      There is a dearth of research attempting to quantify the external (physical) and internal (physiological) demands of amateur boxing performance. Therefore, the purpose of this programme of research was to investigate the external demands of amateur boxing performance, and subsequently, develop a sport-specific simulation protocol that could replicate these demands and the accompanying physiological responses while appraising the reliability and validity of the attempt.To achieve this it was necessary initially to identify key offensive and defensive performance indicators and assess the intra- and inter-observer reliability with which such actions could be quantified. Intra-observer reliability was deemed excellent with high agreement (>92%) for all actions identified. Inter-observer reliability was less impressive (>75%), though remained consistently high nevertheless. Subsequently, research utilising this template quantified the offensive and defensive external demands and effectiveness (i.e. frequency of actions deemed successful) according to the independent and interactive influences of contest outcome, weight class and ability using post-contest video analysis. Main effects, two- and three-way interactions were established when appraising the frequency of actions and their outcomes in relation to the independent variables. Whilst the ability of the boxers evidenced the most prominent impact, contest outcome and weight class remained important influences for most actions. Moreover, substantial (CV >30%) within-group variation was evidenced implicating the role of boxer ‘styles’ and strategies in modifying the demands. The offensive and defensive demands were then supplemented with Global Positioning System (GPS) analyses of the boxers’ sport-specific time-displacement movements. Having established the GPS’s reliability and validity for assessing the boxingmovements, it was observed that boxers typically moved a distance of 35.9 m·min-1 at an average speed of 0.6 m·s-1. Such data was amalgamated with the technical demands to produce a boxing-specific simulation protocol that was reflective of the average competitive demand and thus had the potential to be a boxing conditioning and fitness test (BOXFIT). Despite providing the most valid external demand to-date, owing to confounding influences and within-group dispersion, application of the typical external demand was shown to afford only an approximation of the actual demands in all boxers. As such an issue is characteristic of simulation protocols, the BOXFIT was still employed to evaluate the physiological response and appraise the associated reliability and validity. The internal demand was characterised by a high aerobic cardiopulmonary response (peak heart rate > 189 b·min-1; peak 𝑉̇O2 > 55 ml·kg-1·min-1) coupled with a marked indication of anaerobic energy provision (blood lactate = 4.6 ± 1.3 mmol·l-1). The reliability of the physiological responses elicited by BOXFIT performance was generally sufficient to enable the detection of moderate effects (i.e. 0.6 x pooled SD) and practically relevant changes in physiological and physical performance owing to training and nutritional interventions. However, the BOXFIT-induced responses underestimated selected markers of internal load (e.g. Mean heart rate ≈ -4.5%), questioning its validity. Thus, application of the average external demand typically approximated, rather than replicated, the actual physiology of boxing. With modifications, the validity of the external demands and internal response could be improved. The BOXFIT might therefore be used as part of a boxer’s conditioning, providing a sport-specific means of training and offers an ergonomic framework to assess the impact of systematic, intervention-based changes in boxing-specific exercise physiology.
    • Development of an Automated Pain Facial Expression Detection System for Sheep (Ovis Aries).

      McLennan, Krista; Mahmoud, Marwa; University of Chester; University of Cambridge (MDPI, 25/04/2019)
      Detecting signs of pain in sheep is a challenging problem, as they are a prey species and would usually try to hide any signs that they are unwell or injured. This means that treating ill or injured sheep and preventing any further spread of contagious diseases such as footrot can be slow. The recent development and publication of a Sheep Pain Facial Expression Scale (SPFES) has provided a tool to reliably detect pain in this species. However, due to the increase in intensification in farming and larger flock sizes being cared for by individual farmers, there is less time to spend monitoring sheep for changes in behaviour that may indicate illness or injury. Having an automated system that could detect changes in the facial expression of individual sheep would mean that farmers could receive information directly about particular individuals that need assessment. This would allow treatment to be provided in a timely and direct manner, reducing suffering. We have been developing the SPFES further in order for it to become an automated system. In this paper, we present our novel framework that integrates SPFES concepts with automatic facial expression analysis technologies.
    • The development of immunoassays to identify and quantify species source of gum Arabic

      Ireland, H. Elyse; Clutterbuck, Abigail L.; Cloquet, Jean-Phillipe; Thurston, Miranda; Williams, Peter A.; Cronk, Quentin C.; Dewey, France M.; Williams, John H. H.; University College Chester (Ireland, Thurston, Williams, J H H) (American Chemical Society, 2004)
    • Development of independence from the mother in Gorilla gorilla gorilla

      Nowell, Angela A.; Fletcher, Alison W.; University of Chester (Springer Verlag, 2007-04)
      This article investigates the development of independence in a population of wild western gorillas (Gorilla gorilla gorilla) at Mbeli Bai, Nouabalé-Ndoki National Park, Republic of Congo.
    • The development of vegetarian omega-3 oil in water nanoemulsions suitable for integration into functional food products

      Lane, Katie E.; Li, Weili; Smith, Christopher J.; Derbyshire, Emma J.; Liverpool John Moores University; University of Chester (Elsevier, 31/03/2016)
      Global trends show that habitual omega-3 intakes are short of recommended guidelines, particularly among vegetarians and vegans. The potential health implications of low long chain omega-3 polyunsaturated fatty acid (LCω3PUFA) intakes coupled with concerns about sustainability of fish stocks call for innovative approaches to provide food based solutions to this problem. Nanoemulsions are systems with extremely small droplet sizes that could provide a solution while improving the bioavailability of LCω3PUFA. Oil in water nanoemulsion systems were successfully created using ultrasound with oil loads of up to 50% (w/w) using vegetarian LCω3PUFA oils (flaxseed and algae). Nanoemulsions of 50% (w/w) with mean droplet size measurements of 192 (flaxseed) and 182 nm (algae) using combinations of the emulsifiers Tween 40 and lecithin were prepared. This technique could be applied to create vegetarian LCω3PUFA nanoemulsions suitable for integration into enriched functional food products with the potential to increase LCω3PUFA intake and bioavailability
    • Development, Digestibility and Oxidation Properties of LC3PUFA Nanoemulsion and Its Effects on Sensory Profile of Food

      Zhou, QiQian (University of Chester, 2019-02)
      The long chain omega-3 polyunsaturated fatty acids (LC3PUFA) in human diets are mainly derived from oily fish and fish oil based supplements. Currently, the consumption of oily fish in the UK is far below the recommended level. LC3PUFA's non-fish sources such as algal oil with DHA (docosahexaenoic acid) are particularly important for vegetarians, non-fish eaters, and pregnant women. In previous work, high DHA vegetative algal oil load 50% w/w was successfully used to develop an oil-in-water nanoemulsion system suitable for functional food enrichment. The aims of this study included to investigate the effect of selected emulsifiers on oil-in-water nanoemulsions of algal oil prepared using ultrasonic technology. To improve the stability and digestibility of nanoemulsions within an In vitro digestion model. To examine the oxidation stability of nanoemulsions of algal oil and bulk algal oil with composition and droplet size changes during a 5 weeks storage trial at a temperature of 4 °C, 20 °C and 40 °C respectively. To evaluate sensory properties and consumer acceptability of food products with the incorporation of resulted nanoemulsion and find out possible relationship between the sensory profile of foods and the characteristics of added nanoemulsion. Nanoemulsion of LC3PUFA algal oil was developed with selected 6% w/w emulsifiers, including Lecithin (LN), Tween 40 (TN), Tween 60, equal ratio of Tween 40 and lecithin (LTN), 50% w/w Algal oil and 44%w/w water using a homogenizer and ultrasound processor. The results show that the nanoemulsion has been stabilised with selected emulsifiers (LN, TN & LTN) and the smallest droplet size of nanoemulsion was obtained using the combination of lecithin and Tween 40 at ratio 50:50. The In vitro digestion experiments were conducted with a model of fed state gastric and duodenal digestion using method of Lin et al (2014). The results show that the omega-3 oil nanoemulsion (LE/TW 50:50) were stable over 60 min in the gastric phase, in contrast omega-3 nanoemulsion (LE 100%) was destabilised at the gastric phase in 60 min, in which the droplet size diameter was significantly larger than at the beginning of gastric phase (P ≤ 0.05). The droplet size, fatty composition and oxidised compounds were measured to compare bulk algal oil and nanoemulsions stabilised with lecithin (LN) and Tween 40 (TN) solely and in combination (LTN) over a storage period of 5 weeks at temperatures of 4, 20 and 40°C. The results show the droplet size of nanoemulsions had no significant changes for samples stored at tested temperatures over 5 weeks storage. There were no significant differences in DHA composition within the weeks and temperatures used. For the GCHS analysed results, the increase in temperature to 40 ºC and storage time had a significant effect on the development of propanal for all samples (P≤0.05). Nanoemulsions prepared with lecithin alone had significantly higher development of propanal in week 1 at both 40 ºC and 20 ºC (P≤0.05). Lecithin (sole and combination with Tween 40) had more significant increases in oxidised volatiles at 40°C, which may be due to the instability of linoleic acid found in lecithin molecules which located in the outer layer of the oil droplets. There were no significant increase in oxidised compounds from the beginning to the end of storage for all tested samples stored at 4 °C. The sensory testing was also conducted on white sauce incorporated with omega-3 nanoemulsions with selected emulsifiers and bulk algal oil. The results show that the sensory attributes and overall acceptability of foods enriched with omega-3 nanoemulsion were statistically significantly lower than that of control sample (P≤ 0.05). Overall, the smallest droplet size of nanoemulsion was achieved with combination of lecithin and Tween 40 at a ratio of 50:50 by using ultrasonic processor. The stability and digestibility of nanoemulsion with the combination of lecithin and Tween 40 was improved in an In vitro digestion approach. A storage period of 5 weeks and temperature have no significant effect on the droplet size of tested nanoemulsion samples. However, there is a significant increase of the oxidised volatiles at 40 °C for all samples. Sensory testing show the white sauce with nanoemulsion has a stronger fishy taste and less overall liking than with bulk oil, indicating the smaller drop size is more ready to spread and reach the sensors of the mouth.
    • Dickkopf-1 as a potential therapeutic target in Paget's disease of bone

      McCarthy, Helen S.; Marshall, Michael J.; Charles Salt Centre, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust in Oswestry / University of Chester ; Charles Salt Centre, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust in Oswestry (Ashley, 2010-02)
      This article discusses Dickkopf-1 (DKK-1), which is a soluble inhibitor of Wnt signalling and its excessive expression contributes to bone loss in rheumatoid arthritis and multiple myeloma. New therapeutics have been developed for treatment of these conditions that target DKK-1 expression. DKK-1 is elevated in serum of patients with Paget's disease of the bone (PDB) and evidence is accumulating for a role of DKK-1 in PDB. At present there is no cure for PDB and the current treatment of choice are bisphosphonates. These treat the resorptive phase of PDB but do not prevent its return. This article offers a new perspective on the aetiology of PDB and speculate on DKK-1 as a therapeutic target.