Validated repeatability of patient-reported outcome measures following primary total hip replacement:a mode of delivery comparison study with randomized sequencing

Background and purpose — Patient-reported outcome measures (PROMs) are used to understand better the outcomes after total hip replacement (THR). These are administered in different settings using a variety of methods. We investigated whether the mode of delivery of commonly used PROMs affects the reported scores, 1 year after THR. Patients and methods — A prospective test–retest mode comparison study with randomized sequence was done in 66 patients who had undergone primary THR. PROMs were administered by 4 modes: self-administration, face-to-face interview, telephone interview, and postal questionnaire. PROMs included: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), EQ5D-3L (EQ5D), and Self-Administered Patient Satisfaction Scale (SAPS). Linear regression was used to estimate relationships between the mean scores for PROMs by mode. Individual paired differences by mode were calculated, relationships between modes were identified, and results adjusted by time delay and participant age. Results — There was no statistically significant difference between the mean PROM scores recorded for each mode of delivery for each score. Statistically significant differences in the individual paired differences were detected between modes for the WOMAC stiffness subscale, OHS, EQ5D, and SAPS. OHS difference in individual paired means between face-to-face and telephone interview exceeded the minimal clinically important difference. Interpretation — PROMs mode of administration can affect the recorded results. Modes should not be mixed and may not be comparable between studies. It should not be assumed that different modes will obtain the same results and where not already established this should be checked by researchers before use

Posterior approach to optimise patient-reported outcome from revision hip arthroplasty

Introduction Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery. Methods A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires. Results 205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach. The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups. Discussion Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA. </jats:sec

Gender essentialism and occupational segregation in insolvency practice

Advances towards egalitarianism in professional recruitment may be offset by processes of occupational re-segregation. Drawing on gender theory this paper investigates horizontal segregation in the UK insolvency profession, as revealed through the lived experiences of female and male practitioners. It is shown that horizontal segregation pervades at different levels of practice and is undergirded by various elements of gender essentialism. Physical essentialism explains why insolvency practice has been traditionally gendered male. Interactional essentialism combines with the management of work-life balance to define the subfields of corporate and personal insolvency as masculine and feminine respectively. Gender essentialist assumptions also pervade the distribution of roles and the allocation of work tasks. Networks are identified as arenas for the reproduction and perpetuation of occupational segregation. The findings indicate the continuing potency of gender in everyday professional life, the limitations of diversity-orientated policies and the complexities of formulating transformative agendas

Search for gravitational-wave bursts in LIGO \u27s third science run

We report on a search for gravitational-wave bursts in data from the three LIGO interferometric detectors during their third science run. The search targets subsecond bursts in the frequency range 100-1100 Hz for which no waveform model is assumed and has a sensitivity in terms of the root-sum-square (rss) strain amplitude of hrss ∼ 10-20 Hz -1/2. No gravitational-wave signals were detected in the eight days of analysed data. © 2006 IOP Publishing Ltd

Upper limits on a stochastic background of gravitational waves

The Laser Interferometer Gravitational-Wave Observatory has performed a third science run with much improved sensitivities of all three interferometers. We present an analysis of approximately 200 hours of data acquired during this run, used to search for a stochastic background of gravitational radiation. We place upper bounds on the energy density stored as gravitational radiation for three different spectral power laws. For the flat spectrum, our limit of 0 \u3c 8.4 × 10 -4 in the 69-156 Hz band is ∼10 5 times lower than the previous result in this frequency range. © 2005 The American Physical Society

Searching for a stochastic background of gravitational waves with the laser interferometer gravitational-wave observatory

The Laser Interferometer Gravitational-Wave Observatory (LIGO) has performed the fourth science run, S4, with significantly improved interferometer sensitivities with respect to previous runs. Using data acquired during this science run, we place a limit on the amplitude of a stochastic background of gravitational waves. For a frequency independent spectrum, the new Bayesian 90% upper limit is ΩGW × [H0/(12 km s-1 Mpc-1)]2 \u3c 6.5 × 10-5. This is currently the most sensitive result in the frequency range 51-150 Hz, with a factor of 13 improvement over the previous LIGO result. We discuss the complementarity of the new result with other constraints on a stochastic background of gravitational waves, and we investigate implications of the new result for different models of this background. © 2007. The American Astronumical Society. All rights reserved

T wave abnormalities, high body mass index, current smoking and high lipoprotein (a) levels predict the development of major abnormal Q/QS patterns 20 years later. A population-based study

BACKGROUND: Most studies on risk factors for development of coronary heart disease (CHD) have been based on the clinical outcome of CHD. Our aim was to identify factors that could predict the development of ECG markers of CHD, such as abnormal Q/QS patterns, ST segment depression and T wave abnormalities, in 70-year-old men, irrespective of clinical outcome. METHODS: Predictors for development of different ECG abnormalities were identified in a population-based study using stepwise logistic regression. Anthropometrical and metabolic factors, ECG abnormalities and vital signs from a health survey of men at age 50 were related to ECG abnormalities identified in the same cohort 20 years later. RESULTS: At the age of 70, 9% had developed a major abnormal Q/QS pattern, but 63% of these subjects had not been previously hospitalized due to MI, while 57% with symptomatic MI between age 50 and 70 had no major Q/QS pattern at age 70. T wave abnormalities (Odds ratio 3.11, 95% CI 1.18–8.17), high lipoprotein (a) levels, high body mass index (BMI) and smoking were identified as significant independent predictors for the development of abnormal major Q/QS patterns. T wave abnormalities and high fasting glucose levels were significant independent predictors for the development of ST segment depression without abnormal Q/QS pattern. CONCLUSION: T wave abnormalities on resting ECG should be given special attention and correlated with clinical information. Risk factors for major Q/QS patterns need not be the same as traditional risk factors for clinically recognized CHD. High lipoprotein (a) levels may be a stronger risk factor for silent myocardial infarction (MI) compared to clinically recognized MI