Do the Potential Benefits of Metal-on-Metal Hip Resurfacing Justify the Increased Cost and Risk of Complications?

Metal-on-metal hip resurfacing arthroplasty (MoM HRA) may offer potential advantages over total hip arthroplasty (THA) for certain patients with advanced osteoarthritis of the hip. However, the cost effectiveness of MoM HRA compared with THA is unclear. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of MoM HRA to THA. A Markov decision model was constructed to compare the quality-adjusted life-years (QALYs) and costs associated with HRA versus THA from the healthcare system perspective over a 30-year time horizon. We performed sensitivity analyses to evaluate the impact of patient characteristics, clinical outcome probabilities, quality of life and costs on the discounted incremental costs, incremental clinical effectiveness, and the incremental cost-effectiveness ratio (ICER) of HRA compared to THA. MoM HRA was associated with modest improvements in QALYs at a small incremental cost, and had an ICER less than $50,000 per QALY gained for men younger than 65 and for women younger than 55. MoM HRA and THA failure rates, device costs, and the difference in quality of life after conversion from HRA to THA compared to primary THA had the largest impact on costs and quality of life. MoM HRA could be clinically advantageous and cost-effective in younger men and women. Further research on the comparative effectiveness of MoM HRA versus THA should include assessments of the quality of life and resource use in addition to the clinical outcomes associated with both procedures. Level I, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence

“This is not a test”:How do human resource development professionals use personality tests as tools of their professional practice?

Although human resource development (HRD) professionals enjoy the use of personality tests in their practice, the appeal of these tests to some is harshly criticized by others. Personality tests attract through optimistic descriptions and ease of use for individual and team development while often lacking predictive and discriminant validities. Despite those concerns, the personality‐testing market can be characterized as a dynamic industry, with many professionals using assessments in developmental settings such as management training and executive coaching. The aim of this article is to explore how individual meaning‐making and organizational sensemaking theories help to explain the widespread and sustained use of personality tests in developmental contexts among HRD professionals. Using grounded theory and inductive analysis, we distill meaning from semistructured interviews with 18 HRD professionals. Through pattern analysis, we establish six strategies that describe practical approaches in personality testing: 1. Ethical‐protective, 2. Scientific‐selective, 3. Cautious‐avoiding, 4. Cautious‐embracing, 5. User friendly‐pragmatic, and 6. Knowledgeable‐accommodating. We find that HRD professionals deal with cognitive dissonances and paradoxical situations in their professional personality test use practice on a regular basis. Research limitations and implications for practice and future research are discussed

Tracing animal genomic evolution with the chromosomal-level assembly of the freshwater sponge Ephydatia muelleri

Abstract The genomes of non-bilaterian metazoans are key to understanding the molecular basis of early animal evolution. However, a full comprehension of how animal-specific traits such as nervous systems arose is hindered by the scarcity and fragmented nature of genomes from key taxa, such as Porifera. Ephydatia muelleri is a freshwater sponge found across the northern hemisphere. Here we present its 326 Mb genome, assembled to high contiguity (N50: 9.88 Mb) with 23 chromosomes on 24 scaffolds. Our analyses reveal a metazoan-typical genome architecture, with highly shared synteny across Metazoa, and suggest that adaptation to the extreme temperatures and conditions found in freshwater often involves gene duplication. The pancontinental distribution and ready laboratory culture of E. muelleri make this a highly practical model system, which with RNAseq, DNA methylation and bacterial amplicon data spanning its development and range allows exploration of genomic changes both within sponges and in early animal evolution

Cell–cell and cell–matrix dynamics in intraperitoneal cancer metastasis

The peritoneal metastatic route of cancer dissemination is shared by cancers of the ovary and gastrointestinal tract. Once initiated, peritoneal metastasis typically proceeds rapidly in a feed-forward manner. Several factors contribute to this efficient progression. In peritoneal metastasis, cancer cells exfoliate into the peritoneal fluid and spread locally, transported by peritoneal fluid. Inflammatory cytokines released by tumor and immune cells compromise the protective, anti-adhesive mesothelial cell layer that lines the peritoneal cavity, exposing the underlying extracellular matrix to which cancer cells readily attach. The peritoneum is further rendered receptive to metastatic implantation and growth by myofibroblastic cell behaviors also stimulated by inflammatory cytokines. Individual cancer cells suspended in peritoneal fluid can aggregate to form multicellular spheroids. This cellular arrangement imparts resistance to anoikis, apoptosis, and chemotherapeutics. Emerging evidence indicates that compact spheroid formation is preferentially accomplished by cancer cells with high invasive capacity and contractile behaviors. This review focuses on the pathological alterations to the peritoneum and the properties of cancer cells that in combination drive peritoneal metastasis

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Coaching as a social process

In this conceptual paper, we argue the importance to the coaching profession of a critical understanding of coaching as a social process, in order to promote coaching as an enabler for change, and facilitate its use in other cultures and challenging contexts. We start with a critical analysis of the origin of coaching, arguing that neoliberal values have been embedded in the discourse of coaching. We also discuss the impact of coaching as an instrumental and ideological device, sometimes used in organisations as a process of control, and suggest that understanding coaching as a social process has the potential to transform it into an enabler for change. We propose a framework for understanding how different philosophical positions affect the way coaches may respond to the challenges of intercultural or oppressive social contexts. We conclude with a discussion of the implications for coaching research and development