Natural history of radiographic first metatarsophalangeal joint osteoarthritis: A nineteen‐year population‐based cohort study

Objective: To assess the long-term prevalence, natural history, progression and incidence of 73 radiographic first metatarsophalangeal joint (1st MTPJ) osteoarthritis (OA). Methods: A longitudinal, cohort design was used in which radiographic OA at the 1st MTPJ was 75 investigated in participants at year 6 (1995) and year 23 (2013-2015) from the Chingford 1000 76 Women study. Radiographic features of osteophytes (OPs) and/or joint space narrowing (JSN) at the 77 1st MTPJ were scored according to a validated foot atlas. Natural history was determined by the 78 change in prevalence, incidence, progression and worsening of OA in the 1st MTPJ. Results: Complete case matched foot radiographic data were available for 193 of the women 80 currently enrolled in the study, mean age: 75.7 years (SD: 5.2; range 69-90). At the level of the 1st 81 MTPJ, prevalence of OA at year 6 was 21.76% in the left and 24.35% in the right and at year 23 was 82 23.83% in the left and 32.64% in the right. Over the 19-year period, 13.5% of women developed 83 incident OA in the right 1st MTPJ and 8.3% in the left. Both progression and worsening of OA were 84 more evident for OPs and in the right 1st MTPJs. Conclusion: In this longest study of the natural history of radiographic 1st MTPJ OA to date, the 86 prevalence and incidence of 1st MTPJ OA increased over a 19-year period. Progression and/or 87 worsening of 1st MTPJ OA over time appears to be driven by OP development rather than JSN 88 suggestive of a biomechanical cause

Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. We report a case of hypersensitivity pneumonitis (HP) in a young person secondary to vaping. He presented with a putative diagnosis of asthma and required extracorporeal membrane oxygenation because of intractable respiratory failure. He developed a critical illness and steroid myopathy and required prolonged rehabilitation. Our patient fulfils diagnostic criteria for HP secondary to e-cigarettes with a positive exposure history, deterioration after skin prick testing, specific serum IgM antibodies against the implicated liquid raising the possibility that the relevant antigen was present in that liquid and radiological and histopathological features compatible with acute HP. There are two learning points. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as much safer than tobacco' at our peril

Effect on survey response rate of hand written versus printed signature on a covering letter: randomised controlled trial [ISRCTN67566265]

BACKGROUND: It is important that response rates to postal surveys are as high as possible to ensure that the results are representative and to maximise statistical power. Previous research has suggested that any personalisation of approach helps to improve the response rate. This experiment tested whether personalising questionnaires by hand signing the covering letter improved the response rate compared with a non-personalised group where the investigator's signature on the covering letter was scanned into the document and printed. METHODS: Randomised controlled trial. Questionnaires about surgical techniques of caesarean section were mailed to 3,799 Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK. Individuals were randomly allocated to receive a covering letter with either a computer printed signature or a hand written signature. Two reminders were sent to non-respondents. The outcome measures were the proportion of questionnaires returned and their time to return. RESULTS: The response rate was 79.1% (1506/1905) in the hand-signed group and 78.4% (1484/1894) in the scanned and printed signature group. There was no detectable difference between the groups in response rate or time taken to respond. CONCLUSION: No advantage was detected to hand signing the covering letter accompanying a postal questionnaire to health professionals

The effect of variation in interpretation of the La Trobe radiographic foot atlas on the prevalence of foot osteoarthritis in older women: the Chingford general population cohort.

Background: The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour. Methods: Foot radiographs of all remaining participants (n =?218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as 'missing'. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints. Results: When radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3-74.3%) than Technique 2 (17.9-46.3%) and lower with a wider range (18.3-74.3%) than Technique 3 (39.9-79.4%). Conclusion: The three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies

White dwarfs with hydrogen-deficient atmospheres and the dark matter content of the Galaxy

The nature of the several microlensing events observed by the MACHO team towards the Large Magellanic Cloud (LMC) is still a subject of debate. Low-mass substellar objects and stars with masses larger than ~M_{sun} have been ruled out as major components of a Massive Astrophysical Compact Halo Object (MACHO) Galactic halo, while stars of half a solar mass seem to be viable candidates. Main sequence stars have been already discarded, and there are tight restrictions on the role played by white dwarfs with hydrogen-dominated atmospheres. In this paper we evaluate the contribution to the dark matter content of the Galaxy of white dwarfs with hydrogen-deficient atmospheres. For this purpose we use a Monte Carlo simulator which incorporates up-to-date evolutionary sequences of white dwarfs with hydrogen-rich and hydrogen-deficient atmospheres. We also take into account detailed descriptions of the thick disk and the halo of our Galaxy as well as of a reliable model of the LMC. We find that the contribution of white dwarfs with hydrogen-deficient atmospheres moderately increases the theoretical estimate of the optical depth with respect to the value obtained when only hydrogen-rich white dwarfs are considered. We also find that the contribuiton of the thick disk population of white dwarfs is comparable to the halo contribution. However, the contributions of both the halo and the thick disk white-dwarf populations are still insufficient to explain the number of events observed by the MACHO team. Finally, we find that the contribution to the halo dark matter of the entire population under study is less than 10% at the 95% conficence level.Comment: 12 pages, 5 figures, accepted for publication in A&

Strengths and weaknesses in executive functioning in children with intellectual disability

Children with intellectual disability (ID) were given a comprehensive range of executive functioning measures, which systematically varied in terms of verbal and non-verbal demands. Their performance was compared to the performance of groups matched on mental age (MA) and chronological age (CA), respectively. Twenty-two children were included in each group. Children with ID performed on par with the MA group on switching, verbal executive-loaded working memory and most fluency tasks, but below the MA group on inhibition, planning, and non-verbal executive-loaded working memory. Children with ID performed below CA comparisons on all the executive tasks. We suggest that children with ID have a specific profile of executive functioning, with MA appropriate abilities to generate new exemplars (fluency) and to switch attention between tasks, but difficulties with respect to inhibiting pre-potent responses, planning, and non-verbal executive-loaded working memory The development of different types of executive functioning skills may, to different degrees, be related to mental age and experience

Invaders in hot water: a simple decontamination method to prevent the accidental spread of aquatic invasive non-native species.

Watersports equipment can act as a vector for the introduction and spread of invasive non native species (INNS) in freshwater environments. To support advice given to recreational water users under the UK Government’s Check Clean Dry biosecurity campaign and ensure its effectiveness at killing a range of aquatic INNS, we conducted a survival experiment on seven INNS which pose a high risk to UK freshwaters. The efficacy of exposure to hot water (45 °C, 15 min) was tested as a method by which waters users could ‘clean’ their equipment and was compared to drying and a control group (no treatment). Hot water had caused 99 % mortality across all species 1 h after treatment and was more effective than drying at all time points (1 h: χ2 = 117.24, p < 0.001; 1 day χ2 = 95.68, p < 0.001; 8 days χ2 = 12.16, p < 0.001 and 16 days χ2 = 7.58, p < 0.001). Drying caused significantly higher mortality than the control (no action) from day 4 (χ2 = 8.49, p < 0.01) onwards. In the absence of hot water or drying, 6/7 of these species survived for 16 days, highlighting the importance of good biosecurity practice to reduce the risk of accidental spread. In an additional experiment the minimum lethal temperature and exposure time in hot water to cause 100 % mortality in American signal crayfish (Pacifastacus leniusculus), was determined to be 5 min at 40 °C. Hot water provides a simple, rapid and effective method to clean equipment. We recommend that it is advocated in future biosecurity awareness campaigns

Biosecurity and Vector Behaviour: Evaluating the Potential Threat Posed by Anglers and Canoeists as Pathways for the Spread of Invasive Non-Native Species and Pathogens

Invasive non-native species (INNS) endanger native biodiversity and are a major economic problem. The management of pathways to prevent their introduction and establishment is a key target in the Convention on Biological Diversity's Aichi biodiversity targets for 2020. Freshwater environments are particularly susceptible to invasions as they are exposed to multiple introduction pathways, including non-native fish stocking and the release of boat ballast water. Since many freshwater INNS and aquatic pathogens can survive for several days in damp environments, there is potential for transport between water catchments on the equipment used by recreational anglers and canoeists. To quantify this biosecurity risk, we conducted an online questionnaire with 960 anglers and 599 canoeists to investigate their locations of activity, equipment used, and how frequently equipment was cleaned and/or dried after use. Anglers were also asked about their use and disposal of live bait. Our results indicate that 64% of anglers and 78.5% of canoeists use their equipment/boat in more than one catchment within a fortnight, the survival time of many of the INNS and pathogens considered in this study and that 12% of anglers and 50% of canoeists do so without either cleaning or drying their kit between uses. Furthermore, 8% of anglers and 28% of canoeists had used their equipment overseas without cleaning or drying it after each use which could facilitate both the introduction and secondary spread of INNS in the UK. Our results provide a baseline against which to evaluate the effectiveness of future biosecurity awareness campaigns, and identify groups to target with biosecurity awareness information. Our results also indicate that the biosecurity practices of these groups must improve to reduce the likelihood of inadvertently spreading INNS and pathogens through these activities