Evaluation of hip pain in older adults

The evaluation of hip pain in patients 65 years and older should include a history and physical examination, followed by pertinent imaging studies. (Strength of Recommendation [SOR]: C, based on expert opinion.) Patients who have hip pain for more than four weeks or who have concerning historical features, signs, or symptoms require hip imaging with radiography. There are no trials comparing the accuracy of magnetic resonance imaging (MRI), computed tomography (CT), and bone scintigraphy. MRI should be used in patients with suspected acute fracture in whom plain radiography does not yield a definitive diagnosis. (SOR: C, based on one small case series.) If MRI is contraindicated or unavailable, CT or bone scintigraphy can be substituted. (SOR: C, based on expert opinion.

Multidrug resistance plasmids commonly reprogram the expression of metabolic genes in <i>Escherichia coli</i>

Multidrug-resistant Escherichia coli is a leading cause of global mortality. Transfer of plasmids carrying genes encoding beta-lactamases, carbapenamases, and colistin resistance between lineages is driving the rising rates of hard-to-treat nosocomial and community infections. Multidrug resistance (MDR) plasmid acquisition commonly causes transcriptional disruption, and while a number of studies have shown strain-specific fitness and transcriptional effects of an MDR plasmid across diverse bacterial lineages, fewer studies have compared the impacts of different MDR plasmids in a common bacterial host. As such, our ability to predict which MDR plasmids are the most likely to be maintained and spread in bacterial populations is limited. Here, we introduced eight diverse MDR plasmids encoding resistances against a range of clinically important antibiotics into E. coli K-12 MG1655 and measured their fitness costs and transcriptional impacts. The scale of the transcriptional responses varied substantially between plasmids, ranging from &gt;650 to &lt;20 chromosomal genes being differentially expressed. However, the scale of regulatory disruption did not correlate significantly with the magnitude of the plasmid fitness cost, which also varied between plasmids. The identities of differentially expressed genes differed between transconjugants, although the expression of certain metabolic genes and functions were convergently affected by multiple plasmids, including the downregulation of genes involved in L-methionine transport and metabolism. Our data show the complexity of the interaction between host genetic background and plasmid genetic background in determining the impact of MDR plasmid acquisition on E. coli.IMPORTANCE: The increase in infections that are resistant to multiple classes of antibiotics, including those isolates that carry carbapenamases, beta-lactamases, and colistin resistance genes, is of global concern. Many of these resistances are spread by conjugative plasmids. Understanding more about how an isolate responds to an incoming plasmid that encodes antibiotic resistance will provide information that could be used to predict the emergence of MDR lineages. Here, the identification of metabolic networks as being particularly sensitive to incoming plasmids suggests the possible targets for reducing plasmid transfer. </p

Magazine and reader constructions of 'metrosexuality' and masculinity: a membership categorisation analysis

Since the launch of men's lifestyle magazines in the 1980s, academic literature has predominantly focused on them as a cultural phenomenon arising from entrepreneurial and commercial initiatives and/or as cultural texts that proffer representations of masculinity such as 'new lad' and 'new dad'. This paper steps aside from the focus on culture and, instead, treats magazine content as a discursive space in which gender and sexuality are oriented to, negotiated, and accomplished within and beyond the magazine itself (i.e. through readers' responses). Specifically, membership categorisation analysis is deployed to explore how the relatively new (and perhaps alternative) category for men - 'metrosexual' - is presented and received. Our analysis suggests that masculinity concerns are central in debates about 'metrosexuality', with self-identified 'metrosexuals' invoking heterosexual prowess and self-respect on the one hand, and critics (e.g. selfidentified 'real men') lamenting 'metrosexuality' for its perceived effeminacy and lack of authenticity on the other. Implications for understanding contemporary masculinities are discussed

Does distributed leadership have a place in destination management organisations? A policy-makers perspective

Within an increasingly networked environment and recent transitions in the landscape of funding for destination management organisations (DMOs) and destinations, pooling knowledge and resources may well be seen as a prerequisite to ensuring the long-term sustainability of reshaped, yet financially constrained DMOs facing severe challenges to deliver value to destinations, visitors and member organisations. Distributed Leadership (DL) is a recent paradigm gaining momentum in destination research as a promising response to these challenges. Building on the scarce literature on DL in a DMO context, this paper provides a policy-makers’ perspective into the place of DL in reshaped DMOs and DMOs undergoing transformation and explores current challenges and opportunities to the enactment and practice of DL. The underpinned investigation used in-depth, semi-structured interviews with policy-makers from VisitEngland following an interview agenda based on the DMO Leadership Cycle. Policy-makers within VisitEngland saw a multitude of opportunities for DMOs with regards to DL, but equally, they emphasised challenges acting as barriers to realising the potential benefits of introducing a DL model to DMOs as a response to uncertainty in the funding landscape

A Large, Uniform Sample of X-ray Emitting AGN from the ROSAT All-Sky and Sloan Digital Sky Surveys: the Data Release 5 Sample

We describe further results of a program aimed to yield ~10^4 fully characterized optical identifications of ROSAT X-ray sources. Our program employs X-ray data from the ROSAT All-Sky Survey (RASS), and both optical imaging and spectroscopic data from the Sloan Digital Sky Survey (SDSS). RASS/SDSS data from 5740 deg^2 of sky spectroscopically covered in SDSS Data Release 5 (DR5) provide an expanded catalog of 7000 confirmed quasars and other AGN that are probable RASS identifications. Again in our expanded catalog, the identifications as X-ray sources are statistically secure, with only a few percent of the SDSS AGN likely to be randomly superposed on unrelated RASS X-ray sources. Most identifications continue to be quasars and Seyfert 1s with 15<m<21 and 0.01<z<4; but the total sample size has grown to include very substantial numbers of even quite rare AGN, e.g., now including several hundreds of candidate X-ray emitting BL Lacs and narrow-line Seyfert 1 galaxies. In addition to exploring rare subpopulations, such a large total sample may be useful when considering correlations between the X-ray and the optical, and may also serve as a resource list from which to select the "best" object (e.g., X-ray brightest AGN of a certain subclass, at a preferred redshift or luminosity) for follow-on X-ray spectral or alternate detailed studies.Comment: Accepted for publication in AJ; 32 pages, including 11 figures, and 6 example table

Constituting monetary conservatives via the 'savings habit': New Labour and the British housing market bubble

The ongoing world credit crunch might well kill off the most recent bubble dynamics in the British housing market by driving prices systematically downwards from their 2007 peak. Nonetheless, the experience of that bubble still warrants analytical attention. The Labour Government might not have been responsible for consciously creating it, but it has certainly grasped the opportunities the bubble has provided in an attempt to enforce a process of agential change at the heart of the British economy. The key issue in this respect is the way in which the Government has challenged the legitimacy of passive welfare receipts in favour of establishing a welfare system based on incorporating the individual into an active asset-holding society. The housing market has taken on new political significance as a means for individuals first to acquire assets and then to accumulate wealth on the back of asset ownership. The ensuing integration of the housing market into an increasingly reconfigured welfare system has permeated into the politics of everyday life. It has been consistent with individuals remaking their political subjectivities in line with preferences for the type of conservative monetary policies that typically keep house price bubbles inflated

Using technology to deliver cancer follow-up : a systematic review

Peer reviewedPublisher PD

Timing and consequences of Bering Strait opening: new insights from 40Ar/39 1 Ar dating 2 of the Barmur Group (Tjörnes beds), northern Iceland

The Barmur Group (informally Tjörnes beds) sedimentary succession of northern Iceland is key to reconstructing the opening of the Bering Strait oceanic gateway because these rocks record migration of bivalve molluscs from the Pacific to the Atlantic via the Arctic. However, the timing of the migration event is poorly constrained owing to a lack of reliable absolute ages. To address this problem, we present the first Ar-Ar radiometric dates from four basaltic lavas that underlie, are intercalated with, and overlie the Barmur Group, and integrate them with existing paleomagnetic records. We show that the Barmur Group has a latest Miocene to early Pliocene age range (c. 6.0–4.4 Ma; C3r–C3n.2n), older than all previous age models. Thus, the Barmur Group does not record the mid-Piacenzian Warm Period, contra some previous suggestions. Abundant Pacific bivalve molluscs appeared in the Barmur Group during subchrons C3n.4n–C3n.3r at 5.235–4.896 Ma, over 1.3 million years earlier than previously suggested. Appearance of Pacific bivalves in the northern Atlantic occurred shortly after the 5.6–5.4 Ma age previously inferred for first appearance of Arctic bivalves in the Pacific. Thus, our data suggest that first opening of the Bering Strait gateway by the latest Miocene (c. 5.5 Ma) was soon followed by bidirectional trans-Arctic faunal exchange, and argue against a hypothesized two-stage faunal exchange process spanning c. 2 million years. Our results also confirm that first opening of the Bering Strait gateway was not directly associated with the growth of large northern hemisphere icesheets, which occurred several million years later

Gradual not sudden change: multiple sites of functional transition across the microvascular bed

In understanding the role of the neurovascular unit as both a biomarker and target for disease interventions, it is vital to appreciate how the function of different components of this unit change along the vascular tree. The cells of the neurovascular unit together perform an array of vital functions, protecting the brain from circulating toxins and infection, while providing nutrients and clearing away waste products. To do so, the brain’s microvasculature dilates to direct energy substrates to active neurons, regulates access to circulating immune cells, and promotes angiogenesis in response to decreased blood supply, as well as pulsating to help clear waste products and maintain the oxygen supply. Different parts of the cerebrovascular tree contribute differently to various aspects of these functions, and previously, it has been assumed that there are discrete types of vessel along the vascular network that mediate different functions. Another option, however, is that the multiple transitions in function that occur across the vascular network do so at many locations, such that vascular function changes gradually, rather than in sharp steps between clearly distinct vessel types. Here, by reference to new data as well as by reviewing historical and recent literature, we argue that this latter scenario is likely the case and that vascular function gradually changes across the network without clear transition points between arteriole, precapillary arteriole and capillary. This is because classically localized functions are in fact performed by wide swathes of the vasculature, and different functional markers start and stop being expressed at different points along the vascular tree. Furthermore, vascular branch points show alterations in their mural cell morphology that suggest functional specializations irrespective of their position within the network. Together this work emphasizes the need for studies to consider where transitions of different functions occur, and the importance of defining these locations, in order to better understand the vascular network and how to target it to treat disease