A case control study to determine the association between Perthes’ disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure

Aims: It is well established that there is a strong association between Perthes’ disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis. Patients and Methods: A hospital case-control study (n = 149/146) examined the association between tobacco smoke exposure and Perthes’ disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure using the urinary cotinine-creatinine ratio, which is a widely used and validated measure of tobacco smoke exposure. Results: The odds of Perthes’ disease significantly increased with reported in utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06, 95% confidence interval (CI) 1.17 to 3.63; paternal smoking OR 2.09, 95% CI 1.26 to 3.46). The cotinine-creatinine ratio was significantly greater in cases, OR 1.63 (95% CI 1.09 to 2.43), suggesting a greater ‘dose’ of current tobacco exposure. Conclusion: An association exists between tobacco smoke exposure and Perthes’ disease but we remain unable to disentangle the association with socioeconomic deprivation

Skeletal Immaturity, Rostral Sparing, and Disparate Hip Morphologies as Biomechanical Causes for Legg-Calve-Perthes’ Disease

Legg-Calvé-Perthes’ (Perthes’) disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The aetiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes’ disease, namely: skeletal immaturity, reduced height and rostral sparing. We present an overview of the literature, summarising the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5-8 at a higher risk for Perthes’ disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes’ disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes’ disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes’ disease could have a biomechanical cause

"Waiting for the best day of your life". A qualitative interview study of patients' and clinicians' experiences of Per thes' disease

Aims Perthes’ disease is an idiopathic avascular necrosis of the developing femoral head, often causing deformity that impairs physical function. Current treatments aim to optimize the joint reaction force across the hip by enhancing congruency between the acetabulum and femoral head. Despite a century of research, there is no consensus regarding the optimal treatment. The aim of this study was to describe the experiences of children, their families, and clinicians when considering the treatment of Perthes’ disease. Methods A qualitative study gathered information from children and their families affected by Perthes’ disease, along with treating clinicians. Interviews followed a coding framework, with the interview schedule informed by behavioural theory and patient and public involvement. Transcripts were analyzed using the framework method. Results A total of 24 interviews took place, with 12 child/family dyads and 12 clinicians from UK NHS centres. Interviews identified widespread variation of routine care. Children/their families recounted positive experiences when included in the decision-making process for treatment. There is a strong desire from clinicians and children/families for consistent guidance from everyone involved in care, which should be based on clinical consensus. Conclusion This is the first study to describe how children/families and clinicians experienced receiving or providing treatment in Perthes’ disease. The results indicate the need for robust evidence to support treatment decisions. Children and families valued feeling involved in the clinical decision-making process. Clinicians acknowledged the central importance of providing patient-centred care, particularly in the absence of robust evidence to guide the optimal treatment decisions. This study will inform a future Delphi project to develop clinical consensus guidelines for the treatment of Perthes’ disease

Rotating Einstein-Yang-Mills Black Holes

We construct rotating hairy black holes in SU(2) Einstein-Yang-Mills theory. These stationary axially symmetric black holes are asymptotically flat. They possess non-trivial non-Abelian gauge fields outside their regular event horizon, and they carry non-Abelian electric charge. In the limit of vanishing angular momentum, they emerge from the neutral static spherically symmetric Einstein-Yang-Mills black holes, labelled by the node number of the gauge field function. With increasing angular momentum and mass, the non-Abelian electric charge of the solutions increases, but remains finite. The asymptotic expansion for these black hole solutions includes non-integer powers of the radial variable.Comment: 63 pages, 10 figure

Self-consistent solution of the Schwinger-Dyson equations for the nucleon and meson propagators

The Schwinger-Dyson equations for the nucleon and meson propagators are solved self-consistently in an approximation that goes beyond the Hartree-Fock approximation. The traditional approach consists in solving the nucleon Schwinger-Dyson equation with bare meson propagators and bare meson-nucleon vertices; the corrections to the meson propagators are calculated using the bare nucleon propagator and bare nucleon-meson vertices. It is known that such an approximation scheme produces the appearance of ghost poles in the propagators. In this paper the coupled system of Schwinger-Dyson equations for the nucleon and the meson propagators are solved self-consistently including vertex corrections. The interplay of self-consistency and vertex corrections on the ghosts problem is investigated. It is found that the self-consistency does not affect significantly the spectral properties of the propagators. In particular, it does not affect the appearance of the ghost poles in the propagators.Comment: REVTEX, 7 figures (available upon request), IFT-P.037/93, DOE/ER/40427-12-N9

Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK

Aims The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes’ disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. Methods A two-round, modified Delphi study was conducted online. An advisory group of children’s orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to ‘Exercises’, ‘Physical activity’, ‘Education/information sharing’, ‘Input from other services’, and ‘Monitoring assessments’. The survey was shared with clinicians who regularly treat children with Perthes’ disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as ‘points to consider’. Results A total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for ‘points to consider’. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes’ disease and their families. Conclusion Children’s orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes’ disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore

The Carriage of Multiresistant Bacteria after Travel (COMBAT) prospective cohort study: Methodology and design

Background: Antimicrobial resistance (AMR) is one of the major threats to public health around the world. Besides the intense use and misuse of antimicrobial agents as the major force behind the increase in antimicrobial resistance, the e

Investigation of the ferromagnetic transition in the correlated 4d perovskites SrRu1−x_{1-x}Rhx_xO3_3

The solid-solution SrRu$_{1-x}$Rh$_x$O$_3$ ($0\le x \le1$) is a variable-electron-configuration system forming in the nearly-cubic-perovskite basis, ranging from the ferromagnetic 4$d^4$ to the enhanced paramagnetic 4$d^5$. Polycrystalline single-phase samples were obtained over the whole composition range by a high-pressure-heating technique, followed by measurements of magnetic susceptibility, magnetization, specific heat, thermopower, and electrical resistivity. The ferromagnetic order in long range is gradually suppressed by the Rh substitution and vanishes at $x \sim 0.6$. The electronic term of specific-heat shows unusual behavior near the critical Rh concentration; the feature does not match even qualitatively with what was reported for the related perovskites (Sr,Ca)RuO$_3$. Furthermore, another anomaly in the specific heat was observed at $x \sim 0.9$.Comment: Accepted for publication in PR

A Comparison of the Technical Communications Practices of Japanese and U.S. Aerospace Engineers and Scientists

To understand the diffusion of aerospace knowledge, it is necessary to understand the communications practices and the information-seeking behaviors of those involved in the production, transfer, and use of aerospace knowledge at the individual, organizational, national, and international levels. In this paper, we report selected results from a survey of Japanese and U.S. aerospace engineers and scientists that focused on communications practices and information-seeking behaviors in the workplace. Data are presented for the following topics: importance of and time spent communicating information, collaborative writing, need for an undergraduate course in technical communications, use of libraries, the use and importance of electronic (computer) networks, and the use and importance of foreign and domestically produced technical reports. The responses of the survey respondents are placed within the context of the Japanese culture. We assume that differences in Japanese and U.S. cultures influence the communications practices and information-seeking behaviors of Japanese and U.S. aerospace engineers and scientists

Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in a population of Dutch travellers: A cross-sectional study

Background: We investigated prevalence and predictive factors for ESBL-E carriage in a population of mostly travellers prior to their travel (n = 2216). In addition, we examined ESBL genotype before travel and compared these to returning travellers. Method: A questionnaire and faecal sample were collected before travel, and a second faecal sample was collected immediately after travel. Faecal samples were analysed for ESBL-E, with genotypic characterization by PCR and sequencing. Risk factors for ESBL-E carriage prior to travel were identified by logistic regression analyses. Results: Before travel, 136 participants (6.1%) were colonized with ESBL-E. Antibiotic use in the past three months (ORadjusted 2.57; 95% CI 1.59–4.16) and travel outside of Europe in the past year (1.92, 1.28–2.87) were risk factors for ESBL-E colonisation prior to travel. Travel outside of Europe carried the largest attributable risk (39.8%). Prior to travel 31.3% (40/128) of participants carried blaCTX-M 15 and 21.9% (28/128) blaCTX-M 14/18. In returning travellers 633 acquired ESBL-E of who 53.4% (338/633) acquired blaCTX-M 15 and 17.7% (112/633) blaCTX-M 14/18. Conclusion: In our population of Dutch travellers we found a pre-travel ESBL-E prevalence of 6.1%. Prior to travel, previous antibiotic use and travel outside of Europe were the strongest independent predictors