The most relevant diagnostic criteria for developmental dysplasia of the hip: a study of British specialists.

BACKGROUND: Developmental dysplasia of the hip (DDH) is the most common orthopaedic disorder in newborns. Despite this considerable variation in practice exists. The aim of this study was to determine the clinical relevance and a ranking order for the diagnostic criteria in DDH amongst paediatric orthopaedic surgeons practicing in the UK. METHOD: One hundred members of the British Society of Children's Orthopaedic Surgery (BSCOS) were asked to rate the importance of 37 criteria useful in the diagnosis of DDH in newborns, using a 10 cm visual analogue scale. We determined the consistency among specialists in rating the criteria with the intraclass correlation coefficient (ICC) and compared the results to a group of international peers. RESULTS: Ortolani/Barlow tests, asymmetry in abduction ≥20° and a first-degree relative treated for DDH ranked among the top ten. Participants demonstrated poor consistency in rating the 37 criteria (ICC 0.39; 95% CI 0.29, 0.52), but for clinical examination criteria alone their consistency improved (ICC 0.52; 0.35, 0.75). The importance ratings of members of BSCOS and members of the European Paediatric Orthopaedic Society differed for 15/37 (41%) criteria (p <0.05). CONCLUSIONS: Members of BSCOS had a preference for criteria relating to clinical examination and ultrasound

Punic amphorae found at Corinth: provenance analysis and implications for the study of long-distance salt fish trade in the Classical period

The Punic Amphora Building (PAB) at Corinth, Greece, excavated in the late 1970s and dated to the mid-5th century BC, provided a remarkable archaeological context for the study of trade connections between Classical Corinth and the Punic West, based on the finding of hundreds of Punic amphorae and associated fish remains. The first studies indicated that these amphorae were mostly imported from the Straits of Gibraltar region, although the exact area/s of provenance remained undetermined. The recent macroscopic restudy of these amphorae suggested the existence of several fabrics, most probably associated with different production sites in southern Spain and/or northern Morocco. In order to verify this hypothesis, a provenance analysis of this material was performed. A total of 178 amphorae from Corinth's PAB were analysed through a combination of thin section petrography and elemental analysis by WD-XRF. Further information was obtained from the analysis of reference materials from production areas, including amphorae from known Punic kiln sites in the western Mediterranean and associated potential raw materials for ceramic production. The results indicated that Punic Gadir, present-day Cádiz, was the main supplier of salt fish which was packaged in amphorae and shipped to Corinth in the fifth century BC, although other Punic sites, especially those located on the coast of present-day Málaga province, also participated in these commercial interactions. The results of this research are of particular importance for the study of long-distance trade networks between the eastern and the western Mediterranean in the Classical period

Formation of Cold Filamentary Structure from Wind Blown Superbubbles

The expansion and collision of two wind-blown superbubbles is investigated numerically. Our models go beyond previous simulations of molecular cloud formation from converging gas flows by exploring this process with realistic flow parameters, sizes and timescales. The superbubbles are blown by time-dependent winds and supernova explosions, calculated from population synthesis models. They expand into a uniform or turbulent diffuse medium. We find that dense, cold gas clumps and filaments form naturally in the compressed collision zone of the two superbubbles. Their shapes resemble the elongated, irregular structure of observed cold, molecular gas filaments and clumps. At the end of the simulations, between 65 and 80 percent of the total gas mass in our simulation box is contained in these structures. The clumps are found in a variety of physical states, ranging from pressure equilibrium with the surrounding medium to highly under-pressured clumps with large irregular internal motions and structures which are rotationally supported.Comment: Submitted to Ap

Spherical Spectral Synthesis and Two-Radius Theorems on Damek-Ricci Spaces

We prove that spherical spectral analysis and synthesis hold in Damek-Ricci spaces and derive two-radius theorems

Identification of the factors associated with outcomes in a condition management programme

&lt;p&gt;Background: A requirement of the Government’s Pathways to Work (PtW) agenda was to introduce a Condition Management Programme (CMP). The aim of the present study was to identify the differences between those who engaged and made progress in this telephone-based biopsychosocial intervention, in terms of their health, and those who did not and to determine the client and practitioner characteristics and programme elements associated with success in a programme aimed at improving health.&lt;/p&gt; &lt;p&gt;Methods: Data were obtained from the CMP electronic spreadsheets and clients paper-based case records. CMP standard practice was that questionnaires were administered during the pre- and post-assessment phases over the telephone. Each client’s record contains their socio-demographic data, their primary health condition, as well as the pre- and post-intervention scores of the health assessment tool administered. Univariate and multivariate statistical analysis was used to investigate the relationships between the database variables. Clients were included in the study if their records were available for analysis from July 2006 to December 2007.&lt;/p&gt; &lt;p&gt; Results: On average there were 112 referrals per month, totalling 2016 referrals during the evaluation period. The majority (62.8%) of clients had a mental-health condition. Successful completion of the programme was 28.5% (575 “completers”; 144 “discharges”). Several factors, such as age, health condition, mode of contact, and practitioner characteristics, were significant determinants of participation and completion of the programme. The results showed that completion of the CMP was associated with a better mental-health status, by reducing the number of clients that were either anxious, depressed or both, before undertaking the programme, from 74% to 32.5%.&lt;/p&gt; &lt;p&gt;Conclusions: Our findings showed that an individual's characteristics are associated with success in the programme, defined as completing the intervention and demonstrating an improved health status. This study provides some evidence that the systematic evaluation of such programmes and interventions could identify ways in which they could be improved.&lt;/p&gt

Clinical and cognitive characteristics of children with attention-deficit hyperactivity disorder, with and without copy number variants

Background Submicroscopic, rare chromosomal copy number variants (CNVs) contribute to neurodevelopmental disorders but it is not known whether they define atypical clinical cases. Aims To identify whether large, rare CNVs in attention-deficit hyperactivity disorder (ADHD) are confined to a distinct clinical subgroup. Method A total of 567 children with ADHD aged 5–17 years were recruited from community clinics. Psychopathology was assessed using the Child and Adolescent Psychiatric Assessment. Large, rare CNVs (>500 kb, <1% frequency) were defined from single nucleotide polymorphism data. Results Copy number variant carriers (13.6%) showed no differences from non-carriers in ADHD symptom severity, symptom type, comorbidity, developmental features, family history or pre-/perinatal markers. The only significant difference was a higher rate of intellectual disability (24% v. 9%, χ2 = 15.5, P = 0.001). Most CNV carriers did not have intellectual disability. Conclusions Large, rare CNVs are not restricted to an atypical form of ADHD but may be more highly enriched in children with cognitive problems

Intratumoral pan-ErbB targeted CAR-T for head and neck squamous cell carcinoma: interim analysis of the T4 immunotherapy study

Background: Locally advanced/recurrent head and neck squamous cell carcinoma (HNSCC) is associated with significant morbidity and mortality. To target upregulated ErbB dimer expression in this cancer, we developed an autologous CD28-based chimeric antigen receptor T-cell (CAR-T) approach named T4 immunotherapy. Patient-derived T-cells are engineered by retroviral transduction to coexpress a panErbB-specific CAR called T1E28ζ and an IL-4-responsive chimeric cytokine receptor, 4αβ, which allows IL-4-mediated enrichment of transduced cells during manufacture. These cells elicit preclinical antitumor activity against HNSCC and other carcinomas. In this trial, we used intratumoral delivery to mitigate significant clinical risk of on-target off-tumor toxicity owing to low-level ErbB expression in healthy tissues. // Methods: We undertook a phase 1 dose-escalation 3+3 trial of intratumoral T4 immunotherapy in HNSCC (NCT01818323). CAR T-cell batches were manufactured from 40 to 130 mL of whole blood using a 2-week semiclosed process. A single CAR T-cell treatment, formulated as a fresh product in 1–4 mL of medium, was injected into one or more target lesions. Dose of CAR T-cells was escalated in 5 cohorts from 1×107−1×109 T4+ T-cells, administered without prior lymphodepletion. // Results: Despite baseline lymphopenia in most enrolled subjects, the target cell dose was successfully manufactured in all cases, yielding up to 7.5 billion T-cells (67.5±11.8% transduced), without any batch failures. Treatment-related adverse events were all grade 2 or less, with no dose-limiting toxicities (Common Terminology Criteria for Adverse Events V.4.0). Frequent treatment-related adverse events were tumor swelling, pain, pyrexias, chills, and fatigue. There was no evidence of leakage of T4+ T-cells into the circulation following intratumoral delivery, and injection of radiolabeled cells demonstrated intratumoral persistence. Despite rapid progression at trial entry, stabilization of disease (Response Evaluation Criteria in Solid Tumors V.1.1) was observed in 9 of 15 subjects (60%) at 6 weeks post-CAR T-cell administration. Subsequent treatment with pembrolizumab and T-VEC oncolytic virus achieved a rapid complete clinical response in one subject, which was durable for over 3 years. Median overall survival was greater than for historical controls. Disease stabilization was associated with the administration of an immunophenotypically fitter, less exhausted, T4 CAR T-cell product. // Conclusions: These data demonstrate the safe intratumoral administration of T4 immunotherapy in advanced HNSCC