Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

Objective To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs. Design Online survey. Participants Surgeons who are members of the AO Foundation. Measures Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ2 tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage. Results 1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine. Conclusions Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help

The dependence of dark matter profiles on the stellar-to-halo mass ratio: a prediction for cusps versus cores

We use a suite of 31 simulated galaxies drawn from the MaGICC project to investigate the effects of baryonic feedback on the density profiles of dark matter haloes. The sample covers a wide mass range: 9.4×109 <Mhalo/M� <7.8×1011, hosting galaxies with stellarmasses in the range 5.0×105 <M∗/M� < 8.3×1010, i.e. from dwarf to L∗. The galaxies are simulated with blastwave supernova feedback and, for some of them, an additional source of energy from massive stars is included. Within this feedback scheme we vary several parameters, such as the initial mass function, the density threshold for star formation, and energy from supernovae and massive stars. The main result is a clear dependence of the inner slope of the dark matter density profile, α in ρ ∝ rα, on the stellar-to-halo mass ratio, M∗/Mhalo. This relation is independent of the particular choice of parameters within our stellar feedback scheme, allowing a prediction for cusp versus core formation. When M∗/Mhalo is low, �0.01 per cent, energy from stellar feedback is insufficient to significantly alter the inner dark matter density, and the galaxy retains a cuspy profile. At higher stellar-to-halo mass ratios, feedback drives the expansion of the dark matter and generates cored profiles. The flattest profiles form where M∗/Mhalo ∼ 0.5 per cent. Above this ratio, stars formed in the central regions deepen the gravitational potential enough to oppose the supernova-driven expansion process, resulting in cuspier profiles. Combining the dependence of α on M∗/Mhalo with the empirical abundance matching relation between M∗ and Mhalo provides a prediction for how α varies as a function of stellar mass. Further, using the Tully–Fisher relation allows a prediction for the dependence of the dark matter inner slope on the observed rotation velocity of galaxies. The most cored galaxies are expected to have Vrot ∼ 50 km s−1, with α decreasing for more massive disc galaxies: spirals with Vrot ∼ 150 km s−1 have central slopes α ≤−0.8, approaching again the Navarro–Frenk–White profile. This novel prediction for the dependence of α on disc galaxy mass can be tested using observational data sets and can be applied to theoretical modelling of mass profiles and populations of disc galaxies

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the lower extremities of a representative population of children classified according to the PCCF. Patients and methods - We included patients up to the age of 17 who were diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at either of 2 tertiary care university hospitals in Switzerland. Patient charts were retrospectively reviewed. Results - More lower extremity fractures occurred in boys (62%, n = 341). Of 548 fractured long bones in the lower extremity, 25% involved the femur and 75% the lower leg. The older the patients, the more combined fractures of the tibia and fibula were sustained (adolescents: 50%, 61 of 123). Salter-Harris (SH) fracture patterns represented 66% of single epiphyseal fractures (83 of 126). Overall, 74 of the 83 SH patterns occurred in the distal epiphysis. Of all the metaphyseal fractures, 74 of 79 were classified as incomplete or complete. Complete oblique spiral fractures accounted for 57% of diaphyseal fractures (120 of 211). Of all fractures, 7% (40 of 548) were classified in the category "other", including 29 fractures that were identified as toddler's fractures. 5 combined lower leg fractures were reported in the proximal metaphysis, 40 in the diaphysis, 26 in the distal metaphysis, and 8 in the distal epiphysis. Interpretation - The PCCF allows classification of lower extremity fracture patterns in the clinical setting. Re-introduction of a specific code for toddler's fractures in the PCCF should be considered

Dermatological remedies in the traditional pharmacopoeia of Vulture-Alto Bradano, inland southern Italy

Dermatological remedies make up at least one-third of the traditional pharmacopoeia in southern Italy. The identification of folk remedies for the skin is important both for the preservation of traditional medical knowledge and in the search for novel antimicrobial agents in the treatment of skin and soft tissue infection (SSTI). Our goal is to document traditional remedies from botanical, animal, mineral and industrial sources for the topical treatment of skin ailments. In addition to SSTI remedies for humans, we also discuss certain ethnoveterinary applications. Field research was conducted in ten communities in the Vulture-Alto Bradano area of the Basilicata province, southern Italy. We randomly sampled 112 interviewees, stratified by age and gender. After obtaining prior informed consent, we collected data through semi-structured interviews, participant-observation, and small focus groups techniques. Voucher specimens of all cited botanic species were deposited at FTG and HLUC herbaria located in the US and Italy. We report the preparation and topical application of 116 remedies derived from 38 plant species. Remedies are used to treat laceration, burn wound, wart, inflammation, rash, dental abscess, furuncle, dermatitis, and other conditions. The pharmacopoeia also includes 49 animal remedies derived from sources such as pigs, slugs, and humans. Ethnoveterinary medicine, which incorporates both animal and plant derived remedies, is addressed. We also examine the recent decline in knowledge regarding the dermatological pharmacopoeia. The traditional dermatological pharmacopoeia of Vulture-Alto Bradano is based on a dynamic folk medical construct of natural and spiritual illness and healing. Remedies are used to treat more than 45 skin and soft tissue conditions of both humans and animals. Of the total 165 remedies reported, 110 have never before been published in the mainland southern Italian ethnomedical literature

Nonlinear Evolution of Cosmological Structures in Warm Dark Matter Models

The dark energy dominated warm dark matter (WDM) model is a promising alternative cosmological scenario. We explore large-scale structure formation in this paradigm. We do this in two different ways: with the halo model approach and with the help of an ensemble of high resolution N-body simulations. Combining these quasi-independent approaches, leads to a physical understanding of the important processes which shape the formation of structures. We take a detailed look at the halo mass function, the concentrations and the linear halo bias of WDM. In all cases we find interesting deviations with respect to CDM. In particular, the concentration-mass relation displays a turnover for group scale dark matter haloes, for the case of WDM particles with masses of the order ~0.25 keV. This may be interpreted as a hint for top-down structure formation on small scales. We implement our results into the halo model and find much better agreement with simulations. On small scales the WDM halo model now performs as well as its CDM counterpart.Comment: accepted for publication in MNRA

A mass-dependent density profile for dark matter haloes including the influence of galaxy formation

We introduce a mass-dependent density profile to describe the distribution of dark matter within galaxies, which takes into account the stellar-to-halo mass dependence of the response of dark matter to baryonic processes. The study is based on the analysis of hydrodynamically simulated galaxies from dwarf to Milky Way mass, drawn from the Making Galaxies In a Cosmological Context project, which have been shown to match a wide range of disc scaling relationships. We find that the best-fitting parameters of a generic double power-law density profile vary in a systematic manner that depends on the stellar-to-halo mass ratio of each galaxy. Thus, the quantity M⋆/Mhalo constrains the inner (γ) and outer (β) slopes of dark matter density, and the sharpness of transition between the slopes (α), reducing the number of free parameters of the model to two. Due to the tight relation between stellar mass and halo mass, either of these quantities is sufficient to describe the dark matter halo profile including the effects of baryons. The concentration of the haloes in the hydrodynamical simulations is consistent with N-body expectations up to Milky Way-mass galaxies, at which mass the haloes become twice as concentrated as compared with pure dark matter runs. This mass-dependent density profile can be directly applied to rotation curve data of observed galaxies and to semi-analytic galaxy formation models as a significant improvement over the commonly used NFW profile

Universal IMF vs dark halo response in early-type galaxies: breaking the degeneracy with the fundamental plane

We use the relations between aperture stellar velocity dispersion (\sigma_ap), stellar mass (M_sps), and galaxy size (R_e) for a sample of \sim 150,000 early-type galaxies from SDSS/DR7 to place constraints on the stellar initial mass function (IMF) and dark halo response to galaxy formation. We build LCDM based mass models that reproduce, by construction, the relations between galaxy size, light concentration and stellar mass, and use the spherical Jeans equations to predict \sigma_ap. Given our model assumptions (including those in the stellar population synthesis models), we find that reproducing the median \sigma_ap vs M_sps relation is not possible with {\it both} a universal IMF and a universal dark halo response. Significant departures from a universal IMF and/or dark halo response are required, but there is a degeneracy between these two solutions. We show that this degeneracy can be broken using the strength of the correlation between residuals of the velocity-mass (\Delta log \sigma_ap) and size-mass (\Delta log R_e) relations. The slope of this correlation, d_vr \equiv \Delta log \sigma_ap/\Delta log R_e, varies systematically with galaxy mass from d_vr \simeq -0.45 at M_sps \sim 10^{10}M_sun, to d_vr \simeq -0.15 at M_sps \sim 10^{11.6} M_sun. The virial fundamental plane (FP) has d_vr=-1/2, and thus we find the tilt of the observed FP is mass dependent. Reproducing this tilt requires {\it both} a non-universal IMF and a non-universal halo response. Our best model has mass-follows-light at low masses (Msps < 10^{11.2}M_sun) and unmodified NFW haloes at M_sps \sim 10^{11.5} M_sun. The stellar masses imply a mass dependent IMF which is "lighter" than Salpeter at low masses and "heavier" than Salpeter at high masses.Comment: 19 pages, 16 figures, accepted to MNRAS. More extensive discussion, 4 new figures, conclusions unchange

Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level

BACKGROUND: Brain-derived neurotrophic factor (BDNF) has neuroprotective, proangiogenic and myogenic effects and, therefore, possibly acts as a psychosomatic mediator. Here, we measured serum BDNF (seBDNF) level in hypertensive patients (HT) and healthy controls (CONT) and its relation to affective temperaments, depression and anxiety scales, and arterial stiffness parameters. METHODS: In this cross-sectional study, affective temperaments, anxiety, and depression were studied with questionnaires (TEMPS-A, HAM-A, and BDI, respectively). SeBDNF level and routine laboratory parameters were measured as well. Arterial stiffness was evaluated with a tonometric method. RESULTS: Allover, 151 HT, and 32 CONT subjects were involved in the study. SeBDNF level was significantly higher in HT compared to CONT (24880 +/- 8279 vs 21202.6 +/- 6045.5 pg/mL, p < 0.05). In the final model of regression analysis, hyperthymic temperament score (Beta = 405.8, p = 0.004) and the presence of hypertension (Beta = 6121.2, p = 0.001) were independent determinants of seBDNF. In interaction analysis, it was found that in HT, a unit increase in hyperthymic score was associated with a 533.3 (95 %CI 241.3-825.3) pg/mL higher seBDNF. This interaction was missing in CONT. CONCLUSIONS: Our results suggest a complex psychosomatic involvement of BDNF in the pathophysiology of hypertension, where hyperthymic affective temperament may have a protective role. BDNF is not likely to have an effect on large arteries

The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery

<p>Abstract</p> <p>Background</p> <p>Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.</p> <p>Methods</p> <p>After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.</p> <p>Results</p> <p>During a median follow-up of 7.6 years (25^th to 75^th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.</p> <p>Conclusions</p> <p>Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.</p

Effects of Picture Size Reduction and Blurring on Emotional Engagement

The activity of basic motivational systems is reflected in emotional responses to arousing stimuli, such as natural pictures. The manipulation of picture properties such as size or detail allows for investigation into the extent to which separate emotional reactions are similarly modulated by perceptual changes, or, rather, may subserve different functions. Pursuing this line of research, the present study examined the effects of two types of perceptual degradation, namely picture size reduction and blurring, on emotional responses. Both manipulations reduced picture relevance and dampened affective modulation of skin conductance, possibly because of a reduced action preparation in response to degraded or remote pictures. However, the affective modulation of the startle reflex did not vary with picture degradation, suggesting that the identification of these degraded affective cues activated the neural circuits mediating appetitive or defensive motivation