Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains

Tibial plateau fractures are debilitating injuries. They can occurin younger individuals who sustain a high energy trauma or, withincreasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1Outside these cases, tibial plateau fractures are relatively uncommon.However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.Fractures of the tibial plateau often are classified according to theSchatzker or AO classification systems.2,3 These systems evaluate theinvolvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articularsurfaces and the relationship of the diaphysis to the metaphysis).Most tibial plateau fractures occur in the lateral aspect of the tibialplateau.1 The increased frequency of lateral fractures is due to themedial tibial plateau being able to resist higher weight-bearing loaddue to the presence of more cancellous bone. More importantly, thelateral plateau has more articular surface exposed during extensioncompared to the medial plateau, which increases likelihood of injury.4The standard of care for most displaced tibial plateau fracturesis surgical management with open reduction and internal fixation(ORIF).5 Conservative management, such as leg bracing, is an optionfor fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty(TKA) is a less common option. Tibial plateau fractures, particularlymedial tibial plateau fractures, caused by direct trauma in the elderly,non-osteoporotic population are uncommon.We present the case of an active male without overt risk for severefracture (10-year fracture risk of 10% via FRAX score) who wasworking to repair a trail in the Rocky Mountains. While other injurieswere more likely given the mechanism of injury and patient risk, thiscase highlighted the importance of considering tibial plateau fracture,even in atypical settings without significant risk. Improved awarenessof this mechanism of injury will lead to more accurate diagnosis andgreater post-injury management

Unifying Approaches to Chiral Bosons

Chiral bosons, or self-dual p-form fields, are ubiquitous in string theoretic contexts but are challenging to treat. Lagrangian constructions invariably introduce a complexity be it auxiliary fields or sacrificing Lorentz invariance. In this note we show how to pass between such different approaches to chiral bosons starting from a Chern Simons point of view to recover formulations of Pasti, Sorokin and Tonin and of Mkrtchyan. This leads to a novel generalisation of the latter to include non-Abelian chiral bosons in 2-dimensions, and generalisations to include twisted self-duality which are relevant in T-duality symmetric approaches to string theory. Our approach also shows how global affine symmetries of two- and higher-dimensional chiral bosons emerge from broken Chern-Simons gauge transformations on the boundary.Comment: 22 page

Homotopy transfer and effective field theory I: tree-level

We use the dictionary between general field theories and strongly homotopyalgebras to provide an algebraic formulation of the procedure of integratingout of degrees of freedom in terms of homotopy transfer. This includes moregeneral effective theories in which some massive modes are kept while othermodes of a comparable mass scale are integrated out, as first explored by Senin the context of closed string field theory. We treatL∞-algebras both in termsof a nilpotent coderivation and, on the dual space, in terms of a nilpotentderivation (corresponding to the BRST charge of the field theory) and provideexplicit formulas for homotopy transfer. These are then shown to govern theintegrating out of degrees of freedom at tree level, while the generalization toloop level will be explored in a sequel to this paper

Compactness in Banach space theory - selected problems

We list a number of problems in several topics related to compactness in nonseparable Banach spaces. Namely, about the Hilbertian ball in its weak topology, spaces of continuous functions on Eberlein compacta, WCG Banach spaces, Valdivia compacta and Radon-Nikod\'{y}m compacta

Genetic Determinants and Epidemiology of Cystic Fibrosis–Related Diabetes: Results from a British cohort of children and adults

OBJECTIVE—Longer survival of patients with cystic fibrosis has increased the occurrence of cystic fibrosis–related diabetes (CFRD). In this study we documented the incidence of CFRD and evaluated the association between mutations responsible for cystic fibrosis and incident CFRD, while identifying potential risk factors

Building the capacity to solve complex health challenges in Sub-Saharan Africa : CARTA’s multidisciplinary PhD training

Objectives: To develop a curriculum (Joint Advanced Seminars- JAS) that produced PhD fellows who understood that health is an outcome of multiple determinants within complex environments and that approaches from a range of disciplines is required to address health and development within the Consortium for Advanced Research Training in Africa. We sought to attract PhD fellows, supervisors and teaching faculty from a range of disciplines into the program. Methods: Multidisciplinary teams developed the JAS curriculum. CARTA PhD fellowships were open to academics in consortium member institutions, irrespective of primary discipline, interested in doing a PhD in public and population health. Supervisors and JAS faculty were recruited from CARTA institutions. We use routine JAS evaluation data (closed and open ended questions) collected from PhD fellows at every JAS, a survey of one CARTA cohort and an external evaluation of CARTA to assess the impact of the JAS curriculum on learning. Results: We describe our pedagogic approach arguing its centrality to an appreciation of multiple disciplines and illustrate how it promotes working in multidisciplinary ways. CARTA has attracted PhD fellows, supervisors and JAS teaching faculty from across a range of disciplines. Evaluations indicate PhD fellows have a greater appreciation of how disciplines other than their own are important to understand health and its determinants and an appreciation and capacity to employ mixed methods research. Conclusions: In the short-term, we have been effective in promoting an understanding of multidisciplinarity resulting in fellows using methods from beyond their discipline of origin. This curriculum has international application

Complex mechanisms linking neurocognitive dysfunction to insulin resistance and other metabolic dysfunction

Scientific evidence has established several links between metabolic and neurocognitive dysfunction, and epidemiologic evidence has revealed an increased risk of Alzheimer’s disease and vascular dementia in patients with diabetes. In July 2015, the National Institute of Diabetes, Digestive, and Kidney Diseases gathered experts from multiple clinical and scientific disciplines, in a workshop entitled “The Intersection of Metabolic and Neurocognitive Dysfunction”, to clarify the state-of-the-science on the mechanisms linking metabolic dysfunction, and insulin resistance and diabetes in particular, to neurocognitive impairment and dementia. This perspective is intended to serve as a summary of the opinions expressed at this meeting, which focused on identifying gaps and opportunities to advance research in this emerging area with important public health relevance