10,237 research outputs found

    Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

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    Introduction: Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures. Methods: We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation. Results: We studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001) than patients in the pre-GFP period. Conclusion: Implementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes

    PC1643+4631A,B: The Lyman-Alpha Forest at the Edge of Coherence

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    This is the first measurement and detection of coherence in the intergalactic medium (IGM) at substantially high redshift (z~3.8) and on large physical scales (~2.5 h^-1 Mpc). We perform the measurement by presenting new observations from Keck LRIS of the high redshift quasar pair PC 1643+4631A, B and their Ly-alpha absorber coincidences. This experiment extends multiple sightline quasar absorber studies to higher redshift, higher opacity, larger transverse separation, and into a regime where coherence across the IGM becomes weak and difficult to detect. We fit 222 discrete Ly-alpha absorbers to sightline A and 211 to sightline B. Relative to a Monte Carlo pairing test (using symmetric, nearest neighbor matching) the data exhibit a 4sigma excess of pairs at low velocity splitting (<150 km/s), thus detecting coherence on transverse scales of ~2.5 h^-1 Mpc. We use spectra extracted from an SPH simulation to analyze symmetric pair matching, transmission distributions as a function of redshift and compute zero-lag cross-correlations to compare with the quasar pair data. The simulations agree with the data with the same strength (~4sigma) at similarly low velocity splitting above random chance pairings. In cross-correlation tests, the simulations agree when the mean flux (as a function of redshift) is assumed to follow the prescription given by Kirkman et al. (2005). While the detection of flux correlation (measured through coincident absorbers and cross-correlation amplitude) is only marginally significant, the agreement between data and simulations is encouraging for future work in which even better quality data will provide the best insight into the overarching structure of the IGM and its understanding as shown by SPH simulations.Comment: 15 pages, 11 figures; accepted for publication in Astronomical Journa

    Applied Force and sEMG Muscle Activity Required To Operate Pistol Grip Control in an Electric Utility Aerial Bucket

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    Electric utility line workers report high levels of fatigue in forearm muscles when operating a conventional pistol grip control in aerial buckets. This study measured the applied force and surface electromyographic (sEMG) signals from four upper extremity muscles required to operate the pistol grip control in two tasks. The first task was movement of the pistol grip in six directions (up/down, forward/rearward, clockwise/counter-clockwise), and the second task was movement of the bucket from its resting position on the truck bed to an overhead conductor on top of a 40 ft tall pole. The force applied to the pistol grip was measured in 14 aerial bucket trucks, and sEMG activity was measured on eight apprentice line workers. The applied force required to move the pistol grip control in the six directions ranged from 12 to 15 lb. The sEMG activity in the extensor digitorum communis (EDC) forearm muscle was approximately twice as great or more than the other three muscles (flexor digitorum superficialis, triceps, and biceps). Line workers exerted 14 to 30% MVCEMG to move the pistol grip in the six directions. Average %MVCEMG of the EDC to move the bucket from the truck platform to an overhead line ranged from 26 to 30% across the four phases of the task. The sEMG findings from this study provide physiologic evidence to support the anecdotal reports of muscle fatigue from line workers after using the pistol grip control for repeated, long durations

    The Stellar Populations and Evolution of Lyman Break Galaxies

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    Using deep near-IR and optical observations of the HDF-N from the HST NICMOS and WFPC2 and from the ground, we examine the spectral energy distributions (SEDs) of Lyman break galaxies (LBGs) at 2.0 < z < 3.5. The UV-to-optical rest-frame SEDs of the galaxies are much bluer than those of present-day spiral and elliptical galaxies, and are generally similar to those of local starburst galaxies with modest amounts of reddening. We use stellar population synthesis models to study the properties of the stars that dominate the light from LBGs. Under the assumption that the star-formation rate is continuous or decreasing with time, the best-fitting models provide a lower bound on the LBG mass estimates. LBGs with ``L*'' UV luminosities are estimated to have minimum stellar masses ~ 10^10 solar masses, or roughly 1/10th that of a present-day L* galaxy. By considering the effects of a second component of maximally-old stars, we set an upper bound on the stellar masses that is ~ 3-8 times the minimum estimate. We find only loose constraints on the individual galaxy ages, extinction, metallicities, initial mass functions, and prior star-formation histories. We find no galaxies whose SEDs are consistent with young (< 10^8 yr), dust-free objects, which suggests that LBGs are not dominated by ``first generation'' stars, and that such objects are rare at these redshifts. We also find that the typical ages for the observed star-formation events are significantly younger than the time interval covered by this redshift range (~ 1.5 Gyr). From this, and from the relative absence of candidates for quiescent, non-star-forming galaxies at these redshifts in the NICMOS data, we suggest that star formation in LBGs may be recurrent, with short duty cycles and a timescale between star-formation events of < 1 Gyr. [Abridged]Comment: LaTeX, 37 pages, 21 figures. Accepted for publication in the Astrophysical Journa
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