Hip fractures in elderly people:Surgery or no surgery? A systematic review and meta-analysis

Iintroduction:  Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture. Objective:  The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years. Methods:  A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist. Results:  Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups. Conclusion:  This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy

In-Brace versus Out-of-Brace Protocol for Radiographic Follow-Up of Patients with Idiopathic Scoliosis:A Retrospective Study

The purpose of this retrospective study was to compare two standardized protocols for radiological follow-up (in-brace versus out-of-brace radiographs) to study the rate of curve progression over time in surgically treated idiopathic scoliosis (IS) patients after failed brace treatment. In-brace radiographs have the advantage that proper fit of the brace and in-brace correction can be evaluated. However, detection of progression might theoretically be more difficult. Fifty-one IS patients that underwent surgical treatment after failed brace treatment were included. For 25 patients, follow-up radiographs were taken in-brace. For the other 26 patients, brace treatment was temporarily stopped before out-of-brace follow-up radiographs were taken. Both groups showed significant curve progression compared to baseline after a mean follow-up period of 3.4 years. The protocol with in-brace radiographs was noninferior regarding curve progression rate over time. The estimated monthly Cobb angle progression based on the mixed-effect model was 0.5 degrees in both groups. No interaction effect was found for time, and patients' baseline Cobb angle (p = 0.98), and for time and patients' initial in-brace correction (p = 0.32). The results of this study indicate that with both in-brace and out-of-brace protocols for radiographic follow-up, a similar rate of curve progression can be expected over time in IS patients with failed brace treatment

Holographic mesons in various dimensions

We calculate the spectrum of fluctuations of a probe Dk-brane in the background of N Dp-branes, for k=p,p+2,p+4 and p< 5. The result corresponds to the mesonic spectrum of a (p+1)-dimensional super-Yang-Mills (SYM) theory coupled to `dynamical quarks', i.e., fields in the fundamental representation -- the latter are confined to a defect for k=p and p+2. We find a universal behaviour where the spectrum is discrete and the mesons are deeply bound. The mass gap and spectrum are set by the scale M ~ m_q/g_{eff}(m_q), where m_q is the mass of the fundamental fields and g_{eff}(m_q) is the effective coupling evaluated at the quark mass, i.e. g_{eff}^2(m_q)=g_{ym}^2 N m_q^{p-3}. We consider the evolution of the meson spectra into the far infrared of three-dimensional SYM, where the gravity dual lifts to M-theory. We also argue that the mass scale appearing in the meson spectra is dictated by holography.Comment: 44 pages, 2 figures; v2: typos corrected, references adde

Framework for assessing sustainability levels in Belgium agricultural systems - SAFE

Sustainability is now regarded as a crucial property of agricultural systems and its evaluation has become a main challenge for scientists, policy makers and farmers. In the last decade, different sets of indicators have been designed both at national and international levels. Meanwhile, more practical environmental impact assessment (EIA) tools have been developed at the farm level . However, none of these indicator sets can be used at both levels. Further, most of these initiatives focus only on environmental aspects of sustainability and do not take socio-economic aspects into consideration. Indicator selection does not always fit in a consistent and comprehensive framework, although there is a strong need to integrate sustainability indicators in order to facilitate comparison and assessment. Finally, few of these works relate to Belgian agriculture, which up til now lacked a tool for assessing the sustainability of its farms. This project aims at providing a framework for assessing sustainability levels in Belgian agricultural systems (SAFE) that overcomes the deficiencies mentioned above. This is achieved by: 1. Considering the concept of agricultural sustainability in a holistic manner – SAFE accounts for all three pillars of sustainability (environmental, economic & social). 2. Developing (a) a consistent approach for defining sustainability principles and criteria and (b) a core list of sustainability indicators identified through a standardized selection procedure. The ‘SAFE selection procedure’ is a flexible scientific process that builts on knowledge and experience of numerous experts. 3. Ensuring that the tool remains as easy as possible to interpret and thus to use, thanks to the integration procedure of sustainability indicators and the graphic expression of the results. 4. Building on a generic methodology. Though the set of selected indicators presented in this report is specific to the Belgian agricultural context, the method developed for the construction of the SAFE tool can be transferred for assessing sustainability levels in other geographical (Europe, world, …) and sectorial contexts. In particular, principles and criteria defined in SAFE have a universal value. 5. Taking action at three spatial levels, depending on the scale of application: (1) parcel (2) farm or (3) watershed for surface water-related issues, landscape/ecosystem for some soil and biodiversity related issues, and administrative units (region, state) for some environmental as well as for some socio-economic issues

Framework for assessing sustainability levels in Belgium agricultural systems - SAFE

Sustainability is now regarded as a crucial property of agricultural systems and its evaluation has become a main challenge for scientists, policy makers and farmers. In the last decade, different sets of indicators have been designed both at national and international levels. Meanwhile, more practical environmental impact assessment (EIA) tools have been developed at the farm level . However, none of these indicator sets can be used at both levels. Further, most of these initiatives focus only on environmental aspects of sustainability and do not take socio-economic aspects into consideration. Indicator selection does not always fit in a consistent and comprehensive framework, although there is a strong need to integrate sustainability indicators in order to facilitate comparison and assessment. Finally, few of these works relate to Belgian agriculture, which up til now lacked a tool for assessing the sustainability of its farms. This project aims at providing a framework for assessing sustainability levels in Belgian agricultural systems (SAFE) that overcomes the deficiencies mentioned above. This is achieved by: 1. Considering the concept of agricultural sustainability in a holistic manner – SAFE accounts for all three pillars of sustainability (environmental, economic & social). 2. Developing (a) a consistent approach for defining sustainability principles and criteria and (b) a core list of sustainability indicators identified through a standardized selection procedure. The ‘SAFE selection procedure’ is a flexible scientific process that builts on knowledge and experience of numerous experts. 3. Ensuring that the tool remains as easy as possible to interpret and thus to use, thanks to the integration procedure of sustainability indicators and the graphic expression of the results. 4. Building on a generic methodology. Though the set of selected indicators presented in this report is specific to the Belgian agricultural context, the method developed for the construction of the SAFE tool can be transferred for assessing sustainability levels in other geographical (Europe, world, …) and sectorial contexts. In particular, principles and criteria defined in SAFE have a universal value. 5. Taking action at three spatial levels, depending on the scale of application: (1) parcel (2) farm or (3) watershed for surface water-related issues, landscape/ecosystem for some soil and biodiversity related issues, and administrative units (region, state) for some environmental as well as for some socio-economic issues

Endovascular treatment of patients with stroke caused by anterior cerebral artery occlusions

Background: Occlusion of the anterior cerebral artery (ACA) is uncommon but may lead to significant disability. The benefit of endovascular treatment (EVT) for ACA occlusions remains uncertain. Methods: We included patients treated with EVT and compared patients with ACA occlusions with patients who had internal carotid artery (ICA) or proximal (M1/M2) middle cerebral artery (MCA) occlusions from the MR CLEAN Registry. Primary outcome was the modified Rankin Scale score (mRS). Secondary outcomes were functional independence (mRS 0–2), National Institutes of Health Stroke Scale (NIHSS) score, delta-NIHSS (baseline minus NIHSS score at 24–48 h), and successful recanalization (expanded thrombolysis in cerebral infarction (eTICI) score 2b-3). Safety outcomes were symptomatic intracranial hemorrhage (sICH), periprocedural complications, and mortality. Results: Of 5193 patients, 11 (0.2%) had primary ACA occlusions. Median NIHSS at baseline was lower in patients with ACA versus ICA/MCA occlusions (11, IQR 9–14; versus 15, IQR 11–19). Functional outcome did not differ from patients with ICA/MCA occlusions. Functional independence was 4/11 (36%) in patients with ACA versus 1949/4815 (41%) in ICA/MCA occlusions; median delta-NIHSS was − 1 (IQR − 7 to 2) and − 4 (IQR − 9 to 0), respectively. Successful recanalization was 4/9 (44%), versus 3083/4787 (64%) in ICA/MCA occlusions. Mortality was 3/11 (27%) versus 1263/4815 (26%). One patient with ACA occlusion had sICH; no other complications occurred. Conclusion: In this cohort ACA occlusions were uncommon. Functional outcome did not differ between patients with ACA occlusions and ICA/MCA occlusions. Prospective research is needed to determine feasibility, safety, and outcomes of EVT for ACA occlusions.</p

A High Spatial Resolution Mid-Infrared Spectroscopic Study of the Nuclei and Star-Forming Regions in Luminous Infrared Galaxies

We present a high spatial (diffraction-limited) resolution (~0.3") mid-infrared (MIR) spectroscopic study of the nuclei and star-forming regions of 4 local luminous infrared galaxies (LIRGs) using T-ReCS on the Gemini South telescope. We investigate the spatial variations of the features seen in the N-band spectra of LIRGs on scales of ~100 pc, which allow us to separate the AGN emission from that of the star formation (SF). We compare our Gemini T-ReCS nuclear and integrated spectra of LIRGs with those obtained with Spitzer IRS. The 9.7um silicate absorption feature is weaker in the nuclei of the LIRGs than in the surrounding regions. This is probably due to the either clumpy or compact environment of the central AGN or young, nuclear starburst. We find that the [NeII] luminosity surface density is tightly and directly correlated with that of Pa-alpha for the LIRG star-forming regions (slope of 1.00+-0.02). Although the 11.3um PAH feature shows also a trend with Pa-alpha, this is not common for all the regions. We also find that the [NeII]\Pa-alpha ratio does not depend on the Pa-alpha equivalent width (EW), i.e., on the age of the ionizing stellar populations, suggesting that, on the scales probed here, the [NeII] emission line is a good tracer of the SF activity in LIRGs. On the other hand, the 11.3um PAH\Pa-alpha ratio increases for smaller values of the Pa-alpha EW (increasing ages), indicating that the 11.3um PAH feature can also be excited by older stars than those responsible for the Pa-alpha emission. Additional high spatial resolution observations are essential to investigate, in a statistical way, the star formation in local LIRGs at the smallest scales and to probe ultimately whether they share the same physical properties as high-z LIRGs, ULIRGs and submillimiter galaxies.Comment: 23 pages (apjstyle), 19 figures, accepted for publicacion in Ap

RegaDB: Community-driven data management and analysis for infectious diseases

Summary: RegaDB is a free and open source data management and analysis environment for infectious diseases. RegaDB allows clinicians to store, manage and analyse patient data, including viral genetic sequences. Moreover, RegaDB pr