Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results

Dual cells with mixed protonic-anionic conductivity for reversible SOFC/SOEC operation

International audienceThe dual cell concept is a novel design for solid oxide fuel cells operating at intermediate temperature. The cell comprises a series of five layers with different compositions, alternating two dense electrolytes and three porous layers, i.e. the outer electrodes and a central membrane. The dual cell concept makes it possible to separate the compartment for water formation from both fuel and oxidant chambers. Such a three-chamber configuration gives many advantages related to fuel dilution, materials corrosion, and reversibility between fuel cell and electrolyser operational modes (SOFC/SOEC) at high temperature. Dual conductivity (protonic/anionic) can be achieved by joining two dense BaCe0.85Y0.15O3-δ (BCY) and Ce0.85Y0.15O2-δ (YDC) electrolytes through a porous ceramic central membrane made up of both materials. Complete anode-supported dual cells have been fabricated by a combination of pressing, casting, printing, wet spraying, and plasma spraying techniques. Electrochemical tests carried out by impedance spectroscopy showed the feasibility of the concept and successful reversible operation of the dual cell. The fabrication route, the microstructural and electrochemical testing results are reported in this work, and partially compared to simulated results from an electrochemical model developed describing the dual cell concept

Policy accommodation versus electoral turnover:Policy representation in Britain, 1945-2015

Does public policy in the UK respond to changes in public preferences? If so, is this the result of the government changing its policy to reflect preferences (‘policy accommodation’) or the result of governments that pursue unpopular policies being replaced at elections by governments more in line with the public (‘electoral turnover’)? We explore these questions by estimating aggregate public preferences (‘the policy mood’) using responses to 287 questions administered 2087 times and policy using budgetary data (‘non-military government expenditure’) for the whole of the post-war period. We find that mood moves in the opposite direction to policy and variations in mood are associated with variations in vote intentions. Policy is responsive to party control but not directly responsive to mood. Shifts in mood eventually lead to a change in government and thus policy, but this process may be very slow if the public has doubts about the competence of the oppositio

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Salt Marsh Monitoring in Jamaica Bay, New York from 2003 to 2013: A Decade of Change from Restoration to Hurricane Sandy

This study used Quickbird-2 and Worldview-2, high resolution satellite imagery, in a multi-temporal salt marsh mapping and change analysis of Jamaica Bay, New York. An object-based image analysis methodology was employed. The study seeks to understand both natural and anthropogenic changes caused by Hurricane Sandy and salt marsh restoration, respectively. The objectives of this study were to: (1) document salt marsh change in Jamaica Bay from 2003 to 2013; (2) determine the impact of Hurricane Sandy on salt marshes within Jamaica Bay; (3) evaluate this long term monitoring methodology; and (4) evaluate the use of multiple sensor derived classifications to conduct change analysis. The study determined changes from 2003 to 2008, 2008 to 2012 and 2012 to 2013 to better understand the impact of restoration and natural disturbances. The study found that 21 ha of salt marsh vegetation was lost from 2003 to 2013. From 2012 to 2013, restoration efforts resulted in an increase of 10.6 ha of salt marsh. Hurricane Sandy breached West Pond, a freshwater environment, causing 3.1 ha of freshwater wetland loss. The natural salt marsh showed a decreasing trend in loss. Larger salt marshes in 2012 tended to add vegetation in 2012–2013 (F4,6 = 13.93, p = 0.0357 and R2 = 0.90). The study provides important information for the resource management of Jamaica Bay

level of patient education and proximal humerus fractures: a predictor and screening method

AbstractPurpose:To identify risk factors of functional outcome following proximal humerus open reduction and internal fixation.Methods: Patients treated for proximal humerus fractures with open reduction and internal fixation were enrolled in a prospective data registry. Patients were evaluated for function using the Disability of the Arm, Shoulder and Hand score for 12 months and as available beyond 12 months. Univariate analyses were conducted to identify variables associated with functional outcome. Significant variables were included in a multivariate regression predicting functional outcome.Results: Demographics and minimum of 12 month follow-up were available for 129 patients (75%). Multiple regression demonstrated postoperative complication (B=8.515 p=0.045), education level (B=-6.269,p<0.0005), age (B=0.241,p=0.049) and Charlson Comorbidity Index (B=6.578, p=0.001) were all significant predictors of functional outcome.Conclusion:Orthopaedic surgeons can use education level, comorbidities, age, and postoperative complication information to screen patients for worse outcomes, establish expectations, and guide care

Nomenclature of the apatite supergroup minerals

The apatite supergroup includes minerals with a generic chemical formulaIXM12VII M23(IVTO4)3X (Z1/4 2); chemically they can be phosphates, arsenates, vanadates, silicates, and sulphates. Themaximum space group symmetry is P63/m, but severalmembers of th

Current Practices Regarding Perioperative Management of Patients With Fracture on Antiplatelet Therapy

Objective: There continues to be controversy over whether operative delay is necessary for patients on antiplatelet therapy, particularly for elderly patients with hip fractures. This study sought to assess current clinical practices of orthopedic surgeons regarding perioperative management of these patients. Methods: A 12-question, Web-based survey was distributed to orthopedic surgeons via e-mail. Questions regarding timing of surgery assumed patients were on antiplatelet therapy and assessed attitudes toward emergent and nonemergent orthopedic cases as well as operative delay for specific closed fracture types. Responses were compared using unpaired, 2-tailed Student t tests for continuous variables and Pearson chi-square tests with odds ratios (ORs) and 95% confidence intervals (CIs) for categorical variables. Statistical significance was defined as a P value <.05. Results: Overall 67 orthopedic surgeons responded. Fifty-two percent (n = 35) of the respondents described their practice as academic. Thirty-nine percent (n = 25) of the surgeons indicated that no delay was acceptable for urgent but nonemergent surgery, and 78% (n = 50) reported no delay for emergent surgery was acceptable. Sixty-eight percent (n = 46) of respondents felt patients on antiplatelet therapy with closed hip fractures did not require operative delay. Surgeons who opted for surgical delay in hip fractures were more likely to delay surgery in other lower extremity fracture types (OR = 16.4, 95% CI 4.48-60.61, P < .001). Sixty-four percent (n = 41) of the surgeons indicated there was no protocol in place at their institution. Conclusions: There continues to be wide variability among orthopedic surgeons with regard to management of patients with fracture on antiplatelet therapy. Over a quarter of surgeons continue to opt for surgical delay in patients with hip fracture. This survey highlights the need to formulate and better disseminate practice management guidelines for patients with fracture on antiplatelet therapy, particularly given the aging population in the United States