A Retrospective Study at Two Level One Trauma Centers on the Association of Internal Injuries with Femoral Fractures

Abstract: Injuries capable of fracturing the femur often involve concurrent internal organ damage. However, up to 25% of injuries are initially missed. Prior studies evaluating the association of femur fractures with internal injury included only automobile trauma, were skewed toward more severe injuries, and were broad database studies. To our knowledge, there are no studies of this kind that include bicycle, motorcycle, and motor vehicle-pedestrian trauma, excluding those deceased at the scene, and which included chart reviews. We hypothesized that in the trauma setting, the presence of a femur fracture would correlate with an increase in concomitant internal organ injuries. Data was retrospectively queried from two Level I Trauma Centers. Patients presenting between January 1, 2005 and December 31, 2012 with trauma activation met inclusion criteria. Patients were stratified based on presence of a femur fracture, open/closed fracture status, and shaft versus non-shaft fractures. Internal organ injuries were documented. Logistic regression analysis was used to determine if the presence of a femur fracture, open fractures, or shaft fractures were predictive of internal injuries. Results were reported as odds ratios with 95% confidence intervals (CI). A p-value \u3c 0.05 was statistically significant. Femur fracture and open fracture were associated with additional internal injury. Shaft fractures were not associated with additional injury. Subjects ≤18 years with femur fracture were more likely to sustain additional injury compared to older age groups. The current study reveals that fractures of the femur in this setting may be associated with additional internal injuries. Open fractures may portend more severe organ injury compared to closed fractures. Femoral fracture in age ≥65 may not be as predictive for associated internal injuries. Development of a standardized grading system may aid in alerting the provider to the potential for these life-threatening injuries. Level of evidence: IV

Criteria for the diagnosis of corticobasal degeneration

Current criteria for the clinical diagnosis of pathologically confirmed corticobasal degeneration (CBD) no longer reflect the expanding understanding of this disease and its clinicopathologic correlations. An international consortium of behavioral neurology, neuropsychology, and movement disorders specialists developed new criteria based on consensus and a systematic literature review. Clinical diagnoses (early or late) were identified for 267 nonoverlapping pathologically confirmed CBD cases from published reports and brain banks. Combined with consensus, 4 CBD phenotypes emerged: corticobasal syndrome (CBS), frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA), and progressive supranuclear palsy syndrome (PSPS). Clinical features of CBD cases were extracted from descriptions of 209 brain bank and published patients, providing a comprehensive description of CBD and correcting common misconceptions. Clinical CBD phenotypes and features were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies. Probable CBD criteria require insidious onset and gradual progression for at least 1 year, age at onset ≥50 years, no similar family history or known tau mutations, and a clinical phenotype of probable CBS or either FBS or naPPA with at least 1 CBS feature. The possible CBD category uses similar criteria but has no restrictions on age or family history, allows tau mutations, permits less rigorous phenotype fulfillment, and includes a PSPS phenotype. Future validation and refinement of the proposed criteria are needed

Reactions of the halonium ions of carenes and pinenes: An experimental and theoretical study

The reactions of vinylcyclopropane (+)-2-carene (1) and vinylcyclobutanes (-)-β-pinene (7),  (-)-α-pinene (11), and (-)-nopol (12) with electrophilic halogens in the presence of oxygen and nitrogen nucleophiles in various solvents have been investigated. The halonium ion intermediates that were presumably formed were very reactive and led to opening of the conjugated cyclopropane or cyclobutane. Reactions of chloramine-T trihydrate with compound 1 in acetonitrile gave amidine 13 and diazepine 14. Reactions of chloramine-T trihydrate with pinenes in methylene chloride gave allylic tosylamines 22, 16B and 24. Mechanisms to explain the observations are proposed and supported by ab initio and Density Functional Theory calculations on the carenes and pinenes in this report and their bromonium ion intermediates. For comparisons, the relative extent of conjugation with the bromonium ion moiety of these, as well as select cyclohexene and cyclohexadiene systems and their corresponding bromonium ions, were optimized at the B3LYP/cc-pVDZ level of theory, and then these geometries were analyzed using the absolute hardness index at the Hartree-Fock/aug-cc-pVDZ and B3LYP/aug-cc-pVDZ levels of theory. Additionally, Natural Population Analysis charges were calculated for these systems using Møller-Plessett Second-Order Perturbation Theory electron densities and the aug-cc-pVDZ basis set. Combining the results of these theoretical methods with analysis of structural details of their optimized geometries gives much electronic structure insight into the extent of conjugation of bromonium ions of the carenes and pinenes reported here, and places them in relative context of more traditional conjugated and non-conjugated bromonium ion systems. In particular, bromonium ions of compounds 1, 7, and 11 display structural distortions, charge delocalizations and hardness values comparable with those of traditional conjugated cyclohexadienes, with possible reasons for subtle differences presented

Patient perspectives of managing fatigue in ankylosing spondylitis, and views on potential interventions: a qualitative study

<p>Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies.</p> <p>Methods: This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis.</p> <p>Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course.</p> <p>Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.</p&gt

The precision electroweak data in warped extra-dimension models

The Randall-Sundrum scenario with Standard Model fields in the bulk and a custodial symmetry is considered. We determine the several minimal quark representations allowing to address the anomalies in the forward-backward b-quark asymmetry A^b_FB, while reproducing the bottom and top masses via wave function overlaps. The calculated corrections of the Zbb coupling include the combined effects of mixings with both Kaluza-Klein excitations of gauge bosons and new b'-like states. It is shown that the mechanism, in which the left-handed doublet of third generation quarks results from a mixing on the UV boundary of introduced fields Q_1L and Q_2L, is necessary for phenomenological reasons. Within the obtained models, both the global fit of R_b with A^b_FB [at the various center of mass energies] and the fit of last precision electroweak data in the light fermion sector can simultaneously be improved significantly with respect to the pure Standard Model case, for M_KK = 3,4,5 TeV (first KK gauge boson) and a best-fit Higgs mass m_h > 115 GeV i.e. compatible with the LEP2 direct limit. The quantitative analysis of the oblique parameters S,T,U even shows that heavy Higgs mass values up to ~500 GeV may still give rise to an acceptable quality of the electroweak data fit, in contrast with the Standard Model. The set of obtained constraints on the parameter space, derived partly from precision electroweak data, is complementary of a future direct exploration of this parameter space at the LHC. In particular, we find that custodians, like b' modes, can be as light as ~1200 GeV i.e. a mass lying possibly in the potential reach of LHC.Comment: 24 pages, 8 figures. Added references, corrected typos and Higgs mass dependence discussion complete

Growth and structural transformation

Structural transformation refers to the reallocation of economic activity across the broad sectors agriculture, manufacturing, and services. This review article synthesizes and evaluates recent advances in the research on structural transformation. We begin by presenting the stylized facts of structural transformation across time and space. We then develop a multi-sector extension of the one-sector growth model that encompasses the main existing theories of structural transformation. We argue that this multi-sector model serves as a natural benchmark to study structural transformation and that it is able to account for many salient features of structural transformation. We also argue that this multi-sector model delivers new and sharper insights for understanding economic development, regional income convergence, aggregate productivity trends, hours worked, business cycles, wage inequality, and greenhouse gas emissions. We conclude by suggesting several directions for future research on structural transformation.For financial support, Herrendorf thanks the Spanish Ministry of Education (Grants ECO2009-11165 and ECO2012-31358); Rogerson thanks both the NSF and the Korea Science Foundation (WCU-R33-10005); and Valentinyi thanks the Hungarian Scientific Research Fund (OTKA) (Project K-105660-ny

Plant and animal endemism in the eastern Andean slope: challenges to conservation

Andean slope: challenges to conservatio

The effects of corporate and country sustainability characteristics on the cost of debt: an international investigation

We investigate the relationship between corporate and country sustainability on the cost of bank loans. We look into 470 loan agreements signed between 2005 and 2012 with borrowers based in 28 different countries across the world and operating in all major industries. Our principal findings reveal that country sustainability, relating to both social and environmental frameworks, has a statistically and economically impactful effect on direct financing of economic activity. An increase of one unit in a country's sustainability score is associated with an average decrease in the cost of debt by 64 basis points. Our international analysis shows that the environmental dimension of a country's institutional framework is approximately twice as impactful as the social dimension, when it comes to determining the cost of corporate loans. On the other hand, we find no conclusive evidence that firm-level sustainability influences the interest rates charged to borrowing firms by banks. Our main findings survive a battery of robustness tests and additional analyses concerning subsamples, alternative sustainability metrics and the effects of financial crisis

Physics searches at the LHC

With the LHC up and running, the focus of experimental and theoretical high energy physics will soon turn to an interpretation of LHC data in terms of the physics of electroweak symmetry breaking and the TeV scale. We present here a broad review of models for new TeV-scale physics and their LHC signatures. In addition, we discuss possible new physics signatures and describe how they can be linked to specific models of physics beyond the Standard Model. Finally, we illustrate how the LHC era could culminate in a detailed understanding of the underlying principles of TeV-scale physics.Comment: 184 pages, 55 figures, 14 tables, hundreds of references; scientific feedback is welcome and encouraged. v2: text, references and Overview Table added; feedback still welcom