The consistency of care for older patients with a hip fracture:are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

Summary: In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24–48 h after arrival at the hospital, while the length of hospital stay shortened. Introduction: Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation. Methods: Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods. Results: A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years. Conclusions: The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24–48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population

Design, Implementation and First Measurements with the Medipix Neutron Camera in CMS

The Medipix detector is the first device dedicated to measuring mixed-field radiation in the CMS cavern and able to distinguish between different particle types. Medipix2-MXR chips bump bonded to silicon sensors with various neutron conversion layers developed by the IEAP CTU in Prague were successfully installed for the 2008 LHC start-up in the CMS experimental and services caverns to measure the flux of various particle types, in particular neutrons. They have operated almost continuously during the 2010 run period, and the results shown here are from the proton run between the beginning of July and the end of October 2010. Clear signals are seen and different particle types have been observed during regular LHC luminosity running, and an agreement in the measured flux rate is found with the simulations. These initial results are promising, and indicate that these devices have the potential for further and future LHC and high energy physics applications as radiation monitoring devices for mixed field environments, including neutron flux monitoring. Further extensions are foreseen in the near future to increase the performance of the detector and its coverage for monitoring in CMS.Comment: 15 pages, 16 figures, submitted to JINS

Adverse health outcomes in vitamin D supplementation trials for depression:A systematic review

BACKGROUND: Vitamin D deficiency is a universal risk factor for adverse health outcomes. Since depression is consistently associated with low vitamin D levels as well as several adverse health outcomes, vitamin D supplementation may be especially relevant for depressed persons. This review examines the potential benefits of vitamin D for (somatic) health outcomes in randomised controlled supplementation trials for depression. METHOD: Systematic literature search to assess whether adverse health outcomes, such as frailty, falls, or cognitive functioning, were included in vitamin D supplementation trials for depression, and whether these outcomes were affected by supplementation. The revised Cochrane tool for assessing risk of bias in randomised trials was used. RESULTS: Thirty-one trials were included. Adverse health outcomes were considered in five studies. Two studies reported some beneficial effect on an adverse health outcome. CONCLUSIONS AND IMPLICATIONS: While depressed persons are at increased risk of vitamin D deficiency, supplementation trials hardly addressed the common negative health consequences of low vitamin D levels as secondary outcome measures. Well-designed trials of the effects of vitamin D supplementation in late-life depression should explore whether adverse health outcomes can be prevented or stabilised, and whether depression benefits from this improvement

A prospective study into change of vitamin D levels, depression and frailty among depressed older persons

Objectives While vitamin D is involved in frailty as well as depression, hardly any study has examined the course of vitamin D levels prospectively. The objective of this study is to examine whether a change of vitamin D in depressed older adults is associated with either depression course, course of frailty, or both. Methods The study population consisted of 232 of 378 older adults (60-93 years) with a DSM-IV defined depressive disorder participating in the Netherlands Study of Depression in Older persons, a prospective clinical cohort study. Baseline and 2-year follow-up data on depressive disorder (DSM-IV diagnosis), symptom severity (inventory of depressive symptoms), frailty phenotype (and its individual components) and vitamin D levels were obtained. Linear mixed models were used to study the association of change in vitamin D levels with depression course, course of frailty, and the combination. Results Vitamin D levels decreased from baseline to follow-up, independent from depression course. An increase in frailty was associated with a significantly sharper decrease of vitamin D levels over time. Post hoc analyses showed that this association with frailty might be driven by an increase of exhaustion over time and counteracted by an increase in walking speed. Conclusions Our findings generate the hypothesis that vitamin D supplementation in late-life depression may improve frailty, which may partly explain inconsistent findings of randomised controlled trials evaluating the effect of vitamin D for depression. We advocate to consider frailty (components) as an outcome in future supplementation trials in late-life depression

Integrated Analysis of Production Potential and Profitability of a Horizontal Well in the Lower Glen Rose Formation, Maverick County, Texas

The U.S. Department of Energy/Morgantown Energy Technology Center (DOE/METC) awarded a contract in 1991 to Prime Energy Corporation (PEC) to demonstrate the benefit of using horizontal wells to recover gas from low permeability formations. The project area was located in the Chittim field of Maverick County, Texas. The Lower Glen Rose Formation in the Chittim field was a promising horizontal well candidate based on the heterogenous nature of the reservoir (suggested by large well-to-well variances in reserves) and the low percentage of economical vertical wells. Since there was substantial evidence of reservoir heterogeneity, it was unknown whether the selected, wellsite would penetrate a reservoir with the desired properties for a horizontal well. Thus, an integrated team was formed to combine geologic analysis, seismic interpretation, reservoir engineering, reservoir simulation, and economic assessment to analyze the production potential and profitability of completing a horizontal well in the Lower Glen Rose formation