Teriparatide and Pelvic Fracture Healing: A Phase 2 Randomized Controlled Trial

Purpose: To determine if teriparatide (20 ug/day; TPTD) results in improved radiologic healing, reduced pain and improved functional outcome vs. placebo over 3 months in pelvic fracture patients. Methods: This randomized-placebo-controlled study enrolled 35 patients (women and men ≥50 years old) within 4 weeks of pelvic fracture and evaluated the effect of blinded TPTD versus placebo over 3 months on fracture healing. Fracture healing from CT images at 0 and 3 months was assessed as cortical bridging using a 5-point scale. The numeric rating scale (NRS) for pain was administered monthly. Physical performance was assessed monthly by Continuous Summary Physical Performance Score (based on 4m walk speed, timed repeated chair stands, and balance) and the Timed Up and Go (TUG) test. Results: The mean age was 82 and >80% were female. The intention to treat analysis showed no group difference in cortical bridging score and 50% of fractures in TPTD-treated and 53% of fractures in placebo-treated patients were healed at 3 months, unchanged after adjustment for age, sacral fracture, and fracture displacement. Median pain score dropped significantly in both groups with no group differences. Both CSPPS and TUG improved in the teriparatide group, whereas there was no improvement in the placebo group (group difference p<0.03 for CSPPS at 2 and 3 months). Conclusion: In this small randomized, blinded study, there was no improvement in radiographic healing (CT at 3 months) or pain with TPTD vs placebo, however, there was improved physical performance in TPTD-treated subjects that was not evident in the placebo group

A constructive study of the module structure of rings of partial differential operators

The purpose of this paper is to develop constructive versions of Stafford's theorems on the module structure of Weyl algebras A n (k) (i.e., the rings of partial differential operators with polynomial coefficients) over a base field k of characteristic zero. More generally, based on results of Stafford and Coutinho-Holland, we develop constructive versions of Stafford's theorems for very simple domains D. The algorithmization is based on the fact that certain inhomogeneous quadratic equations admit solutions in a very simple domain. We show how to explicitly compute a unimodular element of a finitely generated left D-module of rank at least two. This result is used to constructively decompose any finitely generated left D-module into a direct sum of a free left D-module and a left D-module of rank at most one. If the latter is torsion-free, then we explicitly show that it is isomorphic to a left ideal of D which can be generated by two elements. Then, we give an algorithm which reduces the number of generators of a finitely presented left D-module with module of relations of rank at least two. In particular, any finitely generated torsion left D-module can be generated by two elements and is the homomorphic image of a projective ideal whose construction is explicitly given. Moreover, a non-torsion but non-free left D-module of rank r can be generated by r+1 elements but no fewer. These results are implemented in the Stafford package for D=A n (k) and their system-theoretical interpretations are given within a D-module approach. Finally, we prove that the above results also hold for the ring of ordinary differential operators with either formal power series or locally convergent power series coefficients and, using a result of Caro-Levcovitz, also for the ring of partial differential operators with coefficients in the field of fractions of the ring of formal power series or of the ring of locally convergent power series. © 2014 Springer Science+Business Media

Embedding in Switching Classes with Skew Gains

In the context of graph transformation we look at the operation of switching, which can be viewed as an elegant method for realizing global transformations of (group-labelled) graphs through local transformations of the vertices