Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

Background: Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. Methods: We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. Findings: We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18–1·30, p=0·010). Interpretation: Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.måsjekke

Design of a Spherical Fuel Element for a Gas Cooled Fast Reactor

A study is done to develop a fuel cycle for a Gas Cooled Fast Reactor (GCFR). The design goals are: highly efficient use of (depleted) uranium, application of Pu recycled from LWR discharge as fissile material, high temperature output, and simplicity of design. The design focuses on spherical TRISO-like fuel elements, a homogeneous core at startup, providing for easy fuel fabrication, and self-breeding capability with a flat keff with burnup. Nitride fuel (15N > 99%) has been selected because of it's favourable thermal conductivity, high Heavy Metal density and compatability with PUREX reprocessing. Two core concepts have been studied: one with coated particles embedded inside fuel pebbles, and one with coated particles cooled directly by helium. The result is that a flat keff can be achieved for a long period of time, using coated particles cooled directly, with a homogeneous core at startup, with a closed fuel cycle and a simple refueling and reprocessing scheme

Scaling of Aharonov-Bohm couplings and the dynamical vacuum in gauge theories

Recent results on the vacuum polarization induced by a thin string of magnetic flux lead us to suggest an analogue of the Copenhagen `flux spaghetti' QCD vacuum as a possible mechanism for avoiding the divergence of perturbative QED, thus permitting consistent completion of the full, nonperturbative theory. The mechanism appears to operate for spinor, but not scalar, QED.Comment: 11 pages, ITP-SB-92-40, (major conceptual evolution from original

Lattice calculations for A=3,4,6,12 nuclei using chiral effective field theory

We present lattice calculations for the ground state energies of tritium, helium-3, helium-4, lithium-6, and carbon-12 nuclei. Our results were previously summarized in a letter publication. This paper provides full details of the calculations. We include isospin-breaking, Coulomb effects, and interactions up to next-to-next-to-leading order in chiral effective field theory.Comment: 38 pages, 11 figures, final publication versio

Spin 3/23/2 Interacting Fields and Heavy Baryon Chiral Perturbation Theory

We analyze the consistency of the Chiral Lagrangian approach to the description of the spin 3/2 interacting theory. We argue that to lowest order in the 1/m expansion, the formalism leads to the appropriated constraints and the theory is free of the so called ``off shell" ambiguities.Comment: 12 pages, Late

Nernst Effect of stripe ordering La1.8−x_{1.8-x}Eu0.2_{0.2}Srx_xCuO4_4

We investigate the transport properties of La$_{1.8-x}$Eu$_{0.2}$Sr$_x$CuO$_4$ ($x=0.04$, 0.08, 0.125, 0.15, 0.2) with a special focus on the Nernst effect in the normal state. Various anomalous features are present in the data. For $x=0.125$ and 0.15 a kink-like anomaly is present in the vicinity of the onset of charge stripe order in the LTT phase, suggestive of enhanced positive quasiparticle Nernst response in the stripe ordered phase. At higher temperature, all doping levels except $x=0.2$ exhibit a further kink anomaly in the LTO phase which cannot unambiguously be related to stripe order. Moreover, a direct comparison between the Nernst coefficients of stripe ordering La$_{1.8-x}$Eu$_{0.2}$Sr$_x$CuO$_4$ and superconducting La$_{2-x}$Sr$_x$CuO$_4$ at the doping levels $x=0.125$ and $x=0.15$ reveals only weak differences. Our findings make high demands on any scenario interpreting the Nernst response in hole-doped cuprates

Topological and geometrical restrictions, free-boundary problems and self-gravitating fluids

Let (P1) be certain elliptic free-boundary problem on a Riemannian manifold (M,g). In this paper we study the restrictions on the topology and geometry of the fibres (the level sets) of the solutions f to (P1). We give a technique based on certain remarkable property of the fibres (the analytic representation property) for going from the initial PDE to a global analytical characterization of the fibres (the equilibrium partition condition). We study this analytical characterization and obtain several topological and geometrical properties that the fibres of the solutions must possess, depending on the topology of M and the metric tensor g. We apply these results to the classical problem in physics of classifying the equilibrium shapes of both Newtonian and relativistic static self-gravitating fluids. We also suggest a relationship with the isometries of a Riemannian manifold.Comment: 36 pages. In this new version the analytic representation hypothesis is proved. Please address all correspondence to D. Peralta-Sala

Defective formation of IgA memory B cells, Th1 and Th17 cells in symptomatic patients with selective IgA deficiency

Objective: Selective IgA deficiency (sIgAD) is the most common primary immunodeficiency in Western countries. Patients can suffer from recurrent infections and autoimmune diseases because of a largely unknown aetiology. To increase insights into the pathophysiology of the disease, we studied memory B and T cells and cytokine concentrations in peripheral blood. Methods: We analysed 30 sIgAD patients (12 children, 18 adults) through detailed phenotyping of peripheral B-cell, CD8+ T-cell and CD4+ T-cell subsets, sequence analysis of IGA and IGG transcripts, in vitro B-cell activation and blood cytokine measurements. Results: All patients had significantly decreased numbers of T-cell-dependent (TD; CD27+) and T-cell-independent (TI; CD27−) IgA memory B cells and increased CD21low B-cell numbers. IgM+IgD− memory B cells were decreased in children and normal in adult patients. IGA and IGG transcripts contained normal SHM levels. In sIgAD children, IGA transcripts more frequently used IGA2 than controls (58.5% vs. 25.1%), but not in adult patients. B-cell activation after in vitro stimulation was normal. However, adult sIgAD patients exhibited increased blood levels of TGF-β1, BAFF and APRIL, whereas they had decreased Th1 and Th17 cell numbers. Conclusion: Impaired IgA memory formation in sIgAD patients is not due to a B-cell activation defect. Instead, decreased Th1 and Th17 cell numbers and high blood levels of BAFF, APRIL and TGF-β1 might reflect disturbed regulation of IgA responses in vivo. These insights into B-cell extrinsic immune defects suggest the need for a broader immunological focus on genomics and functional analyses to unravel the pathogenesis of sIgAD

Hamilton's Formalism for Systems with Constraints

The main goal of these lectures is to introduce and review the Hamiltonian formalism for classical constrained systems and in particular gauge theories. Emphasis is put on the relation between local symmetries and constraints and on the relation between Lagrangean and Hamiltonian symmetries.Comment: 52 pages, revised LATEX version, ETH-TH/93-48, Lectures given at the Seminar "The Canonical Formalism in Classical and Quantum General Relativity", Bad Honnef, September 9