Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures.

OBJECTIVE: To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray. DESIGN: Multicentre randomised controlled trial. SETTING: Emergency departments in eight UK hospitals. PARTICIPANTS: Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb. MAIN OUTCOME MEASURES: Patients' reported pain using the Wong Baker face pain scale, ratings of reaction to treatment of the patients and acceptability of treatment by staff and parents, and adverse events. RESULTS: 404 eligible patients completed the trial (204 patients given nasal diamorphine spray and 200 given intramuscular morphine). Onset of pain relief was faster in the spray group than in the intramuscular group, with lower pain scores in the spray group at 5, 10, and 20 minutes after treatment but no difference between the groups after 30 minutes. 80% of patients given the spray showed no obvious discomfort compared with 9% given intramuscular morphine (difference 71%, 95% confidence interval 65% to 78%). Treatment administration was judged acceptable by staff and parents, respectively, for 98% (199 of 203) and 97% (186 of 192) of patients in the spray group compared with 32% (64 of 199) and 72% (142 of 197) in the intramuscular group. No serious adverse events occurred in the spray group, and the frequencies of all adverse events were similar in both groups (spray 24.1% v intramuscular morphine 18.5%; difference 5.6%, -2.3% to 13.6%). CONCLUSION: Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures. The diamorphine spray should be used in place of intramuscular morphine

The Role of Texture, Cracks, and Fractures in Highly Anisotropic Shales

Organic shales generally have low permeability unless fractures are present. However, how gas, oil, and water flows into these fractures remains enigmatic. The alignment of clay minerals and the alignment of fractures and cracks are effective means to produce seismic anisotropy. Thus, the detection and characterization of this anisotropy can be used to infer details about lithology, rock fabric, and fracture and crack properties within the subsurface. We present a study characterizing anisotropy using S wave splitting from microseismic sources in a highly anisotropic shale. We observe very strong anisotropy (up to 30%) with predominantly VTI (vertical transverse isotropy) symmetry, but with evidence of an HTI (horizontal transverse isotropy) overprint due to a NE striking vertical fracture set parallel to the maximum horizontal compressive stress. We observe clear evidence of a shear wave triplication due to anisotropy, which to our knowledge is one of only a very few observations of such triplications in field‐scale data. We use modal proportions of minerals derived from X‐ray fluorescence data combined with realistic textures to estimate the contribution of intrinsic anisotropy as well as possible contributions of horizontally aligned cracks. We find that aligned clays can explain much of the observed anisotropy and that any cracks contributing to the vertical transverse isotropy (VTI) must have a low ratio of normal to tangential compliance (ZN/ZT), typical of isolated cracks with low hydraulic connectivity. Subhorizontal cracks have also been observed in the reservoir, and we propose that their reactivation during hydraulic fracturing may be an important mechanism to facilitate gas flow

Water, oceanic fracture zones and the lubrication of subducting plate boundaries - insights from seismicity

We investigate the relationship between subduction processes and related seismicity for the Lesser Antilles Arc using the Gutenberg-Richter law. This power lawdescribes the earthquakemagnitude distribution, with the gradient of the cumulative magnitude distribution being commonly known as the b-value. The Lesser Antilles Arc was chosen because of its alongstrike variability in sediment subduction and the transition from subduction to strike-slip movement towards its northern and southern ends. The data are derived from the seismicity catalogues from the Seismic Research Centre of The University of the West Indies and the Observatoires Volcanologiques et Sismologiques of the Institut de Physique du Globe de Paris and consist of subcrustal events primarily from the slab interface. The b-value is found using a Kolmogorov-Smirnov test for a maximum-likelihood straight line-fitting routine. We investigate spatial variations in b-values using a grid-search with circular cells as well as an along-arc projection. Tests with different algorithms and the two independent earthquake cataloges provide confidence in the robustness of our results. We observe a strong spatial variability of the b-value that cannot be explained by the uncertainties. Rather than obtaining a simple north-south b-value distribution suggestive of the dominant control on earthquake triggering being water released from the sedimentary cover on the incoming American Plates, or a b-value distribution that correlates with on the obliquity of subduction, we obtain a series of discrete, high b-value 'bull's-eyes' along strike. These bull's-eyes, which indicate stress release through a higher fraction of small earthquakes, coincide with the locations of known incoming oceanic fracture zones on the American Plates. We interpret the results in terms of water being delivered to the Lesser Antilles subduction zone in the vicinity of fracture zones providing lubrication and thus changing the character of the related seismicity. Our results suggest serpentinization around mid-ocean ridge transform faults, which go on to become fracture zones on the incoming plate, plays a significant role in the delivery of water into the mantle at subduction zones

The Coupled Magmatic and Hydrothermal Systems of the Restless Aluto Caldera, Ethiopia

Seismicity can be used to better understand interactions between magma bodies, hydrothermal systems and their host rocks—key factors influencing volcanic unrest. Here, we use earthquake data to image, for the first time, the seismic velocity structure beneath Aluto, a deforming volcano in the Main Ethiopian Rift. Traveltime tomography is used to jointly relocate seismicity and image 3D P- and S-wave velocity structures and the ratio between them (VP/VS). At depths of 4–9 km, the seismicity maps the top of a large low velocity zone with high VP/VS, which we interpret as a more ductile and melt-bearing region. A shallow (<3 km) hydrothermal system exhibits low seismic velocities and very low VP/VS (∼1.40), consistent with the presence of gases exsolved from a deeper melt-rich mush body. The Artu Jawe fault and fracture system provides the migration pathway that connects the deeper mush body with the shallow hydrothermal system. Together, these observations demonstrate that the interaction between magmatic and hydrothermal systems, driven by the exchange of fluids, is responsible for the restless behavior of Aluto

The impact of partially missing communities~on the reliability of centrality measures

Network data is usually not error-free, and the absence of some nodes is a very common type of measurement error. Studies have shown that the reliability of centrality measures is severely affected by missing nodes. This paper investigates the reliability of centrality measures when missing nodes are likely to belong to the same community. We study the behavior of five commonly used centrality measures in uniform and scale-free networks in various error scenarios. We find that centrality measures are generally more reliable when missing nodes are likely to belong to the same community than in cases in which nodes are missing uniformly at random. In scale-free networks, the betweenness centrality becomes, however, less reliable when missing nodes are more likely to belong to the same community. Moreover, centrality measures in scale-free networks are more reliable in networks with stronger community structure. In contrast, we do not observe this effect for uniform networks. Our observations suggest that the impact of missing nodes on the reliability of centrality measures might not be as severe as the literature suggests

Development of anisotropic structure in the Earth's lower mantle by solid-state convection

Seismological observations reveal highly anisotropic patches at the bottom of the Earth's lower mantle, whereas the bulk of the mantle has been observed to be largely isotropic(1-4). These patches have been interpreted to correspond to areas where subduction has taken place in the past or to areas where mantle plumes are upwelling, but the underlying cause for the anisotropy is unknown-both shape-preferred orientation of elastically heterogenous materials(5) and lattice-preferred orientation of a homogeneous material(6-8) have been proposed. Both of these mechanisms imply that large-strain deformation occurs within the anisotropic regions, but the geodynamic implications of the mechanisms differ. Shape-preferred orientation would imply the presence of large elastic (and hence chemical) heterogeneity whereas lattice-preferred orientation requires deformation at high stresses. Here we show, on the basis of numerical modelling incorporating mineral physics of elasticity and development of lattice-preferred orientation, that slab deformation in the deep lower mantle can account for the presence of strong anisotropy in the circum-Pacific region. In this model-where development of the mineral fabric (the alignment of mineral grains) is caused solely by solid-state deformation of chemically homogeneous mantle material-anisotropy is caused by large-strain deformation at high stresses, due to the collision of subducted slabs with the core-mantle boundary.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62804/1/416310a.pd

Tidal triggering of microseismicity at the equatorial mid‐Atlantic ridge, inferred from the PI‐LAB experiment

The gravitational pulls from the moon and the sun result in tidal forces which influence both Earth's solid and water mass. These stresses are periodically added to the tectonic ones and may become sufficient for initiating rupture in fault systems critically close to failure. Previous research indicates correlations between increased seismicity rates and low tides for fast- and intermediate-spreading mid-ocean ridges in the Pacific Ocean. Here, we present a microseismicity data set (4,719 events) recorded by an ocean bottom seismometer deployment at the equatorial Mid-Atlantic Ridge. We show that low, as well as decreasing ocean water level, result in relatively elevated seismicity rates at higher magnitudes (lower b-values), translated into increased probabilities of stronger event occurrence at or towards low tides. Moreover, seismic bursts (enhanced activity rate clusters), occurring at rates well above the reference seismicity, are exclusively present during values of either high tidally induced extensional stresses or high extensional stress rates. Although the b-value differences are not significant enough to be conclusive, the seismicity rate variations exhibit statistical significance, supporting the previous findings for tidal triggering at low tides within normal-faulting regimes and extending the range of observations to slow-spreading ridges. Observed triggering of slip on low angle faults at low tides is predicted by Coulomb stress modeling. The triggering of slip on high angle faults observed here, is not easily explained without another factor. It may be related to the presence of a shallow magma body beneath the ridge, as supported by previous seismic imaging in the region

A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women

Background: A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods: A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results: Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion: Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment

Mesoscopic structure and social aspects of human mobility

The individual movements of large numbers of people are important in many contexts, from urban planning to disease spreading. Datasets that capture human mobility are now available and many interesting features have been discovered, including the ultra-slow spatial growth of individual mobility. However, the detailed substructures and spatiotemporal flows of mobility - the sets and sequences of visited locations - have not been well studied. We show that individual mobility is dominated by small groups of frequently visited, dynamically close locations, forming primary "habitats" capturing typical daily activity, along with subsidiary habitats representing additional travel. These habitats do not correspond to typical contexts such as home or work. The temporal evolution of mobility within habitats, which constitutes most motion, is universal across habitats and exhibits scaling patterns both distinct from all previous observations and unpredicted by current models. The delay to enter subsidiary habitats is a primary factor in the spatiotemporal growth of human travel. Interestingly, habitats correlate with non-mobility dynamics such as communication activity, implying that habitats may influence processes such as information spreading and revealing new connections between human mobility and social networks.Comment: 7 pages, 5 figures (main text); 11 pages, 9 figures, 1 table (supporting information