Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The tragedy of American diplomacy? Rethinking the Marshall Plan

Two British scholars reassess what they view as the decisive episode in the early Cold War, the Marshall Plan. Far from seeing the Plan as a mere act of generosity by the United States, they argue that it was an integral part of an increasingly aggressive U.S. posture toward the Soviet Union. The Soviet Union was still seeking a cooperative relationship with the United States, but the U.S. decision to establish a European Recovery Program (ERP) without a sincere intention of including the Soviet Union posed a threat to Soviet security interests. Josif Stalin wanted to prevent the United States from luring the East European countries away from the Soviet Union's sphere of influence and into the Western sphere. Although Stalin was reluctant to abandon his bid for close cooperation with the West, the Marshall Plan left him with little choice. As the ERP progressed, Stalin drastically tightened his hold over Eastern Europe and imposed Soviet-style systems on the countries in the region. The Marshall Plan thus had the "tragic" effect of creating a long-term divide in Europe that consigned tens of millions of people to life under tyranny

Bat-Associated Leptospirosis

Leptospirosis is a globally prevalent disease that affects humans, causing systemic illness that may lead to multi-organ involvement. Clinical signs include sudden fever, general malaise, muscular pain, conjunctival suffusion, and jaundice. Disease is caused by pathogenic bacteria including over 200 serologic variants. Most serologic variants have primary reservoirs in wild mammals, which continually infect and colonize domesticated animals. The organism has been recovered from rats, swine, dogs, cattle, and other animals, notably bats. Most studies have focused on domestic animals as reservoir hosts; however, because of their abundance, spatial distribution, and interrelationship with domestic animals, bats are becoming an epidemiologically significant source of leptospires. We present a case of serologically confirmed leptospirosis after bat exposure to add to the growing literature of bats as a possible source of transmission. Recognition of the common presentation of leptospirosis and Weil’s disease, and identification of animal vectors, including bats, allows for the selection of appropriate antibiotic management to aid in resolution of symptomotology