Symptomatic plate removal after treatment of facial fractures

Aims: To identify the rates and reasons for plate removal (PR) among patients treated for facial fractures. Materials and methods: A retrospective review of files of 238 patients. Results: Forty-eight patients (20.2%) had plates removed. The reason for removal was objective in 33.3% and subjective in 29.2%. The most common subjective reason was cold sensitivity, and the most common objective reason was wound dehiscence/infection. Women had PR for subjective reasons more often than men (p = 0.018). Removal was performed more often for subjective reasons after zygomatico-orbital fractures than after mandibular fractures (p = 0.002). Plates inserted in the mandible from an intraoral approach were removed more frequently than extraorally inserted mandibular plates, intraorally inserted maxillary plates, and extraorally inserted plates in other locations (p < 0.001). Orbital rim plates had a higher risk of being removed than maxillary or frontal bone plates (p = 0.02). Conclusions: Subjective discomfort is a notable reason for PR among Finnish patients, suggesting that the cold climate has an influence on the need for removal. Patients receiving mandibular osteosynthesis with miniplates from an intraoral approach are at risk of hardware removal because of wound dehiscence/infection and loose/broken hardware, reminding us that more rigid fixation devices should not be forgotten despite the widespread use of miniplates. (C) 2010 European Association for Cranio-Maxillo-Facial Surger

Blunt cerebrovascular injuries in the craniofacial fracture population - Are we screening the right patients?

Current knowledge of blunt cerebrovascular injuries (BCVIs) in craniomaxillofacial fracture (CMF) patients is limited. The purpose of this study was to determine the occurrence of BCVIs in patients with all types of CMF. This retrospective study included CMF patients in a level 1 trauma centre during a 3-year period. Patients who were not imaged with computed tomography angiography and patients with mechanisms other than blunt injury were excluded. The primary outcome variable was BCVI. A total of 753 patients were included in the analysis. A BCVI was detected in 4.4% of the patients screened. BCVIs occurred in 8.7% of cranial fracture patients, 7.1% of combined craniofacial fracture patients, and 3.1% of facial fracture patients. The risk of BCVI was significantly increased in patients with isolated cranial fractures (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.18?5.50; P = 0.017), those involved in motor vehicle accidents (OR 3.42, 95% CI 1.63?7.17; P = 0.001), and those sustaining high-energy injuries (OR 3.17, 95% CI 1.57?6.40; P = 0.001). BCVIs in CMF patients are relatively common in highenergy injuries. However, these injuries also occur in minor traumas. Imaging thresholds should be kept low in this patient population when BCVIs are suspected.Peer reviewe

Ammonia as a tracer of chemical equilibrium in the T7.5 dwarf Gliese 570D

We present the first analysis of an optical to mid-infrared spectrum of the T7.5 dwarf Gliese 570D with model atmospheres, synthetic spectra, and brown dwarf evolution sequences. We obtain precise values for the basic parameters of Gl 570D: Teff=800 - 820K, log g (cm/s^2)=5.09 - 5.23, and log L/Lsun= -5.525 to -5.551. The Spitzer IRS spectrum shows prominent features of ammonia (NH3) that can only be fitted by reducing the abundance of NH3 by about one order of magnitude from the value obtained with chemical equilibrium models. We model departures from chemical equilibrium in the atmosphere of Gl 570D by considering the kinetics of nitrogen and carbon chemistry in the presence of vertical mixing. The resulting model spectrum reproduces the data very well.Comment: Accepted for publication in the ApJ. 10 pages, including 3 figure

Cervical spine injuries in facial fracture patients - injury mechanism and fracture type matter

Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries (CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the incidence rates of specific facial fracture types as well as other important variables and their relationship with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type, were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%. Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI 1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI 1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries, clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for sustaining CSIs also. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature

Confidence levels and likelihood terms in IPCC reports : a survey of experts from different scientific disciplines

Scientific assessments, such as those by the Intergovernmental Panel on Climate Change (IPCC), inform policymakers and the public about the state of scientific evidence and related uncertainties. We studied how experts from different scientific disciplines who were authors of IPCC reports, interpret the uncertainty language recommended in the Guidance Note for Lead Authors of the IPCC Fifth Assessment Report on Consistent Treatment of Uncertainties. This IPCC guidance note discusses how to use confidence levels to describe the quality of evidence and scientific agreement, as well likelihood terms to describe the probability intervals associated with climate variables. We find that (1) physical science experts were more familiar with the IPCC guidance note than other experts, and they followed it more often; (2) experts' confidence levels increased more with perceptions of evidence than with agreement; (3) experts' estimated probability intervals for climate variables were wider when likelihood terms were presented with "medium confidence" rather than with "high confidence" and when seen in context of IPCC sentences rather than out of context, and were only partly in agreement with the IPCC guidance note. Our findings inform recommendations for communications about scientific evidence, assessments, and related uncertainties.Peer reviewe

Detailed Analysis of Nearby Bulgelike Dwarf Stars III. Alpha and Heavy-element abundances

The present sample of nearby bulgelike dwarf stars has kinematics and metallicities characteristic of a probable inner disk or bulge origin. Ages derived by using isochrones give 10-11 Gyr for these stars and metallicities are in the range -0.80< [Fe/H]< +0.40. We calculate stellar parameters from spectroscopic data, and chemical abundances of Mg, Si, Ca, Ti, La, Ba, Y, Zr and Eu are derived by using spectrum synthesis. We found that [alpha-elements/Fe] show different patterns depending on the element. Si, Ca and Ti-to-iron ratios decline smoothly for increasing metallicities, and follow essentially the disk pattern. O and Mg, products of massive supernovae, and also the r-process element Eu, are overabundant relative to disk stars, showing a steeper decline for metallicities [Fe/H] > -0.3 dex. [s-elements/Fe] roughly track the solar values with no apparent trend with metallicity for [Fe/H] < 0, showing subsolar values for the metal rich stars. Both kinematical and chemical properties of the bulgelike stars indicate a distinct identity of this population when compared to disk stars.Comment: 21 pages, 9 figures, to appear in Ap

Poroelastic Modelling of CSF circulation via the incorporation of experimentally derived microscale water transport properties

We outline how multicompartmental poroelasticity is applied to the study of dementia. We utilize a 3D version of our poroelastic code to investigate the effects within parenchymal tissue. This system is coupled with multiple pipelines within the VPH-DARE@IT project which account for patient/subject-specific boundary conditions in the arterial compartment, in addition to both an image segmentation-mesh and integrated cardiovascular system model pipeline respectively. This consolidated template allows for the extraction of boundary conditions to run CFD simulations for the ventricles. Finally, we outline some experimental results that will help inform the MPET system

Linear instability criteria for ideal fluid flows subject to two subclasses of perturbations

In this paper we examine the linear stability of equilibrium solutions to incompressible Euler's equation in 2- and 3-dimensions. The space of perturbations is split into two classes - those that preserve the topology of vortex lines and those in the corresponding factor space. This classification of perturbations arises naturally from the geometric structure of hydrodynamics; our first class of perturbations is the tangent space to the co-adjoint orbit. Instability criteria for equilibrium solutions are established in the form of lower bounds for the essential spectral radius of the linear evolution operator restricted to each class of perturbation.Comment: 29 page

Elemental Abundance Ratios in Stars of the Outer Galactic Disk. II. Field Red Giants

We summarize a selection process to identify red giants in the direction of the southern warp of the Galactic disk, employing VI_C photometry and multi-object spectroscopy. We also present results from follow-up high-resolution, high-S/N echelle spectroscopy of three field red giants, finding [Fe/H] values of about -0.5. The field stars, with Galactocentric distances estimated at 10 to 15 kpc, support the conclusion of Yong, Carney, & de Almeida (2005) that the Galactic metallicity gradient disappears beyond R_GC values of 10 to 12 kpc for the older stars and clusters of the outer disk. The field and cluster stars at such large distances show very similar abundance patterns, and, in particular, all show enhancements of the "alpha" elements O, Mg, Si, Ca, and Ti and the r-process element Eu. These results suggest that Type II supernovae have been significant contributors to star formation in the outer disk relative to Type Ia supernovae within the past few Gyrs. We also compare our results with those available for much younger objects. The limited results for the H II regions and B stars in the outer disk also suggest that the radial metallicity gradient in the outer disk is shallow or absent. The much more extensive results for Cepheids confirm these trends, and that the change in slope of the metallicity gradient may occur at a larger Galactocentric distance than for the older stars and clusters. However, the younger stars also show rising alpha element enhancements with increasing R_GC, at least beyond 12 kpc. These trends are consistent with the idea of a progressive growth in the size of the Galactic disk with time, and episodic enrichment by Type II supernovae as part of the disk's growth. [Abridged]Comment: Accepted for publication in A