Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture

Introduction: Iatrogenic patellar fracture is reported as a complication of patella procedures, such as medial patellofemoral ligament reconstruction, reconstruction of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and resurfacing the patella in total knee arthroplasty. Case Presentation: A 65-year-old lady with right patella fracture was treated with open reduction and cerclage wiring. An iatrogenic split fracture was noted during tension of the cerclage wire and was successfully managed by screw fixation of the split fracture. Conclusions: Split fracture is a rare complication of circumferential cerclage wiring of patellar fracture. The surgeon should be aware of the contributing factors in order to avoid this complication

AMPTE/CCE‐SCATHA simultaneous observations of substorm‐associated magnetic fluctuations

This study examines substorm-associated magnetic field fluctuations observed by the AMPTE/CCE and SCATHA satellites in the near-Earth tail. Three tail reconfiguration events are selected, one event on August 28, 1986, and two consecutive events on August 30, 1986. The fractal analysis was applied to magnetic field measurements of each satellite. The result indicates that (1) the amplitude of the fluctuation of the north-south magnetic component is larger, though not overwhelmingly, than the amplitudes of the other two components and (2) the magnetic fluctuations do have a characteristic timescale, which is several times the proton gyroperiod. In the examined events the satellite separation was less than 10 times the proton gyroradius. Nevertheless, the comparison between the AMPTE/CCE and SCATHA observations indicates that (3) there was a noticeable time delay between the onsets of the magnetic fluctuations at the two satellite positions, which is too long to ascribe to the propagation of a fast magnetosonic wave, and (4) the coherence of the magnetic fluctuations was low in the August 28, 1986, event and the fluctuations had different characteristic timescales in the first event of August 30, 1986, whereas some similarities can be found for the second event of August 30, 1986. Result 1 indicates that perturbation electric currents associated with the magnetic fluctuations tend to flow parallel to the tail current sheet and are presumably related to the reduction of the tail current intensity. Results 2 and 3 suggest that the excitation of the magnetic fluctuations and therefore the trigger of the tail current disruption is a kinetic process in which ions play an important role. It is inferred from results 3 and 4 that the characteristic spatial scale of the associated instability is of the order of the proton gyroradius or even shorter, and therefore the tail current disruption is described as a system of chaotic filamentary electric currents. However, result 4 suggests that the nature of the tail current disruption can vary from event to event

A current disruption mechanism in the neutral sheet for triggering substorm expansions

Two main areas were addressed in support of an effort to understand mechanism responsible for the broadband electrostatic noise (BEN) observed in the magnetotail. The first area concerns the generation of BEN in the boundary layer region of the magnetotail whereas the second area concerns the occassional presence of BEN in the neutral sheet region. For the generation of BEN in the boundary layer region, a hybrid simulation code was developed to perform reliable longtime, quiet, highly resolved simulations of field aligned electron and ion beam flow. The result of the simulation shows that broadband emissions cannot be generated by beam-plasma instability if realistic values of the ion beam parameters are used. The waves generated from beam-plasma instability are highly discrete and are of high frequencies. For the plasma sheet boundary layer condition, the wave frequencies are in the kHz range, which is incompatible with the observation that the peak power in BEN occur in the 10's of Hz range. It was found that the BEN characteristics are more consistent with lower hybrid drift instability. For the occasional presence of BEN in the neutral sheet region, a linear analysis of the kinetic cross-field streaming instability appropriate to the neutral sheet condition just prior to onset of substorm expansion was performed. By solving numerically the dispersion relation, it was found that the instability has a growth time comparable to the onset time scale of substorm onset. The excited waves have a mixed polarization in the lower hybrid frequency range. The imposed drift driving the instability corresponds to unmagnetized ions undergoing current sheet acceleration in the presence of a cross-tail electric field. The required electric field strength is in the 10 mV/m range which is well within the observed electric field values detected in the neutral sheet during substorms. This finding can potentially account for the disruption of cross-tail current and its diversion to the ionosphere to form the substorm current wedge. Furthermore, a number of features associated with substorm expansion onset can be understood based on this substorm onset scenario

Associations between touchscreen exposure and hot and cool inhibitory control in 10-month-old infants

Touchscreen use amongst young children has proliferated in recent years, yet little is known about the association between daily touchscreen exposure and inhibitory control in the first year of life. Previous research has found a negative association between the amount of television viewing and inhibitory control in early childhood, but it is unclear whether negative associations with screen use extend to touchscreens. The current study presents an exploratory analysis of the cross-sectional associations between inhibitory control and the amount of touchscreen use amongst 10-month-olds (n = 128–156). Touchscreen exposure was assessed via parent-report. In order to include a range of “hot” and “cool” aspects of inhibitory control, these skills were assessed using lab-based response inhibition and prohibition tasks as well as parent-reported observations of infants’ inhibitory control abilities and broader regulatory behaviors. A “Cognitive Executive Function (EEFQ-CEF)” score (encompassing Inhibitory Control, Flexibility, and Working Memory items) was included as a secondary broader executive function construct to examine whether effects showed specificity to inhibitory control rather than executive functions more generally. Correlation analyses indicated no association between touchscreen exposure and the four indices of IC. However, a positive association was found for the amount of touchscreen exposure and EEFQ-CEF once accounting for sociodemographic variables. The implications of these findings and future directions are discussed

Modeling High Stress Drops, Scaling, Interaction, and Irregularity of Repeating Earthquake Sequences Near Parkfield

Repeating earthquake sequences have been actively investigated to clarify many aspects of earthquake physics. The two particularly well‐studied sequences, known as the Los Angeles and San Francisco repeaters, have several intriguing observations, including their long (for the seismic moment) recurrence times that would suggest stress drops of 300 MPa based on typical assumptions, near‐syncronized timing prior to 2004, and higher than typical inferred stress drops (of 25 to 65 MPa, up to 90 MPa locally), but not as high as the recurrence times suggest. Here we show that all these observations are self‐consistent, in the sense that they can be reproduced in a single fault model. The suitable models build on the standard rate‐and‐state fault models, with velocity‐weakening patches imbedded into a velocity‐strengthening region, by adding either enhanced dynamic weakening during seismic slip or elevated normal stress on the patches, or both, to allow for the higher stress drops. Such models are able to match the observed average properties of the San Francisco and Los Angeles repeaters, as well as the overall nontrivial scaling between the recurrence time and seismic moment exhibited by many repeating sequences as a whole, for reasonable parameter choices based on experiments and theoretical studies. These models are characterized by the occurrence of substantial and variable aseismic slip at the locations of the repeating sources, which explains their atypical relation between recurrence interval and seismic moment, induces variability in the repeating source properties as observed, and results in their neither slip‐ nor time‐predictable behavior

The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review

Purpose The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. Methods A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. Results Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. Conclusion In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. Level of Evidence II

Probing ultrafast carrier dynamics and nonlinear absorption and refraction in core-shell silicon nanowires

We investigate the relaxation dynamics of photogenerated carriers in silicon nanowires consisting of a crystalline core and a surrounding amorphous shell, using femtosecond time-resolved differential reflectivity and transmission spectroscopy at photon energies of 3.15 eV and 1.57 eV. The complex behavior of the differential transmission and reflectivity transients is the mixed contributions from the crystalline core and the amorphous silicon on the nanowire surface and the substrate where competing effects of state filling and photoinduced absorption govern the carrier dynamics. Faster relaxation rates are observed on increasing the photo-generated carrier density. Independent experimental results on crystalline silicon-on-sapphire help us in separating the contributions from the carrier dynamics in crystalline core and the amorphous regions in the nanowire samples. Further, single beam z-scan nonlinear transmission experiments at 1.57 eV in both open and close aperture configurations yield two-photon absorption coefficient \$beta$ (~3 cm/GW) and nonlinear refraction coefficient \$gamma$ (-2.5x10^-4 cm2/GW).Comment: 6 pages, 6 figure