Ageism in Consent? In a decision-making capable geriatric orthopaedic trauma patient population, does increased age impact who physicians consent for surgical fixation?

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent. Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in a pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment. Data was analyzed via chi-squared and t-test analysis in SPSS. Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. 27 (9.8%) decision-making capable patients had HCPs consent for surgery. 20 of the 27 (74.1%) were 80 years of age or older and 7 patients between 70 and 79 had HCP consent. (p=0.07). HCP consent was significant for age (p\u3c0.001), income level (p=0.03), and HCP physically present at consult (p\u3c0.001). Additionally, language other than English was found to be a significant predictor of HCP consent (p=0.035). Conclusion: It is concerning that cognitively intact geriatric orthopaedic trauma patients are not always consented for their own surgical procedures. Factors including age, income, and language contribute to increased risk of HCP consent. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients’ consenting capacity

Transitions among crystal, glass, and liquid in a binary mixture with changing particle size ratio and temperature

Using molecular dynamics simulation we examine changeovers among crystal, glass, and liquid at high density in a two dimensional binary mixture. We change the ratio between the diameters of the two components and the temperature. The transitions from crystal to glass or liquid occur with proliferation of defects. We visualize the defects in terms of a disorder variable "D_j(t)" representing a deviation from the hexagonal order for particle j. The defect structures are heterogeneous and are particularly extended in polycrystal states. They look similar at the crystal-glass crossover and at the melting. Taking the average of "D_j(t)" over the particles, we define a disorder parameter "D(t)", which conveniently measures the degree of overall disorder. Its relaxation after quenching becomes slow at low temperature in the presence of size dispersity. Its steady state average is small in crystal and large in glass and liquid.Comment: 7 pages, 10 figure

Can group-based strategies increase community resilience? Longitudinal predictors of sustained participation in Covid-19 mutual aid and community support groups

Mutual aid groups have been a critical part of the coronavirus disease-2019 (Covid-19) response and continue to address the needs of people in their communities. To understand how mutual aid and similar community support groups can be sustained over time, we test the idea that using group-based strategies initiates psychological trajectories that shape future participation. We conducted a preregistered longitudinal survey among Covid-19 mutual aid and community support volunteers in the United Kingdom (nWave 1 = 600, May 2021; nWave 2 = 299, July–August 2021) who were registered panelists of an independent research organization. Assessments included measures of group-based strategies, collective participation predictors, participation experience, and sustained participation. Volunteers engaged in a wide range of support activities including shopping, emotional support provision, and deliveries. Two group-based strategies—group alliances and group horizontality—longitudinally predicted sustained participation. In addition, sense of community responsibility and burnout were longitudinal predictors of sustained participation. Importantly, predictors of sustained participation diverged for volunteers with different levels of volunteering experience. Our findings highlight group-based strategies as a potential resource for organizers seeking to sustain participation. Use can be tailored depending on the profiles of individual Covid-19 mutual aid volunteers. These findings have significance beyond Covid-19 as they are relevant to sustaining community resilience more generally

O-GlcNAcylation and Regulation of Galectin-3 in Extraembryonic Endoderm Differentiation

The regulation of proteins through the addition and removal of O-linked β-N-acetylglucosamine (O-GlcNAc) plays a role in many signaling events, specifically in stem cell pluripo-tency and the regulation of differentiation. However, these post-translational modifications have not been explored in extraembryonic endoderm (XEN) differentiation. Of the plethora of proteins regulated through O-GlcNAc, we explored galectin-3 as a candidate protein known to have various intracellular and extracellular functions. Based on other studies, we predicted a reduction in global O-GlcNAcylation levels and a distinct galectin expression profile in XEN cells relative to embryonic stem (ES) cells. By conducting dot blot analysis, XEN cells had decreased levels of global O-GlcNAc than ES cells, which reflected a disbalance in the expression of genes encoding O-GlcNAc cycle enzymes. Immunoassays (Western blot and ELISA) revealed that although XEN cells (low O-GlcNAc) had lower concentrations of both intracellular and extracellular galectin-3 than ES cells (high O-GlcNAc), the relative secretion of galectin-3 was significantly increased by XEN cells. Inducing ES cells toward XEN in the presence of an O-GlcNAcase inhibitor was not sufficient to inhibit XEN differentiation. However, global O-GlcNAcylation was found to decrease in differentiated cells and the extracellular localization of galectin-3 accompanies these changes. Inhibiting global O-GlcNAcylation status does not, however, impact pluripotency and the ability of ES cells to differentiate to the XEN lineage

Ferrofluids as thermal ratchets

Colloidal suspensions of ferromagnetic nano-particles, so-called ferrofluids, are shown to be suitable systems to demonstrate and investigate thermal ratchet behavior: By rectifying thermal fluctuations, angular momentum is transferred to a resting ferrofluid from an oscillating magnetic field without net rotating component. Via viscous coupling the noise driven rotation of the microscopic ferromagnetic grains is transmitted to the carrier liquid to yield a macroscopic torque. For a simple setup we analyze the rotation of the ferrofluid theoretically and show that the results are compatible with the outcome of a simple demonstration experiment.Comment: 4 pages, 3 figures, corrected version, improved figures, to be published in Phys. Rev. Let

GNAO1 encephalopathy: broadening the phenotype and evaluating treatment and outcome

OBJECTIVE: To describe better the motor phenotype, molecular genetic features, and clinical course of GNAO1-related disease. METHODS: We reviewed clinical information, video recordings, and neuroimaging of a newly identified cohort of 7 patients with de novo missense and splice site GNAO1 mutations, detected by next-generation sequencing techniques. RESULTS: Patients first presented in early childhood (median age of presentation 10 months, range 0-48 months), with a wide range of clinical symptoms ranging from severe motor and cognitive impairment with marked choreoathetosis, self-injurious behavior, and epileptic encephalopathy to a milder phenotype, featuring moderate developmental delay associated with complex stereotypies, mainly facial dyskinesia and mild epilepsy. Hyperkinetic movements were often exacerbated by specific triggers, such as voluntary movement, intercurrent illnesses, emotion, and high ambient temperature, leading to hospital admissions. Most patients were resistant to drug intervention, although tetrabenazine was effective in partially controlling dyskinesia for 2/7 patients. Emergency deep brain stimulation (DBS) was life saving in 1 patient, resulting in immediate clinical benefit with complete cessation of violent hyperkinetic movements. Five patients had well-controlled epilepsy and 1 had drug-resistant seizures. Structural brain abnormalities, including mild cerebral atrophy and corpus callosum dysgenesis, were evident in 5 patients. One patient had a diffuse astrocytoma (WHO grade II), surgically removed at age 16. CONCLUSIONS: Our findings support the causative role of GNAO1 mutations in an expanded spectrum of early-onset epilepsy and movement disorders, frequently exacerbated by specific triggers and at times associated with self-injurious behavior. Tetrabenazine and DBS were the most useful treatments for dyskinesia

Dispersity-Driven Melting Transition in Two Dimensional Solids

We perform extensive simulations of $10^4$ Lennard-Jones particles to study the effect of particle size dispersity on the thermodynamic stability of two-dimensional solids. We find a novel phase diagram in the dispersity-density parameter space. We observe that for large values of the density there is a threshold value of the size dispersity above which the solid melts to a liquid along a line of first order phase transitions. For smaller values of density, our results are consistent with the presence of an intermediate hexatic phase. Further, these findings support the possibility of a multicritical point in the dispersity-density parameter space.Comment: In revtex format, 4 pages, 6 postscript figures. Submitted to PR

RARS2 mutations in a sibship with infantile spasms

Pontocerebellar hypoplasia is a group of heterogeneous neurodevelopmental disorders characterized by reduced volume of the brainstem and cerebellum. We report two male siblings who presented with early infantile clonic seizures, and then developed infantile spasms associated with prominent isolated cerebellar hypoplasia/atrophy on magnetic resonance imaging (MRI). Using whole exome sequencing techniques, both were found to be compound heterozygotes for one previously reported and one novel mutation in the gene encoding mitochondrial arginyl-tRNA synthetase 2 (RARS2). Mutations in this gene have been classically described in pontocerebellar hypoplasia type six (PCH6), a phenotype characterized by early (often intractable) seizures, profound developmental delay, and progressive pontocerebellar atrophy. The electroclinical spectrum of PCH6 is broad and includes a number of seizure types: myoclonic, generalized tonic-clonic, and focal clonic seizures. Our report expands the characterization of the PCH6 disease spectrum and presents infantile spasms as an associated electroclinical phenotype

Study of solid 4He in two dimensions. The issue of zero-point defects and study of confined crystal

Defects are believed to play a fundamental role in the supersolid state of 4He. We report on studies by exact Quantum Monte Carlo (QMC) simulations at zero temperature of the properties of solid 4He in presence of many vacancies, up to 30 in two dimensions (2D). In all studied cases the crystalline order is stable at least as long as the concentration of vacancies is below 2.5%. In the 2D system for a small number, n_v, of vacancies such defects can be identified in the crystalline lattice and are strongly correlated with an attractive interaction. On the contrary when n_v~10 vacancies in the relaxed system disappear and in their place one finds dislocations and a revival of the Bose-Einstein condensation. Thus, should zero-point motion defects be present in solid 4He, such defects would be dislocations and not vacancies, at least in 2D. In order to avoid using periodic boundary conditions we have studied the exact ground state of solid 4He confined in a circular region by an external potential. We find that defects tend to be localized in an interfacial region of width of about 15 A. Our computation allows to put as upper bound limit to zero--point defects the concentration 0.003 in the 2D system close to melting density.Comment: 17 pages, accepted for publication in J. Low Temp. Phys., Special Issue on Supersolid

Pediatric epilepsy surgery from 2000 to 2018: Changes in referral and surgical volumes, patient characteristics, genetic testing, and postsurgical outcomes

OBJECTIVE: Neurosurgery is a safe and effective form of treatment for select children with drug-resistant epilepsy. Still, there is concern that it remains underutilized, and that seizure freedom rates have not improved over time. We investigated referral and surgical practices, patient characteristics, and postoperative outcomes over the past two decades. METHODS: We performed a retrospective cohort study of children referred for epilepsy surgery at a tertiary center between 2000 and 2018. We extracted information from medical records and analyzed temporal trends using regression analyses. RESULTS: A total of 1443 children were evaluated for surgery. Of these, 859 (402 females) underwent surgical resection or disconnection at a median age of 8.5 years (interquartile range [IQR] = 4.6-13.4). Excluding palliative procedures, 67% of patients were seizure-free and 15% were on no antiseizure medication (ASM) at 1-year follow-up. There was an annual increase in the number of referrals (7%, 95% confidence interval [CI] = 5.3-8.6; p < .001) and surgeries (4% [95% CI = 2.9-5.6], p < .001) over time. Duration of epilepsy and total number of different ASMs trialed from epilepsy onset to surgery were, however, unchanged, and continued to exceed guidelines. Seizure freedom rates were also unchanged overall but showed improvement (odds ratio [OR] 1.09, 95% CI = 1.01-1.18; p = .027) after adjustment for an observed increase in complex cases. Children who underwent surgery more recently were more likely to be off ASMs postoperatively (OR 1.04, 95% CI = 1.01-1.08; p = .013). There was a 17% annual increase (95% CI = 8.4-28.4, p < .001) in children identified to have a genetic cause of epilepsy, which was associated with poor outcome. SIGNIFICANCE: Children with drug-resistant epilepsy continue to be put forward for surgery late, despite national and international guidelines urging prompt referral. Seizure freedom rates have improved over the past decades, but only after adjustment for a concurrent increase in complex cases. Finally, genetic testing in epilepsy surgery patients has expanded considerably over time and shows promise in identifying patients in whom surgery is less likely to be successful