The Interaction Effect Between Previous Stroke and Hip Fracture on Postoperative Mortality:A Nationwide Cohort Study

PURPOSE: It remains uncertain how a history of stroke impacts the prognosis for patients with hip fracture. This study aimed to evaluate mortality following hip fracture surgery by comparing patients with and without a history of stroke. PATIENTS AND METHODS: All patients aged 65 years or above in Denmark receiving hip fracture surgery between 2010 and 2018. For every patient, 10 individuals from the general population without hip fracture were sampled. Comparators had a similar stroke history, age, and sex on the date of hip fracture surgery (index date). We established four cohorts: hip fracture patients with/without stroke and non-hip fracture patients with/without stroke. Outcomes were all-cause mortality at 0–30 days, 31–365 days and 1 to 5 years. Direct standardized mortality rates (MR) with 95% confidence intervals (CI) were computed. We calculated the interaction contrast to estimate excess absolute mortality among patients with both hip fracture and stroke. Through a Cox proportional hazards model, we estimated the hazard ratio (HR) and the attributable proportion as a measure of excess relative mortality attributable to interaction. RESULTS: Of the hip fracture patients, 8433 had a stroke history and 44,997 did not. Of the non-hip fracture patients, 84,330 had a stroke history and 449,962 did not. Corresponding 30-day MRs/100 person years were 148.4 (95% CI: 138.8–158.7), 124.3 (95% CI: 120.7–128.1), 14.3 (95% CI: 13.4–15.2) and 8.4 (95% CI: 8.1–8.7). The interaction contrast was 18.2 (95% CI: 7.5–28.8), and the attributable proportion was 9.0% (95% CI: 2.9–15.1). No interaction was present beyond 30 days. CONCLUSION: We observed excess short-term mortality in patients with stroke and hip fracture, but the effect disappeared at later follow-up periods. Clinicians are encouraged to pay rigorous attention to early complications among hip fracture patients with stroke, as this may serve as a way to reduce mortality

Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates

Objectives. Self-rated health (SRH) and associated risk and protective correlates were investigated among two indigenous adolescent populations, Greenlandic Inuit and Norwegian Sami. Design. Cross-sectional data were collected from ‘‘Well-being among Youth in Greenland’’ (WBYG) and ‘‘The Norwegian Arctic Adolescent Health Study’’ (NAAHS), conducted during 2003 2005 and comprising 10th and 11th graders, 378 Inuit and 350 Sami. Methods. SRH was assessed by one single item, using a 4-point and 5-point scale for NAAHS and WBYG, respectively. Logistic regressions were performed separately for each indigenous group using a dichotomous measure with ‘‘very good’’ (NAAHS) and ‘‘very good/good’’ (WBYG) as reference categories. We simultaneously controlled for various socio-demographics, risk correlates (drinking, smoking, violence and suicidal behaviour) and protective correlates (physical activity, well-being in school, number of close friends and adolescent parent relationship). Results. A majority of both Inuit (62%) and Sami (89%) youth reported ‘‘good’’ or ‘‘very good’’ SRH. The proportion of ‘‘poor/fair/not so good’’ SRH was three times higher among Inuit than Sami (38% vs. 11%, p50.001). Significantly more Inuit females than males reported ‘‘poor/fair’’SRH(44% vs. 29%, p50.05),while no gender differences occurred among Sami (12% vs. 9%, p50.08). In both indigenous groups, suicidal thoughts (risk) and physical activity (protective) were associated with poor and good SRH, respectively. Conclusions. In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer SRH among Sami and Inuit. The Inuit Sami differences in SRH could partly be due to higher ‘‘risk’’ and lower ‘‘protective’’ correlates among Inuit than Sami. The positive impact of physical activity on SRH needs to be targeted in future intervention programs

Combined local and systemic immunization is essential for durable T-cell mediated heterosubtypic immunity against influenza A virus

The threat from unpredictable influenza virus pandemics necessitates the development of a new type of influenza vaccine. Since the internal proteins are highly conserved, induction of T cells targeting these antigens may provide the solution. Indeed, adenoviral (Ad) vectors expressing flu nucleoprotein have previously been found to induce short-term protection in mice. In this study we confirm that systemic (subcutaneous (s.c.) immunization rapidly induced heterosubtypic protection predominantly mediated by CD8 T cells, but within three months clinical protection completely disappeared. Local (intranasal (i.n.)) immunization elicited delayed, but more lasting protection despite relatively inefficient immunization. However, by far, the most robust protection was induced by simultaneous, combined (i.n. + s.c.) vaccination, and, notably, in this case clinical protection lasted at least 8 months without showing any evidence of fading. Interestingly, the superior ability of the latter group to resist reinfection correlated with a higher number of antigen-specific CD8 T cells in the spleen. Thus, detailed analysis of the underlying CD8 T cell responses highlights the importance of T cells already positioned in the lungs prior to challenge, but at the same time underscores an important back-up role for circulating antigen-specific cells with the capacity to expand and infiltrate the infected lungs

Characterisation of plastic scintillators used as an active background shield for neutron detection

This work is part of a JRC Exploratory Research project to develop an active shield that is used to reduce the background due to cosmic radiation in a low-level nuclear waste detection system. The shield consists of an array of plastic scintillators surrounding the detection system. Commercially available plastic scintillation detectors with different thicknesses were characterized for their response to gamma rays, neutrons and muons. Response functions to gamma rays were determined by measurements with radionuclide sources in the energy range from 0.6 MeV to 6.0 MeV. Neutron response functions were measured at mono-energetic neutron beams produced at the Van de Graaff accelerator of the JRC Geel (B) and were derived from results of time-of-flight measurements at the Van de Graaff accelerator of the INFN Legnaro (I). From the response functions for gamma rays and neutrons, light output and resolution functions for protons and electrons were derived. Experimental response functions for muons were determined with the detectors positioned at different orientations. The muon peak is more pronounced in horizontally oriented detectors. Using a scintillator with a minimum thickness of 20 mm a signal caused by the detection of a muon can be separated from events due to natural gamma ray background. For detectors that are stacked, signals caused by the detection of muons can be identified based on a coincidence pattern. Hence, requirements on such a coincidence pattern together with requirements on the light production are effective as parameters for the veto system to be designed.JRC.D.4-Standards for Nuclear Safety, Security and Safeguard

Accelerated dynamic Fourier velocity encoding by exploiting velocity-spatio-temporal correlations

Objective: To describe how the information content in a Fourier velocity encoding (FVE) scan can be transformed into a very sparse representation and to develop a method that exploits the compactness of the data to significantly accelerate the acquisition. Materials and Methods: For validation, fully sampled FVE datasets were acquired in phantom and in vivo experiments. Fivefold and eightfold acceleration was simulated by using only one fifth or one eighth of the data for reconstruction in the proposed method based on the k-t BLAST framework. Reconstructed images were compared quantitatively to those from the fully sampled data. Results: Velocity spectra in the accelerated datasets were comparable to the spectra from fully sampled datasets. The detected peak velocities remained accurate even at eightfold acceleration, and the overall shape of the spectra was well preserved. Slight temporal smoothing was seen in the accelerated datasets. Conclusion: A novel technique for accelerating time-resolved FVE scan is presented. It is possible to accelerate FVE to acquisition speeds comparable to a standard time-resolved phase-contrast sca