Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma. Objectives: Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma. Patients and Methods: Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05. Results: 56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower extremity injuries had significantly increased odds of developing a DVT (OR = 7.55, P = 0.006). The trend toward increased odds of DVT among patients with injuries to the hip/pelvis did not reach statistical significance (OR = 4.51, P = 0.22). Smoking was not found to be an independent risk factor for developing a DVT (P = 0.1217). Conclusions: This is the largest study to date using the NSQIP database to identify risk factors for DVT in orthopaedic trauma patients. Although the incidence of DVT was low in our cohort, the presence of certain risk factors significantly increased the odds of developing a DVT following orthopaedic trauma. These findings will enable orthopaedic surgeons to target at-risk patients and implement post-operative care protocols aimed at reducing the morbidity and mortality associated with DVT in orthopaedic trauma patients

Paper Session II-B - Early Results from the Space Telescope Imaging Spectograph

The STIS instrument was installed into HST in February 1997 during the Servicing Mission 2. It has completed checkout and is beginning its science program, and is working well. Several scientific demonstration observations were taken, illustrating some of the range of scientific uses and modes of observation of STIS. Keywords: Hubble, spectrograph, echelle, ultraviolet, optical, spectra, MAMA, black hole, galaxies, supernov

Altering micro-environments to change population health behaviour: towards an evidence base for choice architecture interventions.

BACKGROUND: The idea that behaviour can be influenced at population level by altering the environments within which people make choices (choice architecture) has gained traction in policy circles. However, empirical evidence to support this idea is limited, especially its application to changing health behaviour. We propose an evidence-based definition and typology of choice architecture interventions that have been implemented within small-scale micro-environments and evaluated for their effects on four key sets of health behaviours: diet, physical activity, alcohol and tobacco use. DISCUSSION: We argue that the limitations of the evidence base are due not simply to an absence of evidence, but also to a prior lack of definitional and conceptual clarity concerning applications of choice architecture to public health intervention. This has hampered the potential for systematic assessment of existing evidence. By seeking to address this issue, we demonstrate how our definition and typology have enabled systematic identification and preliminary mapping of a large body of available evidence for the effects of choice architecture interventions. We discuss key implications for further primary research, evidence synthesis and conceptual development to support the design and evaluation of such interventions. SUMMARY: This conceptual groundwork provides a foundation for future research to investigate the effectiveness of choice architecture interventions within micro-environments for changing health behaviour. The approach we used may also serve as a template for mapping other under-explored fields of enquiry

Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation.

BACKGROUND: Mammographic microcalcifications represent one of the most reliable features of nonpalpable breast cancer yet remain largely unexplored and poorly understood. METHODS: We report a novel model to investigate the in vitro mineralisation potential of a panel of mammary cell lines. Primary mammary tumours were produced by implanting tumourigenic cells into the mammary fat pads of female BALB/c mice. RESULTS: Hydroxyapatite (HA) was deposited only by the tumourigenic cell lines, indicating mineralisation potential may be associated with cell phenotype in this in vitro model. We propose a mechanism for mammary mineralisation, which suggests that the balance between enhancers and inhibitors of physiological mineralisation are disrupted. Inhibition of alkaline phosphatase and phosphate transport prevented mineralisation, demonstrating that mineralisation is an active cell-mediated process. Hydroxyapatite was found to enhance in vitro tumour cell migration, while calcium oxalate had no effect, highlighting potential consequences of calcium deposition. In addition, HA was also deposited in primary mammary tumours produced by implanting the tumourigenic cells into the mammary fat pads of female BALB/c mice. CONCLUSION: This work indicates that formation of mammary HA is a cell-specific regulated process, which creates an osteomimetic niche potentially enhancing breast tumour progression. Our findings point to the cells mineralisation potential and the microenvironment regulating it, as a significant feature of breast tumour development

ENHANCEMENT OF GAS TO WATER MASS-TRANSFER RATES BY A DISPERSED ORGANIC-PHASE

Experimental data are presented on the enhancement of oxygen mass transfer into an aqueous sulphite solution in a stirred cell, due to the presence of a dispersed liquid octene phase. The observed enhancement factors can be described with a new mass transfer theory, called the Film Variable Hold-up (FVH) model. This model is based on the film theory and explains the influence of hold-up, droplet diameter and permeability of the organic phase, on the obtained enhancement. it is assumed that the dispersed phase hold-up gradually increases from zero at x = 0 (the gas-liquid interface) towards a constant average bulk value for x greater than or equal to alpha delta, according to a distribution Function with parameter values alpha = d(43)/delta and beta = 0.3, where d(43) is the volumetric mean diameter of the dispersed droplets, delta is the mass transfer film thickness, and beta is a geometrical factor. Surprisingly, also the experimental data of Bruining et al. (1986) for oxygen mass transfer enhancement due to hexadecane droplets and the data of Littel (1991) for carbon dioxide mass transfer enhancement due to toluene droplets can be reasonably well described, assuming the same dispersed hold-up distribution in the mass transfer film. This may indicate that this dispersed phase distribution is similar for different organic droplets dispersed in water, at least if these systems are characterized by a negative spreading coefficient. The recent observation of Wilkinson et al. (1991), that the reaction rate of the uncatalyzed sulphite oxidation increases with decreasing values of the pH, initially adjusted by adding H2SO4, was confirmed

ENHANCEMENT OF GAS TO WATER MASS-TRANSFER RATES BY A DISPERSED ORGANIC-PHASE

Experimental data are presented on the enhancement of oxygen mass transfer into an aqueous sulphite solution in a stirred cell, due to the presence of a dispersed liquid octene phase. The observed enhancement factors can be described with a new mass transfer theory, called the Film Variable Hold-up (FVH) model. This model is based on the film theory and explains the influence of hold-up, droplet diameter and permeability of the organic phase, on the obtained enhancement. it is assumed that the dispersed phase hold-up gradually increases from zero at x = 0 (the gas-liquid interface) towards a constant average bulk value for x greater than or equal to alpha delta, according to a distribution Function with parameter values alpha = d(43)/delta and beta = 0.3, where d(43) is the volumetric mean diameter of the dispersed droplets, delta is the mass transfer film thickness, and beta is a geometrical factor. Surprisingly, also the experimental data of Bruining et al. (1986) for oxygen mass transfer enhancement due to hexadecane droplets and the data of Littel (1991) for carbon dioxide mass transfer enhancement due to toluene droplets can be reasonably well described, assuming the same dispersed hold-up distribution in the mass transfer film. This may indicate that this dispersed phase distribution is similar for different organic droplets dispersed in water, at least if these systems are characterized by a negative spreading coefficient. The recent observation of Wilkinson et al. (1991), that the reaction rate of the uncatalyzed sulphite oxidation increases with decreasing values of the pH, initially adjusted by adding H2SO4, was confirmed

The importance of innovative research in behavior analysis

The principles of behavior analysis can be used in a wide variety of settings and with diverse populations. Furthermore, these principles can be used in the assessment and treatment of a multitude of behaviors, many of which are not commonly focused on in traditional research. The majority of behavior-analytic research generally focuses on the assessment and treatment of problem behaviors (e.g., self-injurious behavior, aggression, disruption) in special populations, such as individuals with developmental disabilities. However, some behavior-analytic researchers do address problems (e.g., substance abuse, physical activity, safety-related behaviors, sex offender-related behaviors) that lie outside of the mainstream behavior analysis research agenda. The panelists will discuss their personal accounts of conducting research outside of the behavior analysis mainstream and the importance of these lines of research to the field of behavior analysis. Additionally, panelists will discuss the problems faced when conducting such research, and provide advice to those looking to explore novel research areas in the field of behavior analysis