Recent aspects on outcomes in geriatric fracture patients

As the population ages, the number of fragility fractures is expected to increase dramatically. These injuries are frequently associated with less than satisfactory outcomes. Many of the patients experience adverse events or death, and few regain their pre-injury functional status. Many also lose their independence as a result of their fracture. This manuscript will explore problems and some potential solutions to evaluate the outcomes of geriatric fracture care. Specific, system-wide, and societal concerns will be discussed. Limited suggestions will be made for future steps to improve outcomes assessment

Luminosity- and morphology-dependent clustering of galaxies

How does the clustering of galaxies depend on their inner properties like morphological type and luminosity? We address this question in the mathematical framework of marked point processes and clarify the notion of luminosity and morphological segregation. A number of test quantities such as conditional mark-weighted two-point correlation functions are introduced. These descriptors allow for a scale-dependent analysis of luminosity and morphology segregation. Moreover, they break the degeneracy between an inhomogeneous fractal point set and actual present luminosity segregation. Using the Southern Sky Redshift Survey~2 (da Costa et al. 1998, SSRS2) we find both luminosity and morphological segregation at a high level of significance, confirming claims by previous works using these data (Benoist et al. 1996, Willmer et al. 1998). Specifically, the average luminosity and the fluctuations in the luminosity of pairs of galaxies are enhanced out to separations of 15Mpc/h. On scales smaller than 3Mpc/h the luminosities on galaxy pairs show a tight correlation. A comparison with the random-field model indicates that galaxy luminosities depend on the spatial distribution and galaxy-galaxy interactions. Early-type galaxies are also more strongly correlated, indicating morphological segregation. The galaxies in the PSCz catalog (Saunders et al. 2000) do not show significant luminosity segregation. This again illustrates that mainly early-type galaxies contribute to luminosity segregation. However, based on several independent investigations we show that the observed luminosity segregation can not be explained by the morphology-density relation alone.Comment: aastex, emulateapj5, 20 pages, 13 figures, several clarifying comments added, ApJ accepte

Derivation of an optimal directivity pattern for sweet spot widening in stereo sound reproduction

In this paper the correction of the degradation of the stereophonic illusion during sound reproduction due to off-center listening is investigated. The main idea is that the directivity pattern of a loudspeaker array should have a well-defined shape such that a good stereo reproduction is achieved in a large listening area. Therefore, a mathematical description to derive an optimal directivity pattern lopt that achieves sweet spot widening in a large listening area for stereophonic sound applications is described. This optimal directivity pattern is based on parametrized time/intensity trading data coming from psycho-acoustic experiments within a wide listening area. After the study, the required digital FIR filters are determined by means of a least-squares optimization method for a given stereo base setup (two pair of drivers for the loudspeaker arrays and 2.5-m distance between loudspeakers), which radiate sound in a broad range of listening positions in accordance with the derived lopt. Informal listening tests have shown that the lopt worked as predicted by the theoretical simulations. They also demonstrated the correct central sound localization for speech and music for a number of listening positions. This application is referred to as "Position-Independent (PI) stereo.

Dynamical effects of the neutrino gravitational clustering at Planck angular scales

We study the CMB anisotropy induced by the non-linear perturbations in the massive neutrino density associated to the non-linear gravitational clustering proceses. Our results show that for the neutrino fraction in agreement with that indicated by the astroparticle and nuclear physics experiments and a cosmological accreting mass comparable with the mass of known clusters, the angular resolution and the sensitivity of the CMB anisotropy measurements from the Planck surveyor will allow the detection of the dynamical effects of the neutrino gravitational clustering.Comment: 40 pages and 12 figures, submitted to ApJ (14 March 2002

Definition of infection after fracture fixation: A systematic review of randomized controlled trials to evaluate current practice

Introduction: One of the most challenging musculoskeletal complications in modern trauma surgery is infection after fracture fixation (IAFF). Although infections are clinically obvious in many cases, a clear definition of the term IAFF is crucial, not only for the evaluation of published research data but also for the establishment of uniform treatment concepts. The aim of this systematic review was to identify the definitions used in the scientific literature to describe infectious complications after internal fixation of fractures. The hypothesis of this study was that the majority of fracture-related literature do not define IAFF. Material and methods: A comprehensive search was performed in Embase, Cochrane, Google Scholar, Medline (OvidSP), PubMed publisher and Web-of-Science for randomized controlled trials (RCTs) on fracture fixation. Data were collected on the definition of infectious complications after fracture fixation used in each study. Study selection was accomplished through two phases. During the first phase, titles and abstracts were reviewed for relevance, and the full texts of relevant articles were obtained. During the second phase, full-text articles were reviewed. All definitions were literally extracted and collected in a database. Then, a classification was designed to rate the quality of the description of IAFF. Results: A total of 100 RCT’s were identified in the search. Of 100 studies, only two (2%) cited a validated definition to describe IAFF. In 28 (28%) RCTs, the authors used a self-designed definition. In the other 70 RCTs, (70%) there was no description of a definition in the Methods section, although all of the articles described infections as an outcome parameter in the Results section. Conclusion: This systematic review shows that IAFF is not defined in a large majority of the fracture-related literature. To our knowledge, this is the first study conducted with the objective to explore this important issue. The lack of a consensus definition remains a problem in current orthopedic trauma research and treatment and this void should be addressed in the near future

Mapping Cortical Morphology in Youth With Velocardiofacial (22q11.2 Deletion) Syndrome

Objective: Velo-cardio-facial syndrome (VCFS; 22q11.2 deletion syndrome) represents one of the highest known risk factors for schizophrenia. Insofar as up to thirty percent of individuals with this genetic disorder develop schizophrenia, VCFS constitutes a unique, etiologically homogeneous model for understanding the pathogenesis of schizophrenia. Method: Using a longitudinal, case-control design, we acquired anatomic magnetic resonance images to investigate both cross-sectional and longitudinal alterations in surface cortical morphology in a cohort of adolescents with VCFS and age-matched typical controls. All participants were scanned at two time points. Results: Relative to controls, youth with VCFS exhibited alterations in inferior frontal, dorsal frontal, occipital, and cerebellar brain regions at both time points. We observed little change over time in surface morphology of either study group. However, within the VCFS group only, worsening psychosocial functioning over time was associated with Time 2 surface contractions in left middle and inferior temporal gyri. Further, prodromal symptoms at Time 2 were associated with surface contractions in left and right orbitofrontal, temporal and cerebellar regions, as well as surface protrusions of supramarginal gyrus. Conclusions: These findings advance our understanding of cortical disturbances in VCFS that produce vulnerability for psychosis in this high risk population

Natural Double Inflation in Supergravity

We propose a natural double inflation model in supergravity. In this model, chaotic inflation first takes place by virtue of the Nambu-Goldstone-like shift symmetry, which guarantees the absence of the exponential factor in the potential for the inflaton field. During chaotic inflation, an initial value of the second inflation (new inflation) is set. In this model, the initial value of new inflation can be adequately far from the local maximum of the potential for new inflation due to the small linear term of the inflaton in the K\"ahler potential. Therefore, the primordial fluctuations within the present horizon scale may be attributed to both inflations; that is, the first chaotic inflation produces the primordial fluctuations on the large cosmological scales while the second new inflation on the smaller scales. The successive decay of the inflaton for new inflation leads to a reheating temperature low enough to avoid the overproduction of gravitinos in a wide range of the gravitino mass.Comment: 13 pages, to appear in Phys. Rev.

Dimensions of professional competences for interventions towards sustainability

This paper investigates sustainability competences through the eyes of professional practitioners in the field of sustainability and presents empirical data that have been created using an action research approach. The design of the study consists of two workshops, in which professional practitioners in interaction with each other and the facilitators are invited to explore and reflect on the specific knowledge, skills, attitudes and behaviours necessary to conduct change processes successfully towards sustainability in a variety of business and professional contexts. The research focuses on the competences associated with these change processes to devise, propose and conduct appropriate interventions that address sustainability issues. Labelled ‘intervention competence’, this ability comprises an interlocking set of knowledge, skills, attitudes and behaviours that include: appreciating the importance of (trying to) reaching decisions or interventions; being able to learn from lived experience of practice and to connect such learning to one’s own scientific knowledge; being able to engage in political-strategic thinking, deliberations and actions, related to different perspectives; the ability for showing goal-oriented, adequate action; adopting and communicating ethical practices during the intervention process; being able to cope with the degree of complexity, and finally being able to translate stakeholder diversity into collectively produced interventions (actions) towards sustainability. Moreover, this competence has to be practised in contexts of competing values, non-technical interests and power relations. The article concludes with recommendations for future research and practice

Cleft palate, Retrognathia and Congenital Heart Disease in Velo-Cardio-Facial Syndrome: A Phenotype Correlation Study

Objective: Velo-cardio-facial syndrome (VCFS) is caused by a microdeletion of approximately 40 genes from one copy of chromosome 22. Expression of the syndrome is a variable combination of over 190 phenotypic characteristics. As of yet, little is known about how these phenotypes correlate with one another or whether there are predictable patterns of expression. Two of the most common phenotypic categories, congenital heart disease and cleft palate, have been proposed to have a common genetic relationship to the deleted T-box 1 gene (TBX1). The purpose of this study is to determine if congenital heart disease and cleft palate are correlated in a large cohort of human subjects with VCFS. Methods: This study is a retrospective chart review including 316 Caucasian non-Hispanic subjects with FISH or CGH microarray confirmed chromosome 22q11.2 deletions. All subjects were evaluated by the interdisciplinary team at the Velo-Cardio-Facial Syndrome International Center at Upstate Medical University, Syracuse, NY. Each combination of congenital heart disease, cleft palates, and retrognathia was analyzed by Chi square or Fisher exact test. Results: For all categories of congenital heart disease and cleft palate or retrognathia no significant associations were found, with the exception of submucous cleft palate and retrognathia (nominal p = 0.0325) and occult submucous cleft palate and retrognathia (nominal p = 0.000013). Conclusions: Congenital heart disease and cleft palate do not appear to be correlated in human subjects with VCFS despite earlier suggestions from animal models. Possible explanations include modification of the effect of TBX1 by genes outside of the 22q11.2 region that may further influence the formation of the palate or heart, or the presence of epigenetic factors that may effect genes within the deleted region, modifying genes elsewhere, or polymorphisms on the normal copy of chromosome 22. Lastly, it is possible that TBX1 plays a role in palate formation in some species, but not in humans. In VCFS, retrognathia is caused by an obtuse angulation of the skull base. It is unknown if the correlation between retrognathia and cleft palate in VCFS indicates a developmental sequence related to skull morphology, or direct gene effects of both anomalies. Much work remains to be done to fully understand the complex relationships between phenotypic characteristics in VCFS