Effects of patient education on knee joint injections and the impact on patient care and satisfaction in rural Guatemala

Background: As the rates of osteoarthritis increase among the elderly population across the world, the number of intra-articular corticosteroid injections has also steadily increased. The objective of this research study was to compare the ratings of anxiety level, pain level, and education about glucocorticoid injections between the group who received expansive education about joint injections and the group who received minimal education about joint injections. Methods: Each participant was given a pre-injection survey allowing them to rate their anxiety level, pain level, prior education level on knee injections, and duration and severity of symptoms. Each participant completed a post-injection survey following the procedure. Rating data were analyzed using a paired t-test to compare each of the groups to themselves and unpaired t-tests were used to compare the two groups. Demographic and survey data were analyzed using Fisher’s exact test. Results: Statistical significance was noted when a paired t-test was run between pain levels before and after the knee injection was administered in group A and between pain levels before and after the knee injection was administered in group B (p<0.001). A paired t-test also showed statistical significance when comparing the educational levels before and after the knee injection was administered in group A (p=0.04). Conclusions: This research study showed that increased education on corticosteroid knee injections prior to the procedure demonstrated increased education on corticosteroid knee injections after the injection and decreased pain levels following the injection in participants with osteoarthritis in rural Guatemala

Seismicity of the Atlantis Massif detachment fault, 30°N at the Mid-Atlantic Ridge

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 13 (2012): Q0AG11, doi:10.1029/2012GC004210.At the oceanic core complex that forms the Atlantis Massif at 30°N on the Mid-Atlantic Ridge, slip along the detachment fault for the last 1.5–2 Ma has brought lower crust and mantle rocks to the seafloor. Hydroacoustic data collected between 1999 and 2003 suggest that seismicity occurred near the top of the Massif, mostly on the southeastern section, while detected seismicity along the adjacent ridge axis was sparse. In 2005, five short-period ocean bottom seismographs (OBS) were deployed on and around the Massif as a pilot experiment to help constrain the distribution of seismicity in this region. Analysis of six months of OBS data indicates that, in contrast to the results of the earlier hydroacoustic study, the vast majority of the seismicity is located within the axial valley. During the OBS deployment, and within the array, seismicity was primarily composed of a relatively constant background rate and two large aftershock sequences that included 5 teleseismic events with magnitudes between 4.0 and 4.5. The aftershock sequences were located on the western side of the axial valley adjacent to the Atlantis Massif and close to the ridge-transform intersection. They follow Omori's law, and constitute more than half of the detected earthquakes. The OBS data also indicate a low but persistent level of seismicity associated with active faulting within the Atlantis Massif in the same region as the hydroacoustically detected seismicity. Within the Massif, the data indicate a north-south striking normal fault, and a left-lateral, strike-slip fault near a prominent, transform-parallel, north-facing scarp. Both features could be explained by changes in the stress field at the inside corner associated with weak coupling on the Atlantis transform. Alternatively, the normal faulting within the Massif might indicate deformation of the detachment surface as it rolls over to near horizontal from an initial dip of about 60° beneath the axis, and the strike-slip events may indicate transform-parallel movement on adjacent detachment surfaces.We thank the Deep Ocean Exploration Institute at WHOI, Director of Research at WHOI, WHOI’s Department of Geology and Geophysics, and the National Science Foundation for funding the data collection.2013-04-0

Geophysical signatures of oceanic core complexes

Author Posting. © The Authors, 2009. This article is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Geophysical Journal International 178 (2009): 593-613, doi:10.1111/j.1365-246X.2009.04184.x.Oceanic core complexes (OCCs) provide access to intrusive and ultramafic sections of young lithosphere and their structure and evolution contain clues about how the balance between magmatism and faulting controls the style of rifting that may dominate in a portion of a spreading centre for Myr timescales. Initial models of the development of OCCs depended strongly on insights available from continental core complexes and from seafloor mapping. While these frameworks have been useful in guiding a broader scope of studies and determining the extent of OCC formation along slow spreading ridges, as we summarize herein, results from the past decade highlight the need to reassess the hypothesis that reduced magma supply is a driver of long-lived detachment faulting. The aim of this paper is to review the available geophysical constraints on OCC structure and to look at what aspects of current models are constrained or required by the data. We consider sonar data (morphology and backscatter), gravity, magnetics, borehole geophysics and seismic reflection. Additional emphasis is placed on seismic velocity results (refraction) since this is where deviations from normal crustal accretion should be most readily quantified. However, as with gravity and magnetic studies at OCCs, ambiguities are inherent in seismic interpretation, including within some processing/analysis steps. We briefly discuss some of these issues for each data type. Progress in understanding the shallow structure of OCCs (within ∼1 km of the seafloor) is considerable. Firm constraints on deeper structure, particularly characterization of the transition from dominantly mafic rock (and/or altered ultramafic rock) to dominantly fresh mantle peridotite, are not currently in hand. There is limited information on the structure and composition of the conjugate lithosphere accreted to the opposite plate while an OCC forms, commonly on the inside corner of a ridge-offset intersection. These gaps preclude full testing of current models. However, with the data in hand there are systematic patterns in OCC structure, such as the 1–2 Myr duration of this rifting style within a given ridge segment, the height of the domal cores with respect to surrounding seafloor, the correspondence of gravity highs with OCCs, and the persistence of corrugations that mark relative (palaeo) slip along the exposed detachment capping the domal cores. This compilation of geophysical results at OCCs should be useful to investigators new to the topic but we also target advanced researchers in our presentation and synthesis of findings to date

Widespread active detachment faulting and core complex formation near 13°N on the Mid-Atlantic Ridge

Author Posting. © Nature Publishing Group, 2006. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature 442 (2006): 440-443, doi:10.1038/nature04950.Oceanic core complexes are massifs in which lower crustal and upper mantle rocks are exposed at the sea floor. They form at mid-ocean ridges through slip on detachment faults rooted below the spreading axis. To date, most studies of core complexes have been based on isolated inactive massifs that have spread away from ridge axes. A new survey of the Mid-Atlantic Ridge (MAR) near 13°N reveals a segment in which a number of linked detachment faults extend for 75 km along one flank of the spreading axis. The detachment faults are apparently all currently active and at various stages of development. A field of extinct core complexes extends away from the axis for at least 100 km. The new data document the topographic characteristics of actively-forming core complexes and their evolution from initiation within the axial valley floor to maturity and eventual inactivity. Within the surrounding region there is a strong correlation between detachment fault morphology at the ridge axis and high rates of hydroacoustically-recorded earthquake seismicity. Preliminary examination of seismicity and seafloor morphology farther north along the MAR suggests that active detachment faulting is occurring in many segments and that detachment faulting is more important in the generation of ocean crust at this slow-spreading ridge than previously suspected.This work was supported by the National Science Foundation

Dynamics of intraoceanic subduction initiation: 1. Oceanic detachment fault inversion and the formation of supra-subduction zone ophiolites

Subduction initiation is a critical link in the plate tectonic cycle. Intraoceanic subduction zones can form along transform faults and fracture zones, but how subduction nucleates parallel to mid-ocean ridges, as in e.g., the Neotethys Ocean during the Jurassic, remains a matter of debate. In recent years, extensional detachment faults have been widely documented adjacent to slow-spreading and ultraslow-spreading ridges where they cut across the oceanic lithosphere. These structures are extremely weak due to widespread occurrence of serpentine and talc resulting from hydrothermal alteration, and can therefore effectively localize deformation. Here, we show geochemical, tectonic, and paleomagnetic evidence from the Jurassic ophiolites of Albania and Greece for a subduction zone formed in the western Neotethys parallel to a spreading ridge along an oceanic detachment fault. With 2-D numerical modeling exploring the evolution of a detachment-ridge system experiencing compression, we show that serpentinized detachments are always weaker than spreading ridges. We conclude that, owing to their extreme weakness, oceanic detachments can effectively localize deformation under perpendicular far-field forcing, providing ideal conditions to nucleate new subduction zones parallel and close to (or at) spreading ridges. Direct implication of this, is that resumed magmatic activity in the forearc during subduction initiation can yield widespread accretion of suprasubduction zone ophiolites at or close to the paleoridge. Our new model casts the enigmatic origin of regionally extensive ophiolite belts in a novel geodynamic context, and calls for future research on three-dimensional modeling of subduction initiation and how upper plate extension is associated with that

Tectonic structure, evolution, and the nature of oceanic core complexes and their detachment fault zones (13°20′N and 13°30′N, Mid Atlantic Ridge)

Microbathymetry data, in situ observations, and sampling along the 138200N and 138200N oceanic core complexes (OCCs) reveal mechanisms of detachment fault denudation at the seafloor, links between tectonic extension and mass wasting, and expose the nature of corrugations, ubiquitous at OCCs. In the initial stages of detachment faulting and high-angle fault, scarps show extensive mass wasting that reduces their slope. Flexural rotation further lowers scarp slope, hinders mass wasting, resulting in morphologically complex chaotic terrain between the breakaway and the denuded corrugated surface. Extension and drag along the fault plane uplifts a wedge of hangingwall material (apron). The detachment surface emerges along a continuous moat that sheds rocks and covers it with unconsolidated rubble, while local slumping emplaces rubble ridges overlying corrugations. The detachment fault zone is a set of anostomosed slip planes, elongated in the alongextension direction. Slip planes bind fault rock bodies defining the corrugations observed in microbathymetry and sonar. Fault planes with extension-parallel stria are exposed along corrugation flanks, where the rubble cover is shed. Detachment fault rocks are primarily basalt fault breccia at 138200N OCC, and gabbro and peridotite at 138300N, demonstrating that brittle strain localization in shallow lithosphere form corrugations, regardless of lithologies in the detachment zone. Finally, faulting and volcanism dismember the 138300N OCC, with widespread present and past hydrothermal activity (Semenov fields), while the Irinovskoe hydrothermal field at the 138200N core complex suggests a magmatic source within the footwall. These results confirm the ubiquitous relationship between hydrothermal activity and oceanic detachment formation and evolution

Magmatism, serpentinization and life: Insights through drilling the Atlantis Massif (IODP Expedition 357)

IODP Expedition 357 used two seabed drills to core 17 shallow holes at 9 sites across Atlantis Massif ocean core complex (Mid-Atlantic Ridge 30°N). The goals of this expedition were to investigate serpentinization processes and microbial activity in the shallow subsurface of highly altered ultramafic and mafic sequences that have been uplifted to the seafloor along a major detachment fault zone. More than 57 m of core were recovered, with borehole penetration ranging from 1.3 to 16.4 meters below seafloor, and core recovery as high as 75% of total penetration in one borehole. The cores show highly heterogeneous rock types and alteration associated with changes in bulk rock chemistry that reflect multiple phases of magmatism, fluid-rock interaction and mass transfer within the detachment fault zone. Recovered ultramafic rocks are dominated by pervasively serpentinized harzburgite with intervals of serpentinized dunite and minor pyroxenite veins; gabbroic rocks occur as melt impregnations and veins. Dolerite intrusions and basaltic rocks represent the latest magmatic activity. The proportion of mafic rocks is volumetrically less than the amount of mafic rocks recovered previously by drilling the central dome of Atlantis Massif at IODP Site U1309. This suggests a different mode of melt accumulation in the mantle peridotites at the ridge-transform intersection and/or a tectonic transposition of rock types within a complex detachment fault zone. The cores revealed a high degree of serpentinization and metasomatic alteration dominated by talc-amphibole-chlorite overprinting. Metasomatism is most prevalent at contacts between ultramafic and mafic domains (gabbroic and/or doleritic intrusions) and points to channeled fluid flow and silica mobility during exhumation along the detachment fault. The presence of the mafic lenses within the serpentinites and their alteration to mechanically weak talc, serpentine and chlorite may also be critical in the development of the detachment fault zone and may aid in continued unroofing of the upper mantle peridotite/gabbro sequences. New technologies were also developed for the seabed drills to enable biogeochemical and microbiological characterization of the environment. An in situ sensor package and water sampling system recorded real-time variations in dissolved methane, oxygen, pH, oxidation reduction potential (Eh), and temperature and during drilling and sampled bottom water after drilling. Systematic excursions in these parameters together with elevated hydrogen and methane concentrations in post-drilling fluids provide evidence for active serpentinization at all sites. In addition, chemical tracers were delivered into the drilling fluids for contamination testing, and a borehole plug system was successfully deployed at some sites for future fluid sampling. A major achievement of IODP Expedition 357 was to obtain microbiological samples along a west–east profile, which will provide a better understanding of how microbial communities evolve as ultramafic and mafic rocks are altered and emplaced on the seafloor. Strict sampling handling protocols allowed for very low limits of microbial cell detection, and our results show that the Atlantis Massif subsurface contains a relatively low density of microbial life

The internal structure of an oceanic core complex: An integrated analysis of oriented borehole imagery from IODP Hole U1309D (Atlantis Massif)

Oceanic core complexes at slow-spreading ridges represent the uplifted footwalls of large-offset 'detachment' faults that initiate at steep dips, and rotate to flatten via a 'rolling hinge' mechanism in response to flexural unloading. A key question is whether oceanic core complex development is accommodated entirely by displacement on the detachment fault zone, or if significant internal deformation of the footwall occurs during flexure and rotation. We investigate this by constraining the internal architecture of the Atlantis Massif oceanic core complex (Mid-Atlantic Ridge, 30{degree sign}N) using Formation MicroScanner borehole wall images and cores from the 1416 m-deep Integrated Ocean Drilling Program Hole U1309D. Two distinct sets of structures are observed. N-S-striking, E-dipping structures dominating the upper 385 m are interpreted as a brittle to semi-brittle zone of fracturing in the footwall. Structures with this geometry occur down to 750 m below seafloor, suggesting that the detachment damage zone extends deep into the footwall. The nature of this deformation is, however, enigmatic: several cataclastic shear zones with reverse geometry in their current orientations may be rotated extensional faults or relate to shortening at the base of the flexing beam of a very weak footwall. By contrast, E-W-striking, N- and S-dipping structures dominate the lowermost kilometer of the borehole. They likely represent conjugate fractures formed in the hanging wall of a late, E-W normal fault zone, separating gabbroic rocks of the central dome of Atlantis Massif from serpentinized peridotite to the south, responsible for post-detachment uplift of the southern margin of the massif