Octogenarians with blunt splenic injury: not all geriatrics are the same.

Geriatric trauma patients (GTP) (age ≥ 65 years) with blunt splenic injury (BSI) have up to a 6% failure rate of non-operative management (NOM). GTPs failing NOM have a similar mortality rate compared to GTPs managed successfully with NOM. However, it is unclear if this remains true in octogenarians (aged 80-89 years). We hypothesized that the failure rate for NOM in octogenarians would be similar to their younger geriatric cohort, patients aged 65-79 years; however risk of mortality in octogenarians who fail NOM would be higher than that of octogenarians managed successfully with NOM. The Trauma Quality Improvement Program (2010-2016) was queried for patients with BSI. Those undergoing splenectomy within 6 h were excluded to select for patients undergoing NOM. Patients aged 65-79 years (young GTPs) were compared to octogenarians. A multivariable logistic regression model was used to determine the risk for failed NOM and mortality. From 43,041 BSI patients undergoing NOM, 3660 (8.5%) were aged 65-79 years and 1236 (2.9%) were octogenarians. Both groups had a similar median Injury Severity Score (ISS) (p = 0.10) and failure rate of NOM (6.6% young GTPs vs. 6.8% octogenarians p = 0.82). From those failing NOM, octogenarians had similar units of blood products transfused (p > 0.05) and a higher mortality rate (40.5% vs. 18.2%, p < 0.001), compared to young GTPs. Independent risk factors for failing NOM in octogenarians included ≥ 1 unit of packed red blood cells (PRBC) (p = 0.039) within 24 h of admission. Octogenarians who failed NOM had a higher mortality rate compared to octogenarians managed successfully with NOM (40.5% vs 23.6% p = 0.001), which persisted in a multivariable logistic regression analysis (OR 2.25, CI 1.37-3.70, p < 0.001). Late failure of NOM ≥ 24 h (vs. early failure) was not associated with increased risk of mortality (p = 0.88), but ≥ 1 unit of PRBC transfused had higher risk (OR 1.88, CI 1.20-2.95, p = 0.006). Compared to young GTPs with BSI, octogenarians have a similar rate of failed NOM. Octogenarians with BSI who fail NOM have over a twofold higher risk of mortality compared to those managed successfully with NOM. PRBC transfusion increases risk for mortality. Therefore, clinicians should consider failure of NOM earlier in the octogenarian population to mitigate the risk of increased mortality

Gasto de conservación vial relacionado con el patrimonio vial vecinal de la región Lima

La presente investigación “Gasto de conservación vial relacionado con el patrimonio vial vecinal de la Región Lima” tuvo como característica ser una investigación descriptiva/explicativa donde se determinó la incidencia del gasto de conservación vial en el patrimonio vial vecinal de la provincia de Cajatambo dentro del contexto del Decreto de Urgencia N°070-2020 del año 2021 a través de la descripción histórica de la red vial y los servicios de mantenimiento a lo largo de un periodo de tiempo para entender el estado de condición de los camino vecinales antes de la intervención. Luego se calculó el patrimonio vial vecinal de las rutas contempladas en el Decreto de Urgencia N°070-2020 antes y después de la intervención. Posteriormente se detalló el gasto propuesto por el Ministerio de Economía y Finanzas para los servicios de conservación vial. Por último, se determinó si los planes de trabajo se llegaron a cumplir o no. Para el desarrollo de la investigación se empleó los planes viales provinciales participativos encontrados en la web y en la municipalidad provincial de Cajatambo y los planes de trabajo presentados por las empresas contratistas encargadas de la ejecución de los servicios de mantenimiento. Con ello se comprobó que el gasto de S/ 18,444,100.72 en conservación vial elevó el patrimonio vial vecinal de la provincia de Cajatambo para los años mencionados demostrando la incidencia del gasto

Vibrational spectral investigation and natural bond orbital analysis of pharmaceutical compound 7-Amino-2,4-dimethylquinolinium formate – DFT approach

AbstractThe molecular geometry, the normal mode frequencies and corresponding vibrational assignments, natural bond orbital analysis and the HOMO–LUMO analysis of 7-Amino-2,4-dimethylquinolinium formate in the ground state were performed by B3LYP levels of theory using the 6-31G(d) basis set. The optimised bond lengths and bond angles are in good agreement with the X-ray data. The vibrational spectra of the title compound which is calculated by DFT method, reproduces vibrational wave numbers and intensities with an accuracy which allows reliable vibrational assignments. The possibility of N–H⋯O hydrogen bonding was identified using NBO analysis. Natural bond orbital analysis confirms the presence of intramolecular charge transfer and the hydrogen bonding interaction

Trust, guilds and kinship in London, 1330-1680

How was trust created and reinforced between the inhabitants of medieval and early modern cities? And how did the social foundations of trusting relationships change over time? Current research highlights the role of kinship, neighbourhood and associations, particularly guilds, in creating ‘relationships of trust’ and social capital in the face of high levels of migration, mortality and economic volatility, but tells us little about their relative importance or how they developed. We uncover a profound shift in the contribution of family and guilds to trust networks among the middling and elite of one of Europe’s major cities, London, over three centuries, from the 1330s to the 1680s. We examine the networks of sureties created to secure the inheritances of children whose fathers died while they were minors, surviving in the records of London’s Orphans Court. Our analysis of almost fifteen thousand networks evaluates the presence of trusting relationships connected with guild membership, family and place over several centuries. We show a profound increase in the role of kinship – a re-embedding of trust within the family - and a decline of the importance of shared guild membership in connecting Londoner’s who secured orphans’ inheritances together. We suggest these developments are best explained as a result of the impact of the Reformation on the form and intensity of sociability fostered by guilds and the enormous growth of the metropolis

Maintenance hemodialysis patients have high cumulative radiation exposure

Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7mSv, in which 13 patients had a total cumulative effective radiation dose over 75mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients

In situ X-ray imaging of hot cracking and porosity during LPBF of Al-2139 with TiB2 additions and varied process parameters

Laser powder bed fusion (LPBF) additive manufacturing of 2XXX series Al alloys could be used for low volume specialist aerospace components, however, such alloys exhibit hot cracking susceptibility that can lead to component failure. In this study, we show two approaches to suppress the formation of hot cracks by controlling solidification behaviour using: (1) TiB2 additions; and (2) optimisation of LPBF process parameters. Using high-speed synchrotron X-ray radiography, we monitored LPBF of Al-2139 in situ, with and without TiB2 under a range of process conditions. In situ X-ray radiography results captured the crack growth over 1.0 ms at a rate of ca. 110 mm s−1, as well as pore evolution, wetting behaviour and build height. High-resolution synchrotron X-ray computed tomography (sCT) was used to measure the volume fraction of defects, e.g. hydrogen pores and microcracks, in the as-built LPBF samples. Our results show adding TiB2 in Al-2139 reduces the volume of cracks by up to 79 % under a volume energy density of 1000 to 5000 J mm−3, as well as reducing the average length, breadth, and surface area of cracks

The Many Faces of Monetisation: Understanding the Diversity and Extremity of Player Spending in Mobile Games via Massive-scale Transactional Analysis

With the rise of microtransactions, particularly in the mobile games industry, there has been ongoing concern that games reliant on these obtain substantial revenue from a small proportion of heavily involved individuals, to an extent that may be financially burdensome to these individuals. Yet despite substantive grey literature and speculation on this topic, there is little robust data available. We explore the revenue distribution in microtransaction-based mobile games using a transactional dataset of $4.7B in in-game spending drawn from 69,144,363 players of 2,873 mobile games over the course of 624 days. We find diverse revenue distributions in mobile games, ranging from a “uniform” cluster, in which all spenders invest approximately similar amounts, to “hyper-Pareto” games, in which a large proportion of revenue (approximately 38$66,285 each in the 624 days under evaluation in the most extreme case. We discuss implications for future studies on links between gaming and wellbeing