Functional and Clinical Outcomes After Plate Osteosynthesis Versus Intramedullary Nailing of a Humeral Shaft Fracture:The Results of the HUMMER Multicenter, Prospective Cohort Study

BACKGROUND: Plate osteosynthesis (referred to throughout as plating) and intramedullary nailing (referred to throughout as nailing) are the most common operative strategies for humeral shaft fractures. However, it is undecided which treatment is more effective. This study aimed to compare functional and clinical outcomes of these treatment strategies. We hypothesized that plating would result in an earlier recovery of shoulder function and fewer complications. METHODS: From October 23, 2012, to October 3, 2018, adults with a humeral shaft fracture, OTA/AO type 12A or 12B, were enrolled in a multicenter, prospective cohort study. Patients were treated with plating or nailing. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley score, ranges of motion of the shoulder and elbow, radiographic healing, and complications until 1 year. Repeated-measure analysis was done with correction for age, sex, and fracture type. RESULTS: Of the 245 included patients, 76 were treated with plating and 169 were treated with nailing. Patients in the plating group were younger, with a median age of 43 years compared with 57 years for the nailing group (p &lt; 0.001). The mean DASH score after plating improved faster over time, but did not differ significantly from the score after nailing at 12 months (11.7 points [95% confidence interval (CI), 7.6 to 15.7 points]) for plating and 11.2 points [95% CI, 8.3 to 14.0 points] for nailing). The Constant-Murley score and shoulder abduction, flexion, external rotation, and internal rotation displayed a significant treatment effect (p treatment ≤ 0.001), in favor of plating. The plating group had 2 implant-related complications, whereas the nailing group had 24, including 13 nail protrusions and 8 screw protrusions. Plating resulted in more postoperative temporary radial nerve palsy (8 patients [10.5%] compared with 1 patient [0.6%]; p &lt; 0.001) and a trend toward fewer nonunions (3 patients [5.7%] compared with 16 patients [11.9%]; p = 0.285) than nailing. CONCLUSIONS: Plating of a humeral shaft fracture in adults results in faster recovery, especially of shoulder function. Plating was associated with more temporary nerve palsies, but fewer implant-related complications and surgical reinterventions, than nailing. Despite heterogeneity in implants and surgical approach, plating seems to be the preferred treatment option for these fractures. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.</p

Prevalence and risk factors of delirium in psychogeriatric outpatients

Background: Delirium is a serious neuropsychiatric syndrome, which requires timely treatment. However, it is easily missed, especially in older patients with premorbid cognitive disorders. Objectives: The aim of this study is to investigate the prevalence and risk factors of delirium in older outpatients with and without dementia. Method: We assessed 444 patients referred to the memory clinic of a psychiatric hospital between March 2013 and March 2014. Demographic information, medical history, impairments in daily living activities and referral information were registered. Patients underwent a psychiatric examination using the Delirium Rating Scale-Revised-98 and cognitive tests, a physical examination and laboratory tests. We recorded medication use and changes before and after the onset of symptoms. Results: Among the 444 outpatients, 85 had probable delirium (prevalence of 19%), and 10 had subsyndromal delirium (2%). The most common triggers were infection (42%), drug-intoxication or withdrawal (22%), and metabolic/endocrine disturbance (12%). Age (OR 1.07, 95% CI 1.02-1.11) and prior delirium (OR 3.34, 95% CI 1.28-8.69) were independent non-modifiable factors associated with an increased risk of delirium. The only independent modifiable risk factor was infection (OR 17.31, 95% CI 8.44-35.49). Conclusions: A delirium was detected in one of five patients referred for dementia screening. Most patients could be treated at home. Age and prior delirium were predictive of an increased risk of delirium

SEEV4-City approach to KPI Methodology

SEEV4-City is an innovation project funded by the EU Interreg North Sea Region Programme. Its main objective is to demonstrate smart electric mobility and renewable energy solutions integration and share its learnings. The project must report on the results of 6 Operational Pilots (OPs) of the following three Key Performance Indicators (KPIs): A. Estimated CO2 reduction B. Estimated increase in energy autonomy C. Estimated Saving from Grid Investment Deferral The project aimed to establish a common methodology to calculate the contributions to the three main KPIs with significant level of detail and accuracy (where feasible). This was a collaborative exercise between Work package (WP) partners leading WP3-Intelligence (Data analysis, monitoring and simulation), WP4- Operational Pilots Implementation and Coordination and WP5-Policy and Business Case work packages and was done in consultation with the OP partners. The result of this effort is collated in this defined approach the KPI Methodology report. It is part of a collection of reports published by the project covering a variation of specific and cross-cutting analysis as well as different evaluation perspectives spanning the 6 operational pilots

Final report - Leicester City Hall Operational Pilot: V2B and V2G at Leicester City Hall – case study

This report provides evaluation of the SEEV4-City Operational Pilot at Leicester City Hall, in the city of Leicester, U.K. In cooperation with Cenex UK, a demonstration project was set up to evaluate the technical requirements and commercial benefits of V2B (Vehicle to Building) technology at Leicester City Hall, U.K. It is part of a collection of reports published by the project covering a variation of specific and cross-cutting analysis and evaluation perspectives and spans 6 operational pilots. This report is dedicated to the analysis of the pilot itself

Vehicle4 Energy Services (V4ES) Evaluation for Upscaling and Transnational potential: Assessing the potential of further roll-out of 8 differing V4(ES) solutions

This report is intended to collect, present, and evaluate the various solutions applied in individual operational pilots for their (upscaling and transnational transfer) potential, in terms of opportunities and barriers, over the short and long(er)-term. This is done by identifying the main characteristics of the solutions and sites and the relevant influencing factors at different local (dimension) contexts. The analysis provides insights in barriers but also opportunities and conditions for success across four main dimensions that make up the local context landscape. We consider two main roll-out scenarios: 1. Upscaling within the boundaries of the country where the operational pilot (OP) took place 2. Transnational Transfer relates to the potential for transferring a (V4)ES solution to any of the other three (project) countries There are several aspects within the four main dimensions that are cross-cutting for all four countries, either because EU legislation lies at its roots, or because market conditions are fairly similar for certain influencing factors in those dimension. Ultimately, both Smart Charging and V2X market are still in their relevant infancies. The solutions applied in various SEEV4-City pilots are relatively straightforward and simple in ‘smartness’. This helps the potential for adoption but may not always be the optimal solution yet. The Peak shaving or load/demand shifting solutions are viable options to reduce costs for different stakeholders in the (electricity) supply chain. The market is likely to mature and become much smarter in coming 5 – 10 years. This also includes the evolvement (or spin-offs) of the solutions applied in SEEV4-_City as well. At least in the coming (approximately) 5 years Smart Charging appears to have the better financial business case and potential for large scale roll-out with less (impactful) bottlenecks, but looking at longer term V2X holds its potential to play a significant role in the energy transition. A common denominator as primary barriers relates to existing regulation, standards readiness and limited market availability of either hardware or service offerings. SEEV4-City has published a significant collection of varying reports, many taking a specific focus. For more detailed information on, for example a particular solution at one of the OPs or more in-depth policy evaluation, please look into these additional reports. They can be found through the Interreg NSR or project specific website, or one of the partners of the project would be glad to provide them

Final report – Loughborough Operational Pilot: Loughborough V2H Operational Pilot Final report with extension of Burton-upon-Trent with V2G application

This is the final report of the SEEV4-City Operational Pilot (OP) in Loughborough and its second phase in Burton-upon-Trent, UK. It is part of a collection of reports published by the Smart, clean Energy and Electric Vehicles for the City (SEEV4-City) Project

Common Genetic Variation And Age at Onset Of Anorexia Nervosa

Background Genetics and biology may influence the age at onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to AN age at onset and to investigate the genetic associations between age at onset of AN and age at menarche. Methods A secondary analysis of the Psychiatric Genomics Consortium genome-wide association study (GWAS) of AN was performed which included 9,335 cases and 31,981 screened controls, all from European ancestries. We conducted GWASs of age at onset, early-onset AN (< 13 years), and typical-onset AN, and genetic correlation, genetic risk score, and Mendelian randomization analyses. Results Two loci were genome-wide significant in the typical-onset AN GWAS. Heritability estimates (SNP-h2) were 0.01-0.04 for age at onset, 0.16-0.25 for early-onset AN, and 0.17-0.25 for typical-onset AN. Early- and typical-onset AN showed distinct genetic correlation patterns with putative risk factors for AN. Specifically, early-onset AN was significantly genetically correlated with younger age at menarche, and typical-onset AN was significantly negatively genetically correlated with anthropometric traits. Genetic risk scores for age at onset and early-onset AN estimated from independent GWASs significantly predicted age at onset. Mendelian randomization analysis suggested a causal link between younger age at menarche and early-onset AN. Conclusions Our results provide evidence consistent with a common variant genetic basis for age at onset and implicate biological pathways regulating menarche and reproduction.Peer reviewe

Shared genetic risk between eating disorder- and substance-use-related phenotypes:Evidence from genome-wide association studies

First published: 16 February 202

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Mapping genomic loci implicates genes and synaptic biology in schizophrenia

Schizophrenia has a heritability of 60-80%1, much of which is attributable to common risk alleles. Here, in a two-stage genome-wide association study of up to 76,755 individuals with schizophrenia and 243,649 control individuals, we report common variant associations at 287 distinct genomic loci. Associations were concentrated in genes that are expressed in excitatory and inhibitory neurons of the central nervous system, but not in other tissues or cell types. Using fine-mapping and functional genomic data, we identify 120 genes (106 protein-coding) that are likely to underpin associations at some of these loci, including 16 genes with credible causal non-synonymous or untranslated region variation. We also implicate fundamental processes related to neuronal function, including synaptic organization, differentiation and transmission. Fine-mapped candidates were enriched for genes associated with rare disruptive coding variants in people with schizophrenia, including the glutamate receptor subunit GRIN2A and transcription factor SP4, and were also enriched for genes implicated by such variants in neurodevelopmental disorders. We identify biological processes relevant to schizophrenia pathophysiology; show convergence of common and rare variant associations in schizophrenia and neurodevelopmental disorders; and provide a resource of prioritized genes and variants to advance mechanistic studies