Coordination of Care by Primary Care Practices: Strategies, Lessons and Implications

Documents successful strategies for coordinating care within primary care settings, including family and caregivers; with specialists; with hospital settings; and with community-based services. Discusses challenges, lessons learned, and implications

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in young patients

Objectives: Traditionally, bone-patella tendon-bone (BTB) autograft has been the gold standard graft choice for younger, athletic patients requiring ACL reconstruction. However, donor site morbidity, post-operative patella fracture, and increased operative time have led many surgeons to choose BTB allograft for their reconstructions. Opponents of allografts feel that slower healing time, higher rate of graft failure, and potential for disease transmission makes them undesirable graft choices in athletic patients. The purpose of this study is to evaluate the clinical outcomes, both subjective and objective, of young patients that who have undergone either BTB autograft or allograft reconstructions with a minimum of 2-year follow-up. Methods: One hundred and twenty patients (60 autograft, 60 allograft), age 25 and below at time of surgery, were contacted after being retrospectively identified as patients having an ACL reconstruction with either a BTB allograft or autograft by one senior surgeon. Patients were administered the Lysholm Knee Scoring Scale and IKDC Subjective Knee Evaluation questionnaires. Fifty (25 BTB autograft and 25 BTB allograft) of the 120 returned for physical examination as well as completion of a single leg hop test and laxity evaluation using a KT-1000 arthrometer evaluation. Of the 120 patients contacted, there were a total of 7 failures (5.8%) requiring revision, 6 in the allograft group (86%) and 1 in the autograft group (14%). Results: The average Lysholm scores were 89.0 and 89.56 and the average IKDC scores were 90.8 and 92.1 in the autograft and allograft groups respectively. The differences in the Lysholm scores and the IKDC scores were not significant. The single leg hop and KT-1000 scores were also not significantly different. One autograft patient had a minor motion deficit. Three allograft patients had a grade 1 Lachman and pivot glide. One autograft patient and two allograft patients had mild patellafemoral crepitus. There was no significant difference in anterior knee pain between the two groups Conclusion: There is no significant difference in patient-rated outcome between ACL reconstructions using BTB autografts versus allografts. However, the overall study group did reveal an increased failure rate requiring revision in the allograft group. © The Author(s) 2015

Radion Induced Brane Preheating

When the interbrane separation in compact Randall-Sundrum models is stabilized via the Goldberger-Wise mechanism, a potential is generated for the four dimensional field that encodes this geometric information, the so-called radion. Due to its origin as a part of the full five dimensional metric, the radion couples directly to particles on both branes. We exhibit the exponential growth in the number of brane particles due to parametric amplification from radion oscillations and discuss some of the consequences of this process for brane cosmology.Comment: 4 pages, uses ReVTeX, 3 postscript figure

Resummed Photon Spectra for WIMP Annihilation

We construct an effective field theory (EFT) description of the hard photon spectrum for heavy WIMP annihilation. This facilitates precision predictions relevant for line searches, and allows the incorporation of non-trivial energy resolution effects. Our framework combines techniques from non-relativistic EFTs and soft-collinear effective theory (SCET), as well as its multi-scale extensions that have been recently introduced for studying jet substructure. We find a number of interesting features, including the simultaneous presence of SCET$_{\text{I}}$ and SCET$_{\text{II}}$ modes, as well as collinear-soft modes at the electroweak scale. We derive a factorization formula that enables both the resummation of the leading large Sudakov double logarithms that appear in the perturbative spectrum, and the inclusion of Sommerfeld enhancement effects. Consistency of this factorization is demonstrated to leading logarithmic order through explicit calculation. Our final result contains both the exclusive and the inclusive limits, thereby providing a unifying description of these two previously-considered approximations. We estimate the impact on experimental sensitivity, focusing for concreteness on an SU(2)$_{W}$ triplet fermion dark matter - the pure wino - where the strongest constraints are due to a search for gamma-ray lines from the Galactic Center. We find numerically significant corrections compared to previous results, thereby highlighting the importance of accounting for the photon spectrum when interpreting data from current and future indirect detection experiments.Comment: 55+25 pages, 11+2 figures; v3, updated an expression in the appendix to make it applicable at higher order - no impact on the results in this wor

Structure of the full-length TRPV2 channel by cryo-EM.

Transient receptor potential (TRP) proteins form a superfamily Ca(2+)-permeable cation channels regulated by a range of chemical and physical stimuli. Structural analysis of a 'minimal' TRP vanilloid subtype 1 (TRPV1) elucidated a mechanism of channel activation by agonists through changes in its outer pore region. Though homologous to TRPV1, other TRPV channels (TRPV2-6) are insensitive to TRPV1 activators including heat and vanilloids. To further understand the structural basis of TRPV channel function, we determined the structure of full-length TRPV2 at ∼5 Å resolution by cryo-electron microscopy. Like TRPV1, TRPV2 contains two constrictions, one each in the pore-forming upper and lower gates. The agonist-free full-length TRPV2 has wider upper and lower gates compared with closed and agonist-activated TRPV1. We propose these newly revealed TRPV2 structural features contribute to diversity of TRPV channels