Evaluation of FRAX® score use in Maltese osteoporosis management guidelines

Objectives: Recent years have brought a shift towards evidence-based fracture risk engines. Fracture Risk Assessment Tool (FRAX®) is one such diagnostic tool used to evaluate the ten-year probability of osteoporotic fracture risk. The aim of this study was to evaluate the Maltese FRAX® score-based osteoporosis management guidelines and identify the suitability of using such a risk factor engine-based protocol. Study design: Data from 702 patients presenting for bone mineral density (BMD) estimation in 2010- 2011 were collected. In this period, local guidelines were devised but not yet put into practice so all referred patients underwent BMD estimation. These patients were below 65 years of age and above the minimum age for FRAX® use: 40 years. Data included Age, Weight, Height, BMI and the presence of any risk factor components of the FRAX® score tool. BMD was assessed using Norland/Hologic densitometers. FRAX® scores (excluding BMD) for each patient were calculated using the online tool www.shef.ac.uk/FRAX as accessed in 2014. The resulting major osteoporotic fracture risk was compared to age-specific assessment thresholds as set by Kanis et al. (2013). Thus the appropriateness (or otherwise) of densitometry measurements as dictated by local guidelines was determined. Main outcome measures: The main outcome measures in this study were the femoral neck and vertebral body BMD. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of using the FRAX®-based guidelines in under 65 year olds were calculated. Results: Local guidelines for managing <65 year olds were found to have a PPV of 11.26% and a NPV of 94.38 % Conclusion: FRAX®-guided local guidelines are well suited at excluding non-osteoporotic patients (False omission rate of 5.62 %). Positive likelihood ratio for the protocol was found to be 1.27. This means that 1 in every 8.8 patients that would have been referred for BMD estimation were actually osteoporotic.peer-reviewe

Gas Purity effect on GEM Performance in He and Ne at Low Temperatures

The performance of Gas Electron Multipliers (GEMs) in gaseous He, Ne, He+H2 and Ne+H2 was studied at temperatures in the range of 3-293 K. This paper reports on previously published measurements and additional studies on the effects of the purity of the gases in which the GEM performance is evaluated. In He, at temperatures between 77 and 293 K, triple-GEM structures operate at rather high gains, exceeding 1000. There is an indication that this high gain is achieved through the Penning effect as a result of impurities in the gas. At lower temperatures the gain-voltage characteristics are significantly modified probably due to the freeze-out of these impurities. Double-GEM and single-GEM structures can operate down to 3 K at gains reaching only several tens at a gas density of about 0.5 g/l; at higher densities the maximum gain drops further. In Ne, the maximum gain also drops at cryogenic temperatures. The gain drop in Ne at low temperatures can be re-established in Penning mixtures of Ne+H2: very high gains, exceeding 104, have been obtained in these mixtures at 30-77 K, at a density of 9.2 g/l which corresponds to saturated Ne vapor density at 27 K. The addition of small amounts of H2 in He also re-establishes large GEM gains above 30 K but no gain was observed in He+H2 at 4 K and a density of 1.7 g/l (corresponding to roughly one-tenth of the saturated vapor density). These studies are, in part, being pursued in the development of two-phase He and Ne detectors for solar neutrino detection.Comment: 4 pages, 7 figure

Lil....

Ġabra ta’ poeżiji u proża li tinkludi: Biki ta’ Omm ta’ Dun Karm – Ras il-Pellegrin ta’ Manwel Agius – L-Aħħar Tislima ta’ Ġużè Galea – Lil Ibni Herman-Baruch ta’ Karmenu Vassallo – Flus ir-Regħba Ħajja Qasira ta’ P. P. Saydon – Frak ta’ R. M. B. – Id-Dolliegħa u l-Qargħa ta’ R. M. B. – Il-Barrakka ta’ Katrin ta’ P. Pawl Tabone – Ħniena! ta’ Fran. Camilleri – Lil.... ta’ M. Agius.N/

Assessment of intelligibility in dysarthria: development of a Maltese word and phrase list

This paper describes the development of the Maltese Intelligibility Lists (MIL) for the assessment of word and phrase intelligibility in dysarthria. Two main tools were employed: the Frenchay Dysarthria Assessment-2 (FDA), and the Maltese Language Resource Server (MLRS). Three main criteria served as the basis for the construction of the word and phrase lists: frequency of occurrence of Maltese phonemes, word frequency and an analysis of syllable types and structures. The most common 500 words in the MLRS corpus (Korpus Malti v. 3) were broadly transcribed and an analysis of different types of syllables and their frequency of occurrence was carried out. Based on this analysis, the relevant proportion of different syllable types required for the word and phrase lists for Maltese was calculated in line with the number of items present in the FDA-2. With regards to phoneme frequency, the words chosen demonstrate a similar short-vowel and consonant distribution as reported in a previous large-scale study. The MIL consists of 116 words and 50 phrases which are representative of Standard Maltese and can be used in the clinic to assess speech intelligibility in Maltese individuals with dysarthria

Urban noise and psychological distress: A systematic review

Chronic exposure to urban noise is harmful for auditory perception, cardiovascular, gastrointestinal and nervous systems, while also causing psychological annoyance. Around 25% of the EU population experience a deterioration in the quality of life due to annoyance and about 5&ndash;15% suffer from sleep disorders, with many disability-adjusted life years (DALYs) lost annually. This systematic review highlights the main sources of urban noise, the relevant principal clinical disorders and the most effected countries. This review included articles published on the major databases (PubMed, Cochrane Library, Scopus), using a combination of some keywords. The online search yielded 265 references; after selection, the authors have analyzed 54 articles (5 reviews and 49 original articles). From the analysis, among the sources of exposure, we found the majority of items dealing with airports and wind turbines, followed by roads and trains; the main disorders that were investigated in different populations dealt with annoyance and sleep disorders, sometimes associated with cardiovascular symptoms. Regarding countries, studies were published from all over the world with a slight prevalence from Western Europe. Considering these fundamental health consequences, research needs to be extended in such a way as to include new sources of noise and new technologies, to ensure a health promotion system and to reduce the risk of residents being exposed

Allergic anaphylactic risk in farming activities: A systematic review

Allergic disorders in the agriculture sector are very common among farm workers, causing many injuries and occupational diseases every year. Agricultural employees are exposed to multiple conditions and various allergenic substances, which could be related to onset of anaphylactic reactions. This systematic review highlights the main clinical manifestation, the allergens that are mostly involved and the main activities that are usually involved. This research includes articles published on the major databases (PubMed, Cochrane Library, Scopus), using a combination of keywords. The online search yielded 489 references; after selection, by the authors, 36 articles (nine reviews and 27 original articles) were analyzed. From this analysis, the main clinical problems that were diagnosed in this category were respiratory (ranging from rhinitis to asthma) and dermatological (eczema, dermatitis, hives) in nature, with a wide symptomatology (from a simple local reaction to anaphylaxis). The main activities associated with these allergic conditions are harvesting or cultivation of fruit and cereals, beekeepers and people working in greenhouses. Finally, in addition to the allergens already known, new ones have emerged, including triticale, wine, spider and biological dust. For these reasons, in the agricultural sector, research needs to be amplified, considering new sectors, new technologies and new products, and ensuring a system of prevention to reduce this risk.peer-reviewe

Spina bifida-predisposing heterozygous mutations in Planar Cell Polarity genes and Zic2 reduce bone mass in young mice

Fractures are a common comorbidity in children with the neural tube defect (NTD) spina bifida. Mutations in the Wnt/planar cell polarity (PCP) pathway contribute to NTDs in humans and mice, but whether this pathway independently determines bone mass is poorly understood. Here, we first confirmed that core Wnt/PCP components are expressed in osteoblasts and osteoclasts in vitro. In vivo, we performed detailed µCT comparisons of bone structure in tibiae from young male mice heterozygous for NTD-associated mutations versus WT littermates. PCP signalling disruption caused by Vangl2 (Vangl2Lp/+) or Celsr1 (Celsr1Crsh/+) mutations significantly reduced trabecular bone mass and distal tibial cortical thickness. NTD-associated mutations in non-PCP transcription factors were also investigated. Pax3 mutation (Pax3Sp2H/+) had minimal effects on bone mass. Zic2 mutation (Zic2Ku/+) significantly altered the position of the tibia/fibula junction and diminished cortical bone in the proximal tibia. Beyond these genes, we bioinformatically documented the known extent of shared genetic networks between NTDs and bone properties. 46 genes involved in neural tube closure are annotated with bone-related ontologies. These findings document shared genetic networks between spina bifida risk and bone structure, including PCP components and Zic2. Genetic variants which predispose to spina bifida may therefore independently diminish bone mass

Asymmetric interlimb transfer of concurrent adaptation to opposing dynamic forces

Interlimb transfer of a novel dynamic force has been well documented. It has also been shown that unimanual adaptation to opposing novel environments is possible if they are associated with different workspaces. The main aim of this study was to test if adaptation to opposing velocity dependent viscous forces with one arm could improve the initial performance of the other arm. The study also examined whether this interlimb transfer occurred across an extrinsic, spatial, coordinative system or an intrinsic, joint based, coordinative system. Subjects initially adapted to opposing viscous forces separated by target location. Our measure of performance was the correlation between the speed profiles of each movement within a force condition and an ‘average’ trajectory within null force conditions. Adaptation to the opposing forces was seen during initial acquisition with a significantly improved coefficient in epoch eight compared to epoch one. We then tested interlimb transfer from the dominant to non-dominant arm (D → ND) and vice-versa (ND → D) across either an extrinsic or intrinsic coordinative system. Interlimb transfer was only seen from the dominant to the non-dominant limb across an intrinsic coordinative system. These results support previous studies involving adaptation to a single dynamic force but also indicate that interlimb transfer of multiple opposing states is possible. This suggests that the information available at the level of representation allowing interlimb transfer can be more intricate than a general movement goal or a single perceived directional error

Increasing the simulation performance of large-scale evacuations using parallel computing techniques based on domain decomposition

Evacuation simulation has the potential to be used as part of a decision support system during large-scale incidents to provide advice to incident commanders. To be viable in these applications, it is essential that the simulation can run many times faster than real time. Parallel processing is a method of reducing run times for very large computational simulations by distributing the workload amongst a number of processors. This paper presents the development of a parallel version of the rule based evacuation simulation software buildingEXODUS using domain decomposition. Four Case Studies (CS) were tested using a cluster, consisting of 10 Intel Core 2 Duo (dual core) 3.16 GHz CPUs. CS-1 involved an idealised large geometry, with 20 exits, intended to illustrate the peak computational speed up performance of the parallel implementation, the population consisted of 100,000 agents; the peak computational speedup (PCS) was 14.6 and the peak real-time speedup (PRTS) was 4.0. CS-2 was a long area with a single exit area with a population of 100,000 agents; the PCS was 13.2 and the PRTS was 17.2. CS-3 was a 50 storey high rise building with a population of 8000/16,000 agents; the PCS was 2.48/4.49 and the PRTS was 17.9/12.9. CS-4 is a large realistic urban area with 60,000/120,000 agents; the PCS was 5.3/6.89 and the PRTS was 5.31/3.0. This type of computational performance opens evacuation simulation to a range of new innovative application areas such as real-time incident support, dynamic signage in smart buildings and virtual training environments