Postoperative analgesic effect, of preoperatively administered dexamethasone, after operative fixation of fractured neck of femur: randomised, double blinded controlled study.

Background: Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur. Methods: Institutional ethical approval was granted and written informed consent was obtained from each patient. Patients awaiting for surgery at Cork University Hospital were recruited between July 2009 and August 2012. Participating patients, scheduled for surgery were randomly allocated to one of two groups (Dexamethasone or Placebo). Patients in the dexamethasone group received a single dose of intravenous dexamethasone 0.1 mg kg -1 immediately preoperatively. Patients in the placebo group received the same volume of normal saline. Patients underwent operative fixation of fractured neck of femur using standardised spinal anaesthesia and surgical techniques. The primary outcome was pain scores at rest 6 h after the surgery. Results: Thirty seven patients were recruited and data from thirty patients were analysed. The groups were similar in terms of patient characteristics. Pain scores at rest 6 h after the surgery (the principal outcome) were lesser in the dexamethasone group compared with the placebo group [0.8(1.3) vs. 3.9(2.9), mean(SD) p = 0.0004]. Cumulative morphine consumption 24 h after the surgery was also lesser in the dexamethasone group [7.7(8.3) vs. 15.1(9.4), mean(SD) mg, p = 0.04]. Conclusions: A single dose of intravenous dexamethasone 0.1 mg kg -1 administered before operative fixation of fractured neck of femur improve significantly the early postoperative analgesia. Trial registration: ClinicalTrials.gov identifier: NCT01550146, date of registration: 07/03/2012

Strontium isotope analysis of seawater and at a mixture of planktic foraminifera during the Paleocene and Early Eocene from different holes of ODP Leg 2008

We refined the strontium isotope seawater curve for the Paleocene and early Eocene by analysis of samples recovered from the Walvis Ridge during Ocean Drilling Project (ODP) Leg 208. The highest 87Sr/86Sr values occurred in the earliest Paleocene at 65 Ma and generally decreased throughout the Paleocene, reaching minimum values between 53 and 51 Ma in the early Eocene before beginning to increase again at 50 Ma. A plausible explanation for the 87Sr/86Sr decrease between 65 and 51 Ma is increased rates of hydrothermal activity and/or the eruption and weathering of large igneous provinces (e.g., Deccan Traps and North Atlantic). Strontium isotope variations closely parallel sea level and benthic d18O changes during the late Paleocene and early Eocene, supporting previous studies linking tectonic reorganization and increased volcanism to high sea level, high CO2, and warm global temperatures.

(Fig. 1D, 3E) Sea surface temperature and alkenone C37:4 for sediment core MD01-2444 during the penultimate glaciation

Past glacials can be thought of as natural experiments in which variations in boundary conditions influenced the character of climate change. However, beyond the last glacial, an integrated view of orbital- and millennial-scale changes and their relation to the record of glaciation has been lacking. Here, we present a detailed record of variations in the land-ocean system from the Portuguese margin during the penultimate glacial and place it within the framework of ice-volume changes, with particular reference to European ice-sheet dynamics. The interaction of orbital- and millennial-scale variability divides the glacial into an early part with warmer and wetter overall conditions and prominent climate oscillations, a transitional mid-part, and a late part with more subdued changes as the system entered a maximum glacial state. The most extreme event occurred in the mid-part and was associated with melting of the extensive European ice sheet and maximum discharge from the Fleuve Manche river. This led to disruption of the meridional overturning circulation, but not a major activation of the bipolar seesaw. In addition to stadial duration, magnitude of freshwater forcing, and background climate, the evidence also points to the influence of the location of freshwater discharges on the extent of interhemispheric heat transport.

Nd isotopes an geochemistry of bulk deep sea sediments of the Atlantic Ocean

Nd isotopes preserved in fossil fish teeth and ferromanganese crusts have become a common tool for tracking variations in water mass composition and circulation through time. Studies of Nd isotopes extracted from Pleistocene to Holocene bulk sediments using hydroxylamine hydrochloride (HH) solution yield high resolution records of Nd isotopes that can be interpreted in terms of deep water circulation, but concerns about diagenesis and potential contamination of the seawater signal limit application of this technique to geologically young samples. In this study we demonstrate that Nd extracted from the > 63 µm, decarbonated fraction of older Ocean Drilling Program (ODP) sediments using a 0.02 M HH solution produces Nd isotopic ratios that are within error of values from cleaned fossil fish teeth collected from the same samples, indicating that the HH-extractions are robust recorders of deep sea Nd isotopes. This excellent correlation was achieved for 94 paired fish teeth and HH-extraction samples ranging in age from the Miocene to Cretaceous, distributed throughout the north, tropical and south Atlantic, and composed of a range of lithologies including carbonate-rich oozes/chalks and black shales. The strong Nd signal recovered from Cretaceous anoxic black shale sequences is unlikely to be associated with ferromanganese oxide coatings, but may be derived from abundant phosphatic fish teeth and debris or organic matter in these samples. In contrast to the deep water Nd isotopic signal, Sr isotopes from HH-extractions are often offset from seawater values, suggesting that evaluation of Sr isotopes is a conservative test for the integrity of Nd isotopes in the HH fraction. However, rare earth elements (REE) from the HH-extractions and fish teeth produce distinctive middle REE bulge patterns that may prove useful for evaluating whether the Nd isotopic signal represents uncontaminated seawater. Alternatively, a few paired HH-extraction and cleaned fish teeth samples from each site of interest can be used to verify the seawater composition of the HH-extractions. The similarity between isotopic values for the HH-extraction and fish teeth illustrates that the extensive cleaning protocol applied to fish teeth samples is not necessary in typical, carbonate-rich, deep sea sediments.

SYSTEMATIC REVIEW AND META-ANALYSIS: EFFECTS OF WALKING EXERCISE IN CHRONIC MUSCULOSKELETAL PAIN

SYSTEMATIC REVIEW AND META-ANALYSIS: EFFECTS OF WALKING EXERCISE IN CHRONIC MUSCULOSKELETAL PAIN O'Connor S.R.1, Tully M.A.2, Ryan B.3, Baxter D.G.3, Bradley J.M.1, McDonough S.M.11University of Ulster, Health & Rehabilitation Sciences Research Institute, Newtownabbey, United Kingdom, 2Queen's University, UKCRC Centre of Excellence for Public Health (NI), Belfast, United Kingdom, 3University of Otago, Centre for Physiotherapy Research, Dunedin, New ZealandPurpose: To examine the effects of walking exercise on pain and self-reported function in adults with chronic musculoskeletal pain.Relevance: Chronic musculoskeletal pain is a major cause of morbidity, exerting a substantial influence on long-term health status and overall quality of life. Current treatment recommendations advocate various aerobic exercise interventions for such conditions. Walking may represent an ideal form of exercise due to its relatively low impact. However, there is currently limited evidence for its effectiveness.Participants: Not applicable.Methods: A comprehensive search strategy was undertaken by two independent reviewers according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the recommendations of the Cochrane Musculoskeletal Review Group. Six electronic databases (Medline, CINAHL, PsychINFO, PEDro, Sport DISCUS and the Cochrane Central Register of Controlled Trials) were searched for relevant papers published up to January 2010 using MeSH terms. All randomised or non-randomised studies published in full were considered for inclusion. Studies were required to include adults aged 18 years or over with a diagnosis of chronic low back pain, osteoarthritis or fibromyalgia. Studies were excluded if they involved peri-operative or post-operative interventions or did not include a comparative, non exercise or non-walking exercise control group. The U.S. Preventative Services Task Force system was used to assess methodological quality. Data for pain and self-reported function were extracted and converted to a score out of 100.Analysis: Data were pooled and analyzed using RevMan (v.5.0.24). Statistical heterogeneity was assessed using the X2 and I2 test statistics. A random effects model was used to calculate the mean differences and 95% CIs. Data were analyzed by length of final follow-up which was categorized as short (≤8 weeks post randomisation), mid (2-12 months) or long-term (>12 months).Results: A total of 4324 articles were identified and twenty studies (1852 participants) meeting the inclusion criteria were included in the review. Overall, studies were judged to be of at least fair methodological quality. The most common sources of likely bias were identified as lack of concealed allocation and failure to adequately address incomplete data. Data from 12 studies were suitable for meta-analysis. Walking led to reductions in pain at short (<8 weeks post randomisation) (-8.44 [-14.54, -2.33]) and mid-term (>8 weeks - 12 month) follow-up (-9.28 [-16.34, -2.22]). No effect was observed for long-term (>12 month) data (-2.49 [-7.62, 2.65]). For function, between group differences were observed for short (-11.57 [-16.06, -7.08]) and mid-term data (-13.26 [-16.91, -9.62]). A smaller effect was also observed at long-term follow-up (-5.60 [-7.70, -3.50]).Conclusions: Walking interventions were associated with statistically significant improvements in pain and function at short and mid-term follow-up. Long-term data were limited but indicated that these effects do not appear to be maintained beyond twelve months.Implications: Walking may be an effective form of exercise for individuals with chronic musculoskeletal pain. However, further research is required which examines longer term follow-up and dose-response issues in this population.Key-words: 1. Walking exercise 2. Musculoskeletal pain 3. Systematic reviewFunding acknowledgements: Department of Employment and Learning, Northern Ireland.Ethics approval: Not applicable.

Síndrome metabólica em mulheres com síndrome dos ovários policísticos: prevalência em cidade da região nordeste do Brasil

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Síndrome metabólica em mulheres com síndrome dos ovários policísticos: prevalência em cidade da região nordeste do Brasil

Resumo

Missionary life among the cannibals : being the life of the Rev. John Geddie, D.D., first missionary to the New Hebrides : with a history of the Nova Scotia Presbyterian mission on that group / by George Patterson.

http://www.archive.org/details/cannibalmission00pattuoft

Championnats d'Angleterre [Ã Londres], [George] Trowbridge [course de haies] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59971

Poésies d'« ALLAIN CHARRETIER », « PIERRE DE NESSON », « JEHAN CASTEL », « MICHAULT », « GEORGE » et « PIERRE CHASTELLAIN », « MOULINET », [MARTIAL D'AUVERGNE].

Contient : 1 « Les Faiz maistre Allain Charretier », savoir : ; 2 « Louenge et foy et honmaige faicte à la Vierge Marie par maistre Pierre de Nesson » ; 3 « Le Specule des pecheurs », par « Jehan Castel » (fol. 331), — « Requeste de Castel adroissant à monseigneur de Gaucourt ». (fol. 345) ; 4 « Le Passe temps Michault » ; 5 « Le Debat d'Hector et d'Achilles », par « George » [Chastelain] ; 6 « Le Contrepasse temps Michault », par « Pierre Chastellain » ; 7 « Le Temple de Mars », par « Moulinet » ; 8 « L'Amant rendu Cordelier à l'observance d'amours » [par Martial d'Auvergne] ; 9 Pièces anonymes :

Portrait of "Ruth", by George A. Hemstreet, Photographer, Milton [n.d.]

A woman identified only by the broach at her neck as "Ruth" is pictured here in a black and white cabinet card photograph by G. A. Hemstreet. The photo is undated, but believed to be from the late 1870s or early 1880s. The photographer's name is stamped in black ink along the bottom of the card: "G. A. Hemstreet, Photographer, Milton, Ont." This cabinet card was in the possession of Iris Sloman Bell, of St. Catharines, whose relatives include former Black slaves from the United States.G. A. Hemstreet, also known as George A. Hemstreet, was a photographer in Milton, Ontario from 1877 - 1887. Source: Phillips, Glen C. The Ontario photographers list (1851-1900). Sarnia: Iron Gate Publishing Co., 1990.

Letter from S.D. Woodruff to George Rykert

Letter from S.D. Woodruff which he writes from the office of the Port Dalhousie Thorold Railway Company to George Rykert. He submits an abstract of prices of people to undertake the construction of the railway from Port Dalhousie, Mar. 30, 1854.

Estimated cost of the Port Dalhousie and Thorold Railway sent to George Rykert by S.D. Woodruff

Estimated cost of the Port Dalhousie and Thorold Railway sent to George Rykert by S.D. Woodruff, Aug. 5, 1854.