Long-bone fractures in persons with spinal cord injury

STUDY DESIGN Retrospective data analysis. OBJECTIVES To document fracture characteristics, management and related complications in individuals with traumatic spinal cord injury (SCI). SETTING Rehabilitation centre for SCI individuals. METHOD Patients' records were reviewed. Patients with traumatic SCI and extremity fractures that had occurred after SCI were included. Patient characteristics, fractured bone, fracture localisation, severity and management (operative/conservative), and fracture-related complications were extracted. RESULTS A total of 156 long-bone fractures in 107 SCI patients (34 women and 73 men) were identified. The majority of patients were paraplegics (77.6%) and classified as American Spinal Injury Association Impairment Scale A (86.0%). Only the lower extremities were affected, whereby the femur (60.9% of all fractures) was fractured more frequently than the lower leg (39.1%). A total of 70 patients (65.4%) had one fracture, whereas 37 patients (34.6%) had two or more fractures. Simple or extraarticular fractures were most common (75.0%). Overall, 130 (83.3%) fractures were managed operatively. Approximately half of the femur fractures (48.2%) were treated with locking compression plates. In the lower leg, fractures were mainly managed with external fixation (48.8%). Conservative fracture management was applied in 16.7% of the cases and consisted of braces or a well-padded soft cast. Fracture-associated complications were present in 13.5% of the cases but did not differ significantly between operative (13.1%) and conservative (15.4%) fracture management. CONCLUSION SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg. Fractures were mainly managed operatively with a low complication rate.

Displaced Stories: The Interplay of Telling and Being in the Face of Displacement

Throughout the last decades, narrative approaches have become quintessential tools for understanding crisis and displacement. While a focus on individual stories allows for a deep look into the particularity of being-displaced, it simultaneously runs the risk of romanticising the outcome (the life story) of what is indeed the product of a rather complex process (the telling of the life story). In this paper I will discuss a change of perspectives: Rather than laying the focus on life stories as texts, I will suggest to shift the attention towards the existential dynamics of storytelling. By zooming in on my longstanding collaboration with a Somali woman in Melbourne, Australia, I will map out the interplay of telling and being that marked this process. Focusing on one particular storytelling moment, I will suggest the importance of appreciating the intersubjective force of storytelling. Rather than melting the set of stories into a coherent “life story”, I will look at the storytelling moment in its lived messiness. In doing so, I will sketch out its potential to shed light both on the teller’s hopes, imaginations and ambitions, and on the reality of being part of a wider world that often contradicts and shatters these hopes.

When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study.

OBJECTIVE To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). DESIGN Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. METHODS Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. RESULTS In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. CONCLUSIONS Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

The impact of a brief foot care intervention for persons with diabetes

Purpose of the study. The purpose of this randomized controlled clinical trial was to determine if a brief intervention would improve foot self-care behaviors in adult patients with Type 2 diabetes who presented to the emergency department for non-emergent care in a predominantly Hispanic southwestern border community. ^ Methods. A pre-post-test, three-group design was used to compare the foot self-care behaviors of patients who received usual care to those who received lower extremity amputation (LEA) risk assessment and to those who received LEA risk assessment plus a brief foot self-care intervention. After being randomized into 3 groups (N = 167), baseline assessments of demographics, diabetes history, acculturation, and the Summary of Diabetes Self Care Activities (SDSCA) questionnaire and Modified Insulin Management Diabetes Self Efficacy Scale (MIMDSES) were completed in English or Spanish. At one-month, 144 (84%) participants were available for follow-up by the research assistant masked to group assignment. ^ Results. At baseline, significant differences in foot self-care behaviors and self monitoring blood glucose were noted based on ethnicity and gender. Men had significantly lower confidence in their ability to manage their diabetes overall. There was a significant difference between baseline and follow up self reported foot self-care behaviors within the intervention group (t (47) = −4.32, p < .01) and the control group (t (46) = −2.06, p < .05). There were no significant differences between groups for self-reported foot self-care behaviors. There was a significant difference in observed foot self-care behaviors between groups (F(2,135) = 2.99, p < .05). Self-efficacy scores were positively correlated with self-reported self-care behaviors. ^ Conclusions. This predominantly Hispanic population with type 2 diabetes reported performing diabetes self-care behaviors less than five days a week. There were within group changes, but no significant between group changes in reported self-care behaviors. However, at the one month follow up, there were significant differences between groups in observed foot self-care behaviors with the intervention group demonstrating the most accurate behaviors. Differences based on gender and ethnicity emphasize the need to individualize diabetes education. Priorities for culturally competent diabetes education, approaches to increasing self-efficacy and future research directions are suggested. ^

The illness experience of persons with Parkinson's Disease

Background. Parkinson's disease is a chronic, progressive, age-related, neurodegenerative disorder with no known cause or promising cure. While substantial information is known about the pathophysiology of Parkinson's disease, little is known about the illness experience of persons living with the disease. The purpose of this study was to understand how persons with Parkinson's disease construct their illness experience and manage living with their illness on a daily basis. ^ Method. A qualitative study with an ethnographic approach employed the strategies of participant observations and fieldwork. Field data were generated from a two year exposure to two Parkinson's disease support groups in east Texas. Open-ended semi-structured interviews with seven men and seven women with Parkinson's disease were also conducted. These data were combined and analyzed using thematic analysis. ^ Findings. The illness experience is described through the metaphor "Sailing the Sea in The Eye of the Storm." This metaphor served as the overarching theme that covered the two interacting content themes of the voyage of Daily Negotiations in the Midst of Uncertainty and Reconstruction of the Self with Parkinson's Disease. Daily negotiations incorporated navigating daily activities with the uncertainty of both the progression and daily vicissitudes of the disease. Participants described their symptoms as progressive imprisonment that interfered with daily activities. The progressive nature of the disease required the participants to reconstruct their perceptions of themselves. Reconstructing the self involved the paradoxical balancing of preserving the self while simultaneously releasing aspects of the former self to reconstruct the self with Parkinson's disease. This process was reflected in four exemplars: I Know Me." "It's Still Me," "See Me." and "Remember Me." ^ Conclusions. This qualitative study illuminated the struggle of persons in dealing with the uncertainties and fluctuations of Parkinson's disease and the process of reconstructing their perceptions of themselves. The meaning and reconstruction of the illness experience expressed by participants will inform understanding beyond the disease itself to the illness experience that these participants must deal with on a daily basis. ^

Tuberculosis in persons with concomittant diseases in Houston, Texas, 2004 to 2008

The purpose of this study is to evaluate characteristics of tuberculosis (TB) in diabetics and persons infected with HIV from 2004 to 2008 in Houston, Texas. This analysis will allow us to identify demographic trends. Previous studies have shown that in general, there is a higher risk for HIV+ persons to develop active TB, or to re-activate latent TB, as they progress in their HIV infection. In addition, similar to HIV, diabetes mellitus (DM) weakens the immune system so that persons with DM have also been shown to have a tendency to develop TB. This analysis will examine three areas of research: (a) to explore existing TB trends in Houston/Harris County and associated characteristics, (b) to ascertain the common risk factors of DM and HIV that are correlate with TB infections, and (c) from the analysis of the data, to determine if subsequent TB prevention programs are needed for specific subgroups.^

Identification of genetic variants that influence atherosclerosis in young persons

Atherosclerosis is widely accepted as a complex genetic phenotype and is the usual cause of cardiovascular disease, the world’s leading killer. Genetic factors have been proven to be important risk contributors for atherosclerosis and much work has been done to identify promising candidates that might play a role in the development of atherosclerosis. It is well known that many independent replications are needed to unequivocally establish a valid genotype-phenotype association across different populations before the findings are extended to clinical settings and to the expensive follow-up studies designed to identify causal genetic variants. Aiming to replicate the association with atherosclerosis in the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study, we assessed the relationship of 32 atherosclerosis candidate SNPs to atherosclerosis in the PDAY cohort, consisting of AA and EA young people aged 15-34 years who died of non-medical causes. Two association studies, a whole sample study and a 1:1 matched case control study were performed by use of multiple linear regression and logistic regression analyses, respectively. For the whole sample association study, 32 SNPs among 2,650 individuals (1,369 AA and 1,281 EA) were tested for the association with six early atherosclerosis phenotypes: abdominal aorta fatty streaks, abdominal aorta raised lesions, right coronary artery fatty streaks, right coronary artery raised lesions, thoracic aorta fatty streaks, and thoracic aorta raised lesions. For the matched case-control association study, 337 case-control paired samples were included; cases were chosen with the highest total raised lesion scores from the studied population, while controls were randomly selected from individuals that had no raised lesions and matched to cases by age, gender and race. Sixteen SNPs in 13 genes were found to be significantly associated with atherosclerosis in at least one of the PDAY association studies. Among these 16 findings: eight SNPs (rs9579646, rs6053733, rs3849150, rs10499903, rs2148079, rs5073691, rs10116277, and rs17228212) successfully replicated previous results, six SNPs (rs17222814, rs10811661, rs7028570, rs7291467, rs16996148 and rs10401969) were reported as new findings exclusive to our study, the last two of the 16 SNPs, rs501120 and rs6922269, showed either intriguing or conflicting result. SNP rs17222814 in ALOX5AP and SNP rs3849150 in LRRC18 were consistently associated with atherosclerosis in both prior and the two PDAY association studies. SNP rs3849150 was also identified to be highly correlated with a non-synonymous coding SNP, rs17772611, which may damage the protein (polyphen score = 0.996), suggesting that SNP rs17772611 may be the causal functional variant.^ In conclusion, our study added more support for the association of these candidate genes with atherosclerosis. SNPs rs3849150 and rs17772611 of LRRC18, as well as SNP rs17222814 of ALOX5AP, were the most significant findings from our study, and may be ranked among the best for further study.^

Displaced diatom, discoasters and benthic foraminifers at DSDP Hole 72-515A

Late Pliocene to Recent sediments from the southern Brazil Basin (DSDP Hole 515A, hydraulic piston core) were analyzed for evidence of episodic flow of Antarctic Bottom Water (AABW) through the Vema Channel. Carbonate-enriched layers punctuate the post-Pliocene section, otherwise composed predominantly of terrigenous silt and clay. Carbonate enrichment is thought to result from rapid deposition of fine-grained calcareous turbidites, originating in canyons incised on the northern margin of the Rio Grande Rise. The composition of benthic foraminiferal assemblages and the presence of stratigraphically displaced discoasters is consistent with a turbidite origin. Based on the presence of displaced Antarctic diatoms, AABW flow through the Vema Channel apparently has had a major influence on this site for only four periods during the last 2.7 Ma (about 45 to 250; 375 to 430; 700 to 780; 1320 to 1345 thousand yr. ago).

Are Job Networks Localized in a Developing Economy? Search Methods for Displaced Workers in Thailand

Effects of localized personal networks on the choice of search methods are studied in this paper using evidence of displaced workers by establishment closure in Thailand Labor Force Survey, 2001. For the blocks/villages level, there is less significant evidence of local interactions between job-seekers and referrals in developing labor markets. The effects of localized personal networks do not play an important role in the probability of unemployed job-seekers seeking assistance from friends and relatives. Convincing evidence from the data supports the proposition that both self-selection of individual background-like professions and access to large markets determine the choice of job search method.

Income disparity among persons with disabilities assessed by education and sex : findings from a field survey conducted in Metro Manila, the Philippines

How do persons with disabilities (PWDs) earn a living? From the view point of poverty reduction, this question is quite critical in developing countries. This paper presents an investigation of economic activities of PWDs in the Philippines where, among developing countries, disability-related legislation is relatively progressive. In 2008, a field survey was conducted in cooperation with Disability People’s Organizations (DPOs) using a tailor-made questionnaire in four representative cities of Metro Manila. The level and determinants of income of PWDs were examined with Mincer regression. Conclusions are as follows: (1) The incidence and depth of poverty are greater among sample PWDs than that of the total population in Metro Manila. (2) There is remarkable income disparity among PWDs which is associated with education and sex. (3) After controlling individual, parental, and environmental characteristics, it was found that female PWDs are likely to earn less than male PWDs due to fewer opportunities to participate in economic activities. It is suggested that female PWDs are doubly handicapped in earning income.

A technical note on application of internally finned tubes in solar parabolic trough absorber pipes

The heterogeneous incoming heat flux in solar parabolic trough absorber tubes generates huge temperature difference in each pipe section. Helical internal fins can reduce this effect, homogenising the temperature profile and reducing thermal stress with the drawback of increasing pressure drop. Another effect is the decreasing of the outer surface temperature and thermal losses, improving the thermal efficiency of the collector. The application of internal finned tubes for the design of parabolic trough collectors is analysed with computational fluid dynamics tools. Our numerical approach has been qualified with the computational estimation of reported experimental data regarding phenomena involved in finned tube applications and solar irradiation of parabolic trough collector. The application of finned tubes to the design of parabolic trough collectors must take into account issues as the pressure losses, thermal losses and thermo-mechanical stress, and thermal fatigue. Our analysis shows an improvement potential in parabolic trough solar plants efficiency by the application of internal finned tubes.

Functional connectivity measured with magnetoencephalography identifies persons with HIV disease

There is need for a valid and reliable biomarker for HIV Associated Neurocognitive Disorder (HAND). The purpose of the present study was to provide preliminary evidence of the potential utility of neuronal functional connectivity measures obtained using magnetoencephalography (MEG) to identify HIV-associated changes in brain function. Resting state, eyes closed, MEG data from 10 HIV-infected individuals and 8 seronegative controls were analyzed using mutual information (MI) between all pairs of MEG sensors to ...

Arquitecturas desplazadas. Rafael Bergamín y las arquitecturas del exilio español en Venezuela

El siglo XX ha sido el siglo de los desplazamientos. Una ingente cantidad de personas fueron forzadas por motivos políticos, o se vieron obligadas por motivos económicos, a abandonar sus territorios de origen, generando un distanciamiento que en la mayoría de los casos resultaría irrecuperable. Las penurias vividas en Europa, las oportunidades que se abrían en países americanos, o la presión ejercida por los regímenes totalitarios, llevaron a un buen número de profesionales, artistas e intelectuales europeos a territorio americano. El presente trabajo se propone indagar sobre una de esas migraciones que se establecieron en Latinoamérica en la primera mitad del siglo XX: la de los arquitectos españoles que se vieron forzados al exilio. Para ello se busca poner en evidencia no sólo sus aportaciones sino también la influencia que ejerció en su obra la cultura de los países de adopción. Venezuela recibió gran parte del contingente de arquitectos españoles desplazados como consecuencia de la Guerra Civil. Tras México fue el país que mayor número acogió. La llegada de dichos exiliados coincidió con el momento en que la sociedad venezolana, de base agrícola y comercial, pasaría a evidenciar el impacto de la revolución petrolera. Así pues, dicha llegada supuso no sólo la dramática pérdida del mundo previo, implícita en todo exilio, sino el arribo a una sociedad en profundo proceso de cambio. En ambos casos se trataba de “mundos que se desvanecen”. Se propone la asunción de la obra de dichos profesionales como una arquitectura desplazada. Un desplazamiento que se produce en dos sentidos: por un lado, se trata de un desplazamiento físico, por otro, la palabra desplazada habla también de la condición secundaria que adquiere la arquitectura ante el drama vital y de supervivencia que afectó a los exiliados. Así pues, a un desplazamiento físico, verificable, se une un desplazamiento en cuanto al nivel de importancia y de atención asignado a la arquitectura. El trabajo comprende una introducción, cuatro capítulos, y un epílogo, a modo de conclusión. A lo largo de dichos capítulos se conjugan el enfoque individual en la obra de uno de estos arquitectos desterrados, Rafael Bergamín, y la visión “coral” de diversas trayectorias vitales que enfrentaron un destino común. Se elige la figura de Bergamín como eje de desarrollo debido a la presencia significativa que tuvo su obra tanto en España como en Venezuela, y por la caracterización de la misma como obra construida en colaboración. La introducción, “Exilios arquitectónicos”, muestra el sustrato estructural, la fundamentación y la metodología empleada, incluyendo “problematizaciones” sobre el exilio arquitectónico. El primer capítulo, “Memoria de partida”, da cuenta de la formación y actuación, durante la preguerra, de los arquitectos españoles que saldrían al exilio. Se introduce un esquema de base generacional y se revela un panorama para nada unívoco. El segundo capítulo, “Guerra y salida al exilio”, aborda la actuación de dichos arquitectos durante la contienda bélica así como la posterior dispersión general del exilio. El tercer capítulo, “Construir desde lo que se desvanece. Arquitectos del exilio español en Venezuela”, propone diversos presupuestos conceptuales en torno al tema del desplazamiento en la arquitectura, revisando la adscripción disciplinar y profesional de los arquitectos españoles exiliados en Venezuela. El cuarto capítulo, “El regreso”, versa sobre el recorrido final de estos arquitectos. Como marco general, se revisa su itinerario de regreso o, en muchos casos, la imposibilidad de retorno. Por último, se dispone la fuente de los diversos documentos de archivos y repositorios, así como el aparato bibliográfico y referencial, empleados en la investigación. Tres anexos se adjuntan al corpus del trabajo. El primero presenta documentos inéditos, hallados durante el pertinente proceso de investigación; el segundo, dibujos de Bergamín, básicamente de las primeras décadas del siglo XX: caricaturas, anuncios y trabajos de la Escuela; el tercero, un esbozo biográfico de los arquitectos del exilio español. ABSTRACT The 20th Century has been the century of displacements. An enormous number of people were forced to leave their homelands for political or economic reasons, which generated a gap that in most of the cases would be unrecoverable. The hardships that people had to endure in Europe, the opportunities that emerged in American countries, or the pressure exerted by totalitarian regimes drove a good number of European professionals, artists and intellectuals to American territory. This research study is intended to investigate one of those migrations that settled in Latin America during the first half of the 20th century: the one of the Spanish architects that were forced into exile. To achieve this, an attempt was made to expose not only their contributions but also the influence that the culture of the countries which welcomed them exerted in their work. Venezuela received a large portion of Spanish architects who were displaced as a consequence of the Civil War. After Mexico, it was the country that sheltered the greatest number of persons. The arrival of these exiled Spanish architects coincided with the moment in which the Venezuelan society – based on agriculture and commerce – would witness the impact of the revolution of the oil industry. Thus, their arrival supposed not only experiencing the dramatic loss of their previous world – implicit in the notion of the exile – but also settling in a society going through a profound change process. In both cases it was about “two worlds that were vanishing.” The assumption of these architects’ work is regarded as a displaced architecture. A displacement that takes place in two ways: on one hand, there was a physical displacement, and on the other hand, the word displaced also talks about the second place that architecture is given when confronted with the urgent drama of survival that affected the exiled community. Hence, a physical, verifiable displacement is combined with a displacement that has to do with the importance and the attention given to architecture. This research study encompasses an introduction, four chapters, and an epilogue as a conclusion. Throughout the chapters, the individual approach to the work of one of these exiled architects, Rafael Bergamín, runs in parallel to an overall view of various other architects’ career paths that faced a common destiny. The work of the architect Bergamín was chosen as the center of this research study due to the significant presence that his work had in Spain as well as in Venezuela, and because its main characteristic was that it was built in collaboration with other architects. The introduction, “Architectural exiles”, shows the structural contextualization, the explanatory thesis statement and the methodology used, including “problematizations” about the architectural exile. The first chapter, “Memory of departure”, contains the academic background and performance during the pre-war time of the Spanish architects that would go into exile. An outline based on different generations and revealing an unambiguous perspective is introduced. The second chapter, “War and departure into exile”, tackles the performance of the Spanish architects during the war, as well as the following general diaspora into exile. The third chapter, “Building from what vanishes. Architects of the Spanish exile in Venezuela”, proposes various conceptual assumptions concerning the topic of displacement in architecture according to the doctrine and professional affiliations of the Spanish architects exiled in Venezuela. The fourth chapter, “The return”, deals with the end of these architects’ careers. As a general framework, their itineraries to return, or in many cases, the impossibility of returning, are reviewed. Finally, the sources to the various documents of files and repositories, as well as the bibliographical references consulted for the research, are provided. Three annexes have been attached to this research study. The first annex contains unpublished documents found during the research process; the second includes Bergamín’s drawings, basically from the first decades of the 20th century, such as, caricatures, advertisements and assignments done when he was a university student; and the third annex presents a biographical outline of the architects of the Spanish exile.