Fall-related emergency department admission: fall environment and settings and related injury patterns in 6357 patients with special emphasis on the elderly

PRINCIPALS Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. METHODS Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. RESULTS Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). CONCLUSION Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.

The Prophecies of Zechariah : with special reference to the origin and date of chapters 9-14

Leipzig, Univ., Diss., 1896

The ring vaccination trial: a novel cluster randomised controlled trial design to evaluate vaccine efficacy and effectiveness during outbreaks, with special reference to Ebola

A World Health Organization expert meeting on Ebola vaccines proposed urgent safety and efficacy studies in response to the outbreak in West Africa. One approach to communicable disease control is ring vaccination of individuals at high risk of infection due to their social or geographical connection to a known case. This paper describes the protocol for a novel cluster randomised controlled trial design which uses ring vaccination.In the Ebola ça suffit ring vaccination trial, rings are randomised 1:1 to (a) immediate vaccination of eligible adults with single dose vaccination or (b) vaccination delayed by 21 days. Vaccine efficacy against disease is assessed in participants over equivalent periods from the day of randomisation. Secondary objectives include vaccine effectiveness at the level of the ring, and incidence of serious adverse events.Ring vaccination trials are adaptive, can be run until disease elimination, allow interim analysis, and can go dormant during inter-epidemic periods.

How to avoid venous thromboembolism in women at increased risk--with special focus on low-risk periods

Venous thromboembolism (VTE) is a major cause of mortality during Western women's fertile life. Although half of thromboembolic events occur during times of low-risk situations, almost all our knowledge is focused on medical thromboprophylaxis during high-risk situations. Thus, since we only use medical thromboprophylaxis at high-risk periods, lifestyle advice could be an attractive complement both during high- and low-risk situations. The knowledge of how lifestyle factors affect VTE risk has grown in recent years, and women at high risk are often highly motivated to make changes in order to reduce their risk. This review is focused on modifiable risk factors for VTE and advice that may be given to women at increased risk of VTE.

A systematic review on the innervation of peri-implant tissues with special emphasis on the influence of implant placement and loading protocols

OBJECTIVES To systematically review the available literature on the influence of dental implant placement and loading protocols on peri-implant innervation. MATERIAL AND METHODS The database MEDLINE, Cochrane, EMBASE, Web of Science, LILACS, OpenGrey and hand searching were used to identify the studies published up to July 2013, with a populations, exposures and outcomes (PEO) search strategy using MeSH keywords, focusing on the question: Is there, and if so, what is the effect of time between tooth extraction and implant placement or implant loading on neural fibre content in the peri-implant hard and soft tissues? RESULTS Of 683 titles retrieved based on the standardized search strategy, only 10 articles fulfilled the inclusion criteria, five evaluating the innervation of peri-implant epithelium, five elucidating the sensory function in peri-implant bone. Three included studies were considered having a methodology of medium quality and the rest were at low quality. All those papers reported a sensory innervation around osseointegrated implants, either in the bone-implant interface or peri-implant epithelium, which expressed a particular innervation pattern. Compared to unloaded implants or extraction sites without implantation, a significant higher density of nerve fibres around loaded dental implants was confirmed. CONCLUSIONS To date, the published literature describes peri-implant innervation with a distinct pattern in hard and soft tissues. Implant loading seems to increase the density of nerve fibres in peri-implant tissues, with insufficient evidence to distinguish between the innervation patterns following immediate and delayed implant placement and loading protocols. Variability in study design and loading protocols across the literature and a high risk of bias in the studies included may contribute to this inconsistency, revealing the need for more uniformity in reporting, randomized controlled trials, longer observation periods and standardization of protocols.

Modeling postglacial vegetation dynamics of temperate forests on the Olympic Peninsula (WA, USA) with special regard to snowpack

Past and future forest composition and distribution in temperate mountain ranges is strongly influenced by temperature and snowpack. We used LANDCLIM, a spatially explicit, dynamic vegetation model, to simulate forest dynamics for the last 16,000 years and compared the simulation results to pollen and macrofossil records at five sites on the Olympic Peninsula (Washington, USA). To address the hydrological effects of climate-driven variations in snowpack on simulated forest dynamics, we added a simple snow accumulation-and-melt module to the vegetation model and compared simulations with and without the module. LANDCLIM produced realistic present-day species composition with respect to elevation and precipitation gradients. Over the last 16,000 years, simulations driven by transient climate data from an atmosphere-ocean general circulation model (AOGCM) and by a chironomid-based temperature reconstruction captured Late-glacial to Late Holocene transitions in forest communities. Overall, the reconstruction-driven vegetation simulations matched observed vegetation changes better than the AOGCM-driven simulations. This study also indicates that forest composition is very sensitive to snowpack-mediated changes in soil moisture. Simulations without the snow module showed a strong effect of snowpack on key bioclimatic variables and species composition at higher elevations. A projected upward shift of the snow line and a decrease in snowpack might lead to drastic changes in mountain forests composition and even a shift to dry meadows due to insufficient moisture availability in shallow alpine soils.

Summer Abundance of Fishes in a Maine Tidal Cove with Special Reference to Temperature

The daytime abundance and localized distribution of fishes in relation to temperature were studied in a small tidal cove by beach seining on seven dates in the Back River estuary, Maine, during the summers of 1971 and 1972. Temperatures on the seven dates ranged from 15.1–26.2 C, and salinities ranged from 17.3–24.7‰. Eighteen species of fishes were captured, with mummichogs, smooth flounders, Atlantic silversides and Atlantic herring together comprising over 98% of the catch. Mummichogs and Atlantic silversides were captured primarily near the inner end of the cove, while other abundant species were caught mainly at the outer end of the cove. Several species seem well adapted to naturally warm cove temperatures. Others seem now virtually excluded because of warm temperatures. Winter flounder, Atlantic herring, and Atlantic tomcod might be excluded from the cove during daytime in summer if artificial warming of the cove were permitted.

The astrological works of Abraham Ibn Ezra : a literary and linguistic study with special reference to the Old French translation of Hagin

by Raphael Levy

Childhood cancer survivor satisfaction with characteristics of clinical care

This study investigated the characteristics of a clinic that affect how satisfied survivors of childhood cancer are with their medical care. Questionnaire and interview data from the Passport for Care: Texas Implementation project collected between January 2011 to April 2012 were analyzed. Eleven clinics in Texas participated. Questionnaire respondents were childhood cancer survivor patients who had been off therapy for at least 2 years, or their parents. Interview respondents were clinical providers or research staff at the participating clinics. The outcomes evaluated were answers to a single question on satisfaction with care and a composite Percent Satisfaction Score created from seven other questionnaire items that were correlated (Spearman Rho >0.3) with the question on satisfaction. The following characteristics were also evaluated: sex, age, race, education, and type of cancer. The following clinic indicators were evaluated: type of clinic (general vs. dedicated cancer survivor clinics), number of providers, number of survivors, ratio of survivors/providers, distribution of handouts, distribution of treatment summaries, and use of Children's Oncology Group (COG) guidelines. ^ The only demographic characteristic that affected satisfaction was race. A Kruskal-Wallis test showed a statistically significant difference (Chi-square 6.129, 2 d.f., p = 0.0467). To analyze this further, Wilcoxon Rank Sum test of pairings of the three groups were performed. A Bonferroni correction for multiple testing was applied, with p = 0.017 indicating significance at alpha = 0.05. There was no significant difference between the White and Hispanic groups or between the Hispanic and "Other" groups. For the White and "Other" groups there was a significant difference for the satisfaction item (p = 0.0123) but not for the Percent Satisfaction Score (p = 0.0289). These results suggest that race may influence satisfaction and should be evaluated further in future studies. ^ None of the clinic indicators affected the Percent Satisfaction Score. Going to a clinic that distributed patient information handouts (Wilcoxon Rank Sum p = 0.048) and going to a clinic with >=100 survivors (Wilcoxon Rank Sum p = 0.021) were associated with increased satisfaction. The population of childhood cancer survivors is a growing group of individuals with special health needs. In the future survivors will likely seek medical care in a variety of clinical settings, so it is important to investigate features to improve patient satisfaction with clinical care.^

Regional differences regarding land tenancy in rural Rwanda, with special reference to sharecropping in a coffee production area

This paper examines land tenancy systems and tenant contracts in Rwanda, with respect to socioeconomic contexts. Our research in southern and eastern Rwanda produced data suggesting that land borrowing with fixed rents has been generally practiced, and that rent levels have been low in comparison to expected revenues from field production. In the western areas of coffee production, however, the practice of sharecropping has recently appeared. This system is advantageous to landowners, as they are able to acquire half of the harvests; in addition, the fixed rent levels in this region are much higher than those of other regions. In the southern and eastern regions, because land borrowing with fixed rents has been the only tenancy pattern and rent levels have remained low, the economic situation should be interpreted in the context of a continuing traditional Rwandan land tenure system. In contrast, in the western coffee production area, the soaring of fixed rents and the emergence of sharecropping have been brought about by high pressures for land use, which were caused not only by a population increase but also by the development of cash crop production and the existence of a labor exchange system. The increase in rent levels has therefore been offset by a corresponding increase in agricultural productivity.