Impact of malnutrition on 12-month mortality following acute hip fracture

Background Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This study aimed to determine whether malnutrition independently predicted 12-month post-fracture mortality after adjusting for clinically relevant covariates. Methods An ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010–October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. Demographic (age, gender, admission residence) and clinical covariates included fracture type, time to surgery, anaesthesia type, type of surgery, post-surgery time to mobilize and post-operative complications (delirium, pulmonary and deep vein thrombosis, cardiac complications, infections). The Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician. Results A total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (P = 0.007), malnutrition (P < 0.001), time to mobilize >48 h (P < 0.001), delirium (P = 0.003), pulmonary embolism (P = 0.029) and cardiovascular complication (P = 0.04) were associated with 12-month mortality. Logistic regression analysis demonstrated that malnutrition (odds ratio (OR) 2.4 (95% confidence interval (CI) 1.3–4.7, P = 0.007)), in addition to admission from residential care (OR 2.6 (95% CI 1.3–5.3, P = 0.005)) and pulmonary embolism (OR 11.0 (95% CI 1.5–78.7, P = 0.017)), independently predicted 12-month mortality. Conclusions Findings substantiate malnutrition as an independent predictor of 12-month mortality in a representative sample of hip fracture inpatients. Effective strategies to identify and treat malnutrition in hip fracture should be prioritized.

Planar pursuit-evasion with variable speeds, part 1, extremal trajectory maps

Pursuit evasion in a plane is formulated with both players allowed to vary their speeds between fixed limits. A suitable choice of real-space coordinates confers open-loop optimality on the game. The solution in the small is described in terms of the individual players'' extremal trajectory maps (ETM). Each map is independent of role, adversary, and capture radius. An ETM depicts the actual real-space trajectories. A template method of generating constant control arcs is described. Examples of ETM for an aircraft flying at a constant altitude with fixed and varying speeds are presented.

Measurement of sensitivities for the thermal recording of laser beams

A simple technique for determining the energy sensitivities for the thermographic recording of laser beams is described. The principle behind this technique is that, if a laser beam with a known spatial distribution such as a Gaussian profile is used for imaging, the radius of the thermal image formed depends uniquely on the intensity of the impinging beam. Thus by measuring the radii of the images produced for different incident beam intensities the minimum intensity necessary (that is, the threshold) for thermographic imaging is found. The diameter of the laser beam can also be found from this measurement. A simple analysis based on the temperature distribution in the laser heated material shows that there is an inverse square root dependence on pulse duration or period of exposure for the energy fluence of the laser beam required, both for the threshold and the subsequent increase in the size of the recording. It has also been shown that except for low intensity, long duration exposure on very low conductivity materials, heat losses are not very significant.

f Gravity and gravitational singularities

TRAUTMAN has postulated1 that the usual space−time singularity occurring in classical cosmological models and in the gravitational collapse of massive objects could be averted if intrinsic spin effects are incorporated into general relativity by adding torsion terms to the usual Einstein field equations, that is through the Einstein−Cartan theory. Invoking a primordial magnetic field for aligning all the individual nuclear spins he shows that his universe consisting of 1080 aligned neutrons collapses to a minimum radius of the order of 1 cm with a corresponding matter density of 1055 g cm-3.

Mechanics of transition in an axisymmetric laminar boundary layer on a circular cylinder

Measurements of the growth of artificially generated turbulent spots and intermittency distribution in the transition region on a circular cylinder in axial flow show that the instability Reynolds number of 11,000 has a marked effect on the properties. In particular, it is found that the spot production in the initial region when a single turbulent spot has not yet wrapped around the cylinder and the propagation is essentially two-dimensional, is significantly altered. But the transition in the downstream or latter region, where most of the turbulent spots propagate onedimensionally (like the turbulent plugs in a pipe), is not affected. When the radius Reynolds number is more than 11,000, the intermittency law in the initial region is essentially the same as in twodimensional flow on a flat plate and in the latter region it is the one-dimensional flow in a pipe, the demarcation between the two regions being quite sharp.

A note on the movement of single large liquid bubbles in vertical tubes

The flow of single large liquid bubbles under gravity in closed tubes is studied here for the case when the liquid bubble exhibits micropolar behaviour. The film thickness, velocity profile in the bubble and film, and nonNewtonian effects are studied and compared with those for the correspondingNewtonian fluid. The investigation is restricted to the case where the bubble length is far greater than the tube radius.

Stress analysis of a thick plate having a circular hole under axisymmetric radial load

In this paper a solution for the determination of stresses and displacements in a thick plate having a cylindrical hole subjected to localised hydrostatic loading has been given. Detail numerical results have been presented and compared with the results of an infinite hole subjected to localised hydrostatic load and a semiinfinite hole subjected to localised end load. It has been shown that for certain ratio of thickness of the pate to the radius of the hole and loading, the results could be obtained by using the solution of infinite or semiinfinite hole subjected to the same hydrostatic loading.

The structure of turbulent boundary layers along mildly curved surfaces

This paper describes a detailed study of the structure of turbulence in boundary layers along mildly curved convex and concave surfaces. The surface curvature studied corresponds to δ/Rw = ± 0·01, δ being the boundary-layer thickness and Rw the radius of curvature of the wall, taken as positive for convex and negative for concave curvature. Measurements of turbulent energy balance, autocorrelations, auto- and cross-power spectra, amplitude probability distributions and conditional correlations are reported. It is observed that even mild curvature has very strong effects on the various aspects of the turbulent structure. For example, convex curvature suppresses the diffusion of turbulent energy away from the wall, reduces drastically the integral time scales and shifts the spectral distributions of turbulent energy and Reynolds shear stress towards high wavenumbers. Exactly opposite effects, though generally of a smaller magnitude, are produced by concave wall curvature. It is also found that curvature of either sign affects the v fluctuations more strongly than the u fluctuations and that curvature effects are more significant in the outer region of the boundary layer than in the region close to the wall. The data on the conditional correlations are used to study, in detail, the mechanism of turbulent transport in curved boundary layers. (Published Online April 12 2006)

Temporality of the Face-to-Face in Levinas' Ethics

This thesis focuses on a connection between temporality and ethics in the philosophy of Emmanuel Levinas. I argue that Levinas understanding of temporality is rooted in the function of pra-impression which in its turn does not belong to the intentional consciousness but reveals a subject as being open to the Other. In the face-to-face situation with the Other the pra-impression is an essential and constitutive force: it fractures the moment of the present, questions subjectivity and generates a new meaning of temporality. As a result a responsible subject is revealed; responsibility for the Other marks a latent birth of the subject which is prior to any origin of subjectivity, it discloses a meaning of time that does not belong to the subject but is found in the Other. In this study I suggest that pra-impression finds its productive force in language, the function of the feminine, and what Levinas calls the other in the same .

The structure of phosphacymantrene

Proton NMR spectra of phosphacymantrene (π-phospholyl manganese tricarbonyl) orientated in the nematic phases of liquid crystals have been investigated. The derived H-H and H-P direct dipolar coupling constants have been used to determine the relative proton-proton and proton-phosphorus distances. A comparison of the geometrical data of various 5-membered aromatic heterocycles shows that the relative distances between the protons closest to the heteroatom increase with the van der Waals radius of the heteroatom. The results suggest that NMR spectroscopy of orientated molecules can be used to determine van der Waals radii.

Mean Flow Measurements in Turbulent Boundary Layers along Mildly Curved Surfaces

An experimental investigation of the mean flow characteristics of two-dimensional turbulent boundary layers over surfaces of mild longitudinal curvature is reported. The study covered both convex and concave walls of \d/Rw I « 0.013 (d being the boundary-layer thickness and Rw being the wall radius). It was found that, whereas the region close to the wall was not affected significantly by wall curvature, the outer region was very sensitive to even mild wall curvature. A detailed study of the wake region using present and other available data suggests a systematic effect of b/Rw on the wake structure. The paper also discusses in detail the effect of mild wall curvature on the boundary-layer development with particular emphasis on the difference in behavior of the boundary layer at short and long distances from the leading edge of the curved wall, an aspect which has not received sufficient attention in previous experimental investigations. An attempt has been made to explain this behavior from a consideration of the structure of turbulence in boundary layers over curved surfaces taken into account.

Effects of recreational use and fragmentation on the understorey vegetation and soil microbial communities of urban forests in southern Finland

The impacts of fragmentation and recreational use on the hemiboreal urban forest understorey vegetation and the microbial community of the humus layer (the phospholipid fatty acid (PLFA) pattern, microbial biomass and microbial activity, measured as basal respiration) were examined in the greater Helsinki area, southern Finland. Trampling tolerance of 1) herb-rich OMT, 2) mesic MT, and 3) sub-xeric VT forests (in decreasing order of fertility) was studied by comparing relative understorey vegetation cover (urban/untrampled reference ratio) of the three forest types. The trampling tolerance of forest vegetation increased with the productivity of the site (sub-xeric < mesic < herb-rich). Wear of understorey vegetation correlated positively with the number of residents (i.e., recreational pressure) around the forest patch. An increase of 15000 residents within a radius of 1 km around a forest patch was associated with ca. 30% decrease in the relative understorey vegetation cover. The cover of dwarf shrub Vaccinium myrtillus in particular decreased with increasing levels of wear. The cover of mosses in urban forests was less than half of that in untrampled reference areas. Cover of tree saplings, mainly Sorbus aucuparia, and some resilient herbs was higher than in the reference areas. In small urban forest fragments, broad-leaved trees, grasses and herbs were more abundant and mosses were scarcer than in larger urban forest areas. Thus, due to trampling and edge effects, resilient herb and grass species are replacing sensitive dwarf shrubs, mosses and lichens in urban forests. Differences in the soil microbial community structure were found between paths and untrampled areas and the effects of paths extended more than one meter from the paths. Paths supported approximately 25-30% higher microbial biomass with a transition zone of at least 1 m from the path edge. However, microbial activity per unit of biomass was lower on paths than in untrampled areas. Furthermore, microbial biomass and activity were 30-45% lower at the first 20 m into the forest fragments, due to low moisture content of humus near the edge. The decreased microbial activity detected at forest edges and paths implies decreased litter decomposition rates, and thus, a change in nutrient cycling. Changes in the decomposition and nutrient supply may in turn affect the diversity and function of plant communities in urban forests. Keywords: boreal forest vegetation, edge effects, phospholipid fatty acids, trampling, urban woodlands, wear

Pathogenic Mechanisms of Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy (PLOSL)

PATHOGENIC MECHANISMS OF PLOSL Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL), also known as Nasu-Hakola disease, is a recessively inherited disease of brain and bone. PLOSL manifests as early-onset progressive dementia and bone fractures. Mutations in the TYROBP (DAP12) and TREM2 genes have been identified as the primary cause of PLOSL. DAP12 and TREM2 encode important signalling molecules in cells of the innate immune system. The mechanism by which loss-of-function of the DAP12/TREM2 signalling complex leads to PLOSL is currently unknown. The aim of this thesis work was to gain insight into the pathogenic mechanisms behind PLOSL. To first identify the central nervous system (CNS) cell types that express both Dap12 and Trem2, the expression patterns of Dap12 and Trem2 in mouse CNS were analyzed. Dap12 and Trem2 expression was seen from embryonic stage to adulthood and microglial cells and oligodendrocytes were identified as the major Dap12/Trem2 producing cells of the CNS. To subsequently identify the pathways and biological processes associated with DAP12/TREM2 mediated signalling in human cells, genome wide transcript analysis of in vitro differentiated dendritic cells (DCs) of PLOSL patients representing functional knockouts of either DAP12 or TREM2 was performed. Both DAP12 and TREM2 deficient cells differentiated into DCs and responded to pathogenic stimuli. However, the DCs showed morphological differences compared to control cells due to defects in the actin filaments. Transcript profiles of the patient DCs showed differential expression of genes involved in immune response and for genes earlier associated with other disorders of the CNS as well as genes involved in the remodeling of bone, linking the findings with the tissue phenotype of PLOSL patients. To analyze the effect of Dap12 deficiency in the CNS, genome wide expression analysis of Dap12 deficient mouse brain and Dap12 deficient microglia as well as functional analysis of Dap12 deficient microglia was performed. Regulation of several pathways involved in synaptic function and transcripts coding for the myelin components was seen in Dap12 knockout mice. Decreased migration, morphological changes and shortened lifespan of the Dap12 knockout microglia was further observed. Taken together, this thesis work showed that both Dap12 and Trem2 are expressed by CNS microglia and that Dap12 deficiency results in functional defects of these cells. Lack of Dap12 in the CNS also leads to synaptic abnormalities even before pathological changes are seen in the tissue level.This work further showed that loss-of-function of DAP12 or TREM2 leads to changes in morphology and gene expression in human dendritic cells. These data underline the functional diversity of the molecules of the innate immune system and implies their significant contribution also in demyelinating CNS disorders, including those resulting in dementia.

Dark matter dominance at all radii in the superthin galaxy UGC 7321

We model the shape and density profile of the dark matter halo of the low surface brightness, superthin galaxy UGC 7321, using the observed rotation curve and the H i scale height data as simultaneous constraints. We treat the galaxy as a gravitationally coupled system of stars and gas, responding to the gravitational potential of the dark matter halo. An isothermal halo of spherical shape with a core density in the range of View the MathML source and a core radius between 2.5 and 2.9 kpc, gives the best fit to the observations for a range of realistic gas parameters assumed. We find that the best-fit core radius is only slightly higher than the stellar disc scale length (2.1 kpc), unlike the case of the high surface brightness galaxies where the halo core radius is typically 3–4 times the disc scale length of the stars. Thus our model shows that the dark matter halo dominates the dynamics of the low surface brightness, superthin galaxy UGC 7321 at all radii, including the inner parts of the galaxy.

Improving diagnosis of tumor-induced osteomalacia with gallium-68 DOTATATE PET/CT

Context: Tumor-induced osteomalacia (TIO) is a rarely diagnosed disorder presenting with bone pain, fractures, muscle weakness, and moderate-to-severe hypophosphatemia resulting from fibroblast growth factor 23-mediated renal phosphate wasting. Tumors secreting fibroblast growth factor 23 are often small and difficult to find with conventional imaging. Objective: We studied the utility of 68Ga-DOTA-octreotate (DOTATATE) somatostatin receptor positron emission tomography (PET)/computed tomography (CT) imaging in the diagnosis of TIO. Design and Setting: A multicenter case series was conducted at tertiary referral hospitals. Patients and Methods: Six patients with TIO diagnosed between 2003 and 2012 in Australia were referred for DOTATATE PET imaging. We reviewed the clinical history, biochemistry, imaging characteristics, histopathology, and clinical outcome of each patient. Results: Each case demonstrated delayed diagnosis despite severe symptoms. DOTATATE PET/CT imaging demonstrated high uptake and localized the tumor with confidence in each case. After surgical excision, there was resolution of clinical symptoms and serum phosphate, except in one patient who demonstrated residual disease on PET/CT. All tumors demonstrated high somatostatin receptor subtype 2 cell surface receptor expression using immunohistochemistry. Conclusions: In patients with TIO, DOTATATE PET/CT can successfully localize phosphaturic mesenchymal tumors and may be a practical first step in functional imaging for this disorder. Serum phosphate should be measured routinely in patients with unexplained muscle weakness, bone pain, or stress fractures to allow earlier diagnosis of TIO. - See more at: http://press.endocrine.org/doi/abs/10.1210/jc.2012-3642#sthash.eXD0CopL.dpuf