887 resultados para fragility fractures
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Los agrietamientos poligonales representan una forma común de modelado granítico cuyo origen y evolución continúa en fase de estudio, no existiendo una sistematización de estas estructuras diversas. Algunos autores explican su origen por procesos geodinámicos internos, relacionándolo con movimientos de planos de fractura en estados tardíos de consolidación magmática. Otros autores atribuyen su formación y desarrollo a factores externos relacionados con el régimen climático. La gran variedad de agrietamientos poligonales requiere la utilización de un número mayor de variables para definir los distintos orígenes, y las posibles interrelaciones entre los factores externos e internos, así como para explicar la evolución de dichas estructuras y avanzar en la clasificación de los patrones concretos. Este trabajo pretende contribuir a sistematizar los mecanismos que intervienen en el desarrollo de agrietamientos poligonales. Para ello se estudian únicamente agrietamientos poligonales formados sobre planos de fractura verticales o subverticales. En particular se establecen relaciones entre la presencia de agrietamientos poligonales y la red de fracturación, la altura de aparición, la orientación e inclinación de la pared, la morfología de las placas y la profundidad de incisión de las grietas perimetrales. Por otra parte, establece relaciones entre procesos geodinámicos internos y procesos de meteorización externos.
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Antecedentes. Pes Adulto planus (pie plano) es un problema común encontrado por muchos profesionales de la salud. A pesar de la percepción de que el pie plano puede causar dolor y deteriorar su función, la disponibilidad y el uso generalizado de diversos tratamientos, no hay consenso sobre la estrategia óptima de tratamiento. Objetivo. Evaluar la efectividad de las intervenciones conservadoras (no quirúrgicos) para pie plano en los adultos. Método. Se realizó una búsqueda sistemática de la literatura. Esto incluye: el Registro Cochrane Central de Ensayos Controlados; los Juicios CMSG Especializados Registro; una búsqueda electrónica se realizó utilizando MEDLINE (1960 a junio de 2012), EMBASE (1980 a junio de 2012), y CINAHL (1982 - junio de 2012). Revistas especializadas, listas de referencias de ensayos y artículos de revisión se realizaron búsquedas manuales. Criterios de selección: Ensayos aleatorios o cuasialeatorios de intervenciones de tratamiento para el pie plano en los adultos. Se excluyeron los ensayos que incluyeron patologías específicas como el dolor plantar del talón, las fracturas por sobrecarga de los metatarsianos, disfunción del tendón tibial posterior-, fracturas de tobillo, patologías del pie reumatoide, enfermedades neuromusculares y las complicaciones del pie diabético. Recopilación y análisis de datos: Dos autores seleccionaron de forma independiente los resultados de la búsqueda para identificar a aquellos que satisfacen los criterios de inclusión y evaluaron la calidad de los incluidos mediante una lista de control basado en la Evaluación de la Colaboración Cochrane de Riesgo. Esta herramienta se centró en el riesgo de la selección, el rendimiento, la detección, la heterogeneidad y el sesgo de notificación. Resultados. Cuatro ensayos, con 140 sujetos, cumplieron los criterios de inclusión para la revisión. Los cuatro fueron juzgados como de alto riesgo de sesgo en al menos un área, y también estaban en riesgo de sesgo incierto en al menos otra zona. Todos anotaron altamente en relación al sesgo de deserción, debido al corto seguimiento tiempos y diseños experimentales utilizados. Los datos no se agruparon debido al alto nivel de heterogeneidad identificada en las intervenciones evaluadas, los participantes seleccionados y medir los resultados. Los resultados de un estudio sugieren que después de cuatro semanas de uso ortesis puede resultar en una mejora significativa en vaivén lateral medio, y pueden resultar en una mejor, aunque no significativa, en general relacionados con la calidad de vida de los pies (Roma 2004). Un estudio (Redmond 2009) sugiere que su efecto sobre la distribución de la presión plantar en el pie puede no depender de si son personalizados o dispositivos prefabricados. Aunque este estudio se identificaron cambios significativos en algunas variables de presión plantar tanto con la costumbre y dispositivos prefabricados, otro (Esterman 2005) no encontró ningún efecto significativo de longitud ¾ ortesis prefabricadas sobre el dolor, la incidencia de lesiones, salud pie o de calidad de vida en un grupo de reclutas de la fuerza aérea. El cuarto estudio (Jung 2009) sugiere que el ejercicio de los músculos intrínsecos del pie puede mejorar el efecto de las ortesis. A pesar de estos resultados, ya que cada estudio incurrió riesgo de sesgo en al menos un área no se pueden sacar conclusiones
Time for treating bone fracture using rhBMP-2: a randomised placebo controlled mouse fracture trial.
Resumo:
Although the mechanisms of osteoinduction by bone morphogenic proteins (BMPs) are increasingly understood, the most appropriate time to administer BMPs exogenously is yet to be clarified.The purpose of this study was to investigate when BMP may be administered to a fracture arena to maximise the enhancement of healing.Forty mice with externally fixed left femoral fractures were randomised into four groups: Group I, the control group was given a placebo of 30 ll saline at day 0; Groups II, III and IV were given 30 ll saline plus 2.5 lg rhBMP-2, at post-operative days 0, 4 or 8, respectively.Sequential radiographs were taken at days 0, 8, 16.On day 22 the mice were sacrificed and both femora were harvested for biomechanical assessment in 3-point bending and histological evaluation.Radiographic analysis indicated that healing of fractures in Groups II and III was significantly greater (p <0.05) than those in Groups I and IV, at both 16 and 22 days post-fracture. The highest median bone mineral content at the fracture site was evidenced in Group III and II.Furthermore, Group III also had the highest relative ultimate load values, followed by Groups II, IV and I.Greater percentage peak loads were observed between Group I and both Groups II and III (p <0.05). Histological examination confirmed that at 22 days post-fracture, only fractures in Groups II and III had united with woven bone, and Groups I and IV still had considerable amounts of fibrous tissue and cartilage at the fracture gap.Data presented herein indicates that there is a time after fracture when rhBMP administration is most effective, and this may be at the time of surgery as well as in the early fracture healing phases.
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Patients with coxarthrosis (cOA) have a reduced incidence of intracapsular femoral neck fracture, suggesting that cOA offers protection. The distribution of bone in the femoral neck was compared in cases of coxarthrosis and postmortem controls to assess the possibility that disease-associated changes might contribute to reduced fragility. Whole cross-section femoral neck biopsies were obtained from 17 patients with cOA and 22 age- and sex-matched cadaveric controls. Densitometry was performed using peripheral quantitated computed tomography (pQCT) and histomorphometry on 10-µm plastic-embedded sections. Cortical bone mass was not different between cases and controls (P > 0.23), but cancellous bone mass was increased by 75% in cOA (P = 0.014) and histomorphometric cancellous bone area by 71% (P <0.0001). This was principally the result of an increase of apparent density (mass/vol) of cancellous bone (+45%, P = 0.001). Whereas cortical porosity was increased in the cases (P <0.0001), trabecular width was also increased overall in the cases by 52% (P <0.001), as was cancellous connectivity measured by strut analysis (P <0.01). Where osteophytic bone was present (n = 9) there was a positive relationship between the amount of osteophyte and the percentage of cancellous area (P <0.05). Since cancellous bone buttresses and stiffens the cortex so reducing the risk of buckling, the increased cancellous bone mass and connectivity seen in cases of cOA probably explain, at least in part, the ability of patients with cOA to resist intracapsular fracture of the femoral neck during a fall.
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To assess the contribution of accumulated winter precipitation and glacial meltwater to the recharge of deep ground water flow systems in fracture crystalline rocks, measurements of environmental isotope ratios, hydrochemical composition, and in situ parameters of ground water were performed in a deep tunnel. The measurements demonstrate the significance of these ground water recharge components for deep ground water flow systems in fractured granites of a high alpine catchment in the Central Alps, Switzerland. Hydrochemical and in situ parameters, as well as d18O in ground water samples collected in the tunnel, show only small temporal variations. The precipitation record of d18O shows seasonal variations of ~14‰ and a decrease of 0.23‰ ± 0.03‰ per 100 m elevation gain. d2H and d18O in precipitation are well correlated and plot close to the meteoric water line, as well as d2H and d18O in ground water samples, reflecting the meteoric origin of the latter. The depletion of 18O in ground water compared to 18O content in precipitation during the ground water recharge period indicates significant contributions from accumulated depleted winter precipitation to ground water recharge. The hydrochemical composition of the encountered ground water, Na-Ca-HCO3-SO4(-F), reflects an evolution of the ground water along the flowpath through the granite body. Observed tritium concentrations in ground water range from 2.6 to 16.6 TU, with the lowest values associated with a local negative temperature anomaly and anomalous depleted 18O in ground water. This demonstrates the effect of local ground water recharge from meltwater of submodern glacial ice. Such localized recharge from glaciated areas occurs along preferential flowpaths within the granite body that are mainly controlled by observed hydraulic active shear fractures and cataclastic faults.
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The objective of this study was to determine how structure, stratigraphy, and weathering influence fate and transport of contaminants (particularly U) in the ground water and geologic material at the Department of Energy (DOE) Environmental Remediation Sciences Department (ERSD) Field Research Center (FRC). Several cores were collected near four former unlined adjoining waste disposal ponds. The cores were collected, described, analyzed for U, and compared with ground water geochemistry from surrounding multilevel wells. At some locations, acidic U-contaminated ground water was found to preferentially flow in small remnant fractures weathering the surrounding shale (nitric acid extractable U [UNA] usually <50 mg kg–1) into thin (
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The turn within urban policy to address increasingly complex social, economic and environmental problems has exposed some of the fragility of traditional measurement models and their reliance on the rational paradigm. This article looks at the experiences of the European Union (EU) Programme for Peace and Reconciliation in Northern Ireland and its particular attempt to construct new District Partnerships to deliver area-based regeneration programmes. It highlights the need to combine instrumental and interpretative evaluation methods in an attempt to explain the wider contribution of governance to conflict resolution and participatory practice in local development. It concludes by highlighting the value of conceptual approaches that deal with the politics of evaluation and the distributional effects of policy interventions designed to create new relationships within and between multiple stakeholders.
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Objectives: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. Design: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. Setting: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. Participants: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). Interventions: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. Main outcome measures: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. Results: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks. Conclusions: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture.
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Osteoporosis (OP) is one of the most prevalent bone diseases worldwide with bone fracture the major clinical consequence. The effect of OP on fracture repair is disputed and although it might be expected for fracture repair to be delayed in osteoporotic individuals, a definitive answer to this question still eludes us. The aim of this study was to clarify the effect of osteoporosis in a rodent fracture model. OP was induced in 3-month-old rats (n = 53) by ovariectomy (OVX) followed by an externally fixated, mid-diaphyseal femoral osteotomy at 6 months (OVX group). A further 40 animals underwent a fracture at 6 months (control group). Animals were sacrificed at 1, 2, 4, 6, and 8 weeks postfracture with outcome measures of histology, biomechanical strength testing, pQCT, relative BMD, and motion detection. OVX animals had significantly lower BMD, slower fracture repair (histologically), reduced stiffness in the fractured femora (8 weeks) and strength in the contralateral femora (6 and 8 weeks), increased body weight, and decreased motion. This study has demonstrated that OVX is associated with decrease in BMD (particularly in trabecular bone) and a reduction in the mechanical properties of intact bone and healing fractures. The histological, biomechanical, and radiological measures of union suggest that OVX delayed fracture healing. (C) 2007 Orthopaedic Research Society. Published by Wiley Periodicals.
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The electrical conductivities of 1-alkyl-3-methylimidazolium tetrafluoroborate ionic liquids and of 1-hexyl-3-methylimidazolium ionic liquids with different anions were determined in the temperature range between 123 and 393 K on the basis of dielectric measurements in the frequency range from 1 to 10(7) Hz. Most of the ionic liquids form a glass and the conductivity values obey the Vogel-Fulcher-Tammann equation. The glass transition temperatures are increasing with increasing length of the alkyl chain. The fragility is weakly dependent on the alkyl chain length but is highly sensitive to the structure of the anion. (c) 2008 American Institute of Physics.
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We present results from complementary characterizations of the primary relaxation rate of a room temperature ionic liquid (RTIL), 1-hexyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl} imide, [C(6)mim][Tf2N], over a wide temperature range. This extensive data set is successfully merged with existing literature data for conductivity, viscosity, and NMR diffusion coefficients thus providing, for the case of RTILs, a unique description of the primary process relaxation map over more than 12 decades in relaxation rate and between 185 and 430 K. This unique data set allows a detailed characterization of the VTF parameters for the primary process, that are: B = 890 K, T-0 = 155.2 K, leading to a fragility index m = 71, corresponding to an intermediate fragility. For the first time neutron spin echo data from a fully deuteriated sample of RTIL at the two main interference peaks, Q = 0.76 and 1.4 angstrom(-1) are presented. At high temperature (T > 250 K), the collective structural relaxation rate follows the viscosity behavior; however at lower temperatures it deviates from the viscosity behavior, indicating the existence of a faster process.
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En este artículo me propongo mostrar que lo que Sócrates hace con Fedro a lo largo de toda la obra no es otra cosa que utilizar la auténtica retórica (con su doble carga, dialéctica y psicológica) que es descrita en la segunda parte del diálogo. Las tensiones, rivalidades y celos de la situación inicial entre ellos expone un perfil representativo de relaciones entre interlocutores con perspectivas intelectuales opuestas. Es preciso disolver la resistencia emocional por medio de una serie de pasos graduales, estratégicos, y ‘engañosos’ (no se puede develar el propio juego desde el principio). Hay que partir de acuerdos, siquiera parciales, para continuar dialogando. Sin embargo, Sócrates también introduce nociones nuevas acerca del amor, pero éstas pasan desapercibidas a un Fedro obsesionado con la imitación de su enamorado Lisias. Hasta que Sócrates decide cortar el juego y cruzar el río. Este corte provoca un giro en ambos personajes: Fedro se dispone a escuchar lo que Sócrates quiere contarle (el mito del carro alado) y Sócrates se revela ante sí mismo como un personaje capaz de ‘encantar’ a Fedro con la belleza rapsódica del relato y superar su propio temor de convertirse en una bestia devoradora. Al final Sócrates muestra su juego a Fedro y le enseña cómo ha sido posible llegar a un auténtico diálogo filosófico, donde pueda tener lugar la enseñanza y el aprendizaje recíprocos.
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As a consequence of the fragility of various neural structures, preterm infants born at a low gestation and/or birthweight are at an increased risk of developing motor abnormalities. The lack of a reliable means of assessing motor integrity prevents early therapeutic intervention. In this paper, we propose a new method of assessing neonatal motor performance, namely the recording and subsequent analysis of intraoral sucking pressures generated when feeding nutritively. By measuring the infant's control of sucking in terms of a new development of tau theory, normal patterns of intraoral motor control were established for term infants. Using this same measure, the present study revealed irregularities in sucking control of preterm infants. When these findings were compared to a physiotherapist's assessment six months later, the preterm infants who sucked irregularly were found to be delayed in their motor development. Perhaps a goal-directed behaviour such as sucking control that can be measured objectively at a very young age, could be included as part of the neurological assessment of the preterm infant. More accurate classification of a preterm infant's movement abnormalities would allow for early therapeutic interventions to be realised when the infant is still acquiring the most basic of motor functions. (C) Springer-Verlag 2000.
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A sustained reduction in unemployment, economic growth and house price increase have reflected Belfast’s post-conflict renaissance just as readily as the global recession has exposed the fragility of construction-led growth. Rates of segregation had stabilised and new consumption spaces and élite developments further reflected the city’s engagement with globalisation and economic liberalisation. This paper explores the spatial impact of these processes, not least as gentrification has created new layers of residential segregation in a city already preoccupied with high rates of ethno-religious territoriality. A case study of south Belfast connects these shifts to the production of new mixed-religion neighbourhoods. These have the capacity to reduce the relevance of traditional binary identities, but at the same time reproduce new forms of segregation centred on tenure and class. The paper concludes by highlighting the implications for policy and practice, not least as the recession opens new spaces to present alternatives to the market logic.
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The problem of the long-term impact of historical fire on masonry is not clearly understood. Much research focuses on the damage that is caused by fire in isolation, and omits to investigate the subsequent exploitation of weaknesses inherited from fire events. Fire can, for example, cause significant physical, chemical and mineralogical change to sandstone, which may then be exploited by background environmental factors such as salt and freeze–thaw weathering. To explore this experimentally, blocks of Peakmoor Sandstone were subjected to a real fire (as well as lime rendering/removal and frost cycle pre-treatments), and their subsequent response to salt weathering cycles was monitored by weight loss and visual assessment of the pattern of surface damage. Results illustrate that the post-fire deterioration of sandstone is strongly conditioned by fracture networks and soot cover inherited from the fire. The exploitation of fractures can lead to spalling during salt weathering cycles — this takes place as granular dissagregation steadily widens cracks and salts concentrate and crystallise in areas of inherited weakness. Soot cover can have a profound effect on subsequent performance. It reduces surface permeability and can be hydrophobic in character, limiting salt ingress and suppressing decay in the short term. However, as salt crystals concentrate under the soot crust, detachment of this layer can occur, exposing fire-damaged stone beneath. Understanding the subsequent exploitation of stone exposed to fire damage by background environmental factors (for example, salt weathering/ temperature cycling) is key to the post-fire management of stone decay.