The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

Background and purpose - The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) describes the localization and morphology of fractures, and considers severity in 2 categories: (1) simple, and (2) multifragmentary. We evaluated simple and multifragmentary fractures in a large consecutive cohort of children diagnosed with long bone fractures in Switzerland. Patients and methods - Children and adolescents treated for fractures between 2009 and 2011 at 2 tertiary pediatric surgery hospitals were retrospectively included. Fractures were classified according to the AO PCCF. Severity classes were described according to fracture location, patient age and sex, BMI, and cause of trauma. Results - Of all trauma events, 3% (84 of 2,730) were diagnosed with a multifragmentary fracture. This proportion was age-related: 2% of multifragmentary fractures occurred in school-children and 7% occurred in adolescents. In patients diagnosed with a single fracture only, the highest percentage of multifragmentation occurred in the femur (12%, 15 of 123). In fractured paired radius/ulna bones, multifragmentation occurred in 2% (11 of 687); in fractured paired tibia/fibula bones, it occurred in 21% (24 of 115), particularly in schoolchildren (5 of 18) and adolescents (16 of 40). In a multivariable regression model, age, cause of injury, and bone were found to be relevant prognostic factors of multifragmentation (odds ratio (OR) > 2). Interpretation - Overall, multifragmentation in long bone fractures in children was rare and was mostly observed in adolescents. The femur was mostly affected in single fractures and the lower leg was mostly affected in paired-bone fractures. The clinical relevance of multifragmentation regarding growth and long-term functional recovery remains to be determined

On the harmonic measure of stable processes

Using three hypergeometric identities, we evaluate the harmonic measure of a finite interval and of its complementary for a strictly stable real L{\'e}vy process. This gives a simple and unified proof of several results in the literature, old and recent. We also provide a full description of the corresponding Green functions. As a by-product, we compute the hitting probabilities of points and describe the non-negative harmonic functions for the stable process killed outside a finite interval

Additional femoral catheter in combination with popliteal catheter for analgesia after major ankle surgery

Background The contribution of the saphenous nerve in pain after major ankle surgery is unknown. The aim of this study was to evaluate its contribution in this context. Methods Fifty patients were included in this prospective, randomized, controlled study. In all patients [Group P (popliteal) and Group F (popliteal+femoral)], a popliteal catheter was placed before operation and ropivacaine 0.5% (30 ml) administered via this catheter; major ankle surgery was then performed under spinal anaesthesia. In Group PF patients, an additional femoral catheter was sited before operation and ropivacaine 0.5% (10 ml) administered. Six hours after spinal anaesthesia (defined as T0), a continuous infusion of ropivacaine 0.3% (14 ml h−1) was started through the popliteal catheter until T24. Then, the concentration was reduced to 0.2% until T48. Patients in Group PF received continuous ropivacaine 0.2% (5 ml h−1) through the femoral catheter from T0 to T48. I.V. morphine patient-controlled analgesia was used as a rescue analgesia. Pain at rest, pain with movement, adverse effects, and i.v. morphine consumption were assessed. Pain at rest and on movement was evaluated 6 months after operation. Results Pain at rest was comparable in the two groups. In Group PF, patients had significantly reduced pain during movement in the postoperative period (P=0.01) and 6 months after operation (P=0.03). Morphine consumption was significantly reduced in Group PF at T0-T24 and T24-T48 (P=0.01). Adverse effects were comparable in both groups. Conclusions The addition of continuous femoral catheter infusion of ropivacaine to a continuous popliteal catheter infusion improved postoperative analgesia during movement after major ankle surgery. This effect was still present 6 months after surger

Effects of sex chromosome dosage on corpus callosum morphology in supernumerary sex chromosome aneuploidies.

BackgroundSupernumerary sex chromosome aneuploidies (sSCA) are characterized by the presence of one or more additional sex chromosomes in an individual's karyotype; they affect around 1 in 400 individuals. Although there is high variability, each sSCA subtype has a characteristic set of cognitive and physical phenotypes. Here, we investigated the differences in the morphometry of the human corpus callosum (CC) between sex-matched controls 46,XY (N =99), 46,XX (N =93), and six unique sSCA karyotypes: 47,XYY (N =29), 47,XXY (N =58), 48,XXYY (N =20), 47,XXX (N =30), 48,XXXY (N =5), and 49,XXXXY (N =6).MethodsWe investigated CC morphometry using local and global area, local curvature of the CC boundary, and between-landmark distance analysis (BLDA). We hypothesized that CC morphometry would vary differentially along a proposed spectrum of Y:X chromosome ratio with supernumerary Y karyotypes having the largest CC areas and supernumerary X karyotypes having significantly smaller CC areas. To investigate this, we defined an sSCA spectrum based on a descending Y:X karyotype ratio: 47,XYY, 46,XY, 48,XXYY, 47,XXY, 48,XXXY, 49,XXXXY, 46,XX, 47,XXX. We similarly explored the effects of both X and Y chromosome numbers within sex. Results of shape-based metrics were analyzed using permutation tests consisting of 5,000 iterations.ResultsSeveral subregional areas, local curvature, and BLDs differed between groups. Moderate associations were found between area and curvature in relation to the spectrum and X and Y chromosome counts. BLD was strongly associated with X chromosome count in both male and female groups.ConclusionsOur results suggest that X- and Y-linked genes have differential effects on CC morphometry. To our knowledge, this is the first study to compare CC morphometry across these extremely rare groups

Topologically massive magnetic monopoles

We show that in the Maxwell-Chern-Simons theory of topologically massive electrodynamics the Dirac string of a monopole becomes a cone in anti-de Sitter space with the opening angle of the cone determined by the topological mass which in turn is related to the square root of the cosmological constant. This proves to be an example of a physical system, {\it a priory} completely unrelated to gravity, which nevertheless requires curved spacetime for its very existence. We extend this result to topologically massive gravity coupled to topologically massive electrodynamics in the framework of the theory of Deser, Jackiw and Templeton. These are homogeneous spaces with conical deficit. Pure Einstein gravity coupled to Maxwell-Chern-Simons field does not admit such a monopole solution

Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned

Background: Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system. Methods: The course met weekly for two to three hours during July, 2013. Sessions included large group discussions and small group reflection meetings. Topics included leadership styles, emotional intelligence, and leading clinical teams. Course materials were designed internally and featured “business school style” case studies about everyday clinical medicine which explore how leadership skills impact care delivery. Participants evaluated the course’s impact and quality using a post-course survey. Questions were structured in five point likert scale and free text format. Likert scale responses were converted to a 1-5 scale (1 = strongly disagree; 3 = neither agree nor disagree; 5 = strongly agree), and means were compared to the value 3 using one-way T-tests. Responses to free text questions were analyzed using the constant comparative method. Results: All sixteen pilot course participants completed the survey. Participants overwhelmingly agreed that the course provided content and skills relevant to their clinical responsibilities and leadership roles. Most participants also acknowledged that taking the course improved their understanding of their strengths and weaknesses as leaders, different leadership styles, and how to manage interpersonal conflict on clinical teams. 88% also reported that the course increased their interest in pursuing additional leadership training. Conclusions: A clinical leadership course for internal medicine residents designed by colleagues, and utilizing case studies about clinical medicine, resulted in significant self-reported improvements in clinical leadership competencies. Electronic supplementary material The online version of this article (doi:10.1186/s12909-014-0257-2) contains supplementary material, which is available to authorized users

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods - We included children and adolescents (0-17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results - Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation - The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome

Self-consistent computation of gamma-ray spectra due to proton-proton interactions in black hole systems

In the inner regions of an accretion disk around a black hole, relativistic protons can interact with ambient matter to produce electrons, positrons and $\gamma$-rays. The resultant steady state electron and positron particle distributions are self-consistently computed taking into account Coulomb and Compton cooling, $e^-e^+$ pair production (due to $\gamma-\gamma$ annihilation) and pair annihilation. While earlier works used the diffusion approximation to obtain the particle distributions, here we solve a more general integro-differential equation that correctly takes into account the large change in particle energy that occur when the leptons Compton scatter off hard X-rays. Thus this formalism can also be applied to the hard state of black hole systems, where the dominant ambient photons are hard X-rays. The corresponding photon energy spectrum is calculated and compared with broadband data of black hole binaries in different spectral states. The results indicate that the $\gamma$-ray spectra ($E > 0.8$ MeV) of both the soft and hard spectral states and the entire hard X-ray/$\gamma$-ray spectrum of the ultra-soft state, could be due to $p-p$ interactions. These results are consistent with the hypothesis that there always exists in these systems a $\gamma$-ray spectral component due to $p-p$ interactions which can contribute between 0.5 to 10% of the total bolometric luminosty. The model predicts that {\it GLAST} would be able to detect black hole binaries and provide evidence for the presence of non-thermal protons which in turn would give insight into the energy dissipation process and jet formation in these systems.Comment: Accepted for publication in MNRA

The Role of a Hot Gas Environment on the Evolution of Galaxies

Most spiral galaxies are found in galaxy groups with low velocity dispersions; most E/S0 galaxies are found in galaxy groups with relatively high velocity dispersions. The mass of the hot gas we can observe in the E/S0 groups via their thermal X-ray emission is, on average, as much as the baryonic mass of the galaxies in these groups. By comparison, galaxy clusters have as much or more hot gas than stellar mass. Hot gas in S-rich groups, however, is of low enough temperature for its X-ray emission to suffer heavy absorption due to Galactic HI and related observational effects, and hence is hard to detect. We postulate that such lower temperature hot gas does exist in low velocity dispersion, S-rich groups, and explore the consequences of this assumption. For a wide range of metallicity and density, hot gas in S-rich groups can cool in far less than a Hubble time. If such gas exists and can cool, especially when interacting with HI in existing galaxies, then it can help link together a number of disparate observations, both Galactic and extragalactic, that are otherwise difficult to understand.Comment: 16 pages with one figure. ApJ Letters, in pres