Long-term outcomes in open pelvic fractures

BACKGROUND: Open pelvic fractures represent one of the most devastating injuries in orthopedic trauma. The purpose of this study was to document the injury characteristics, complications, mortality, and long-term, health-related quality of life outcomes in patients with open pelvic fractures. METHODS: The trauma registry at an adult trauma center was used to identify all multiple system blunt trauma patients with a pelvic fracture from January of 1987 to August of 1995 (n = 1,179). Demographic data, mechanism of injury, and fracture type were determined from hospital records. Short-term outcome measures included infectious complications, mortality, and length of stay in hospital. Long-term outcomes of survivors were obtained by telephone interview using the SF-36 Health Survey and the Functional Independence Measure. RESULTS: Open pelvic fractures were uncommon, occurring in 44 patients (4%). Patients with open fractures were about 9 years younger, on average, than patients with closed fractures (30 vs. 39, p < 0.001). Similarly, patients with open fractures were more likely to be male (75 vs. 57%, p < 0.02), more likely to have been involved in a motorcycle crash (27 vs. 6%, p < 0.001), and more likely to have an unstable pelvic ring disruption (45 vs. 25%, p < 0.001). Open pelvic fracture patients required more blood than closed pelvic fracture patients, both in the first day (16 vs. 4 units, p < 0.001) and during the total hospital admission (29 vs. 9 units, p < 0.001). Five patients with perineal wounds did not receive a diverting colostomy; in turn, these individuals had a total of six pelvic infectious complications (one abscess, two with osteomyelitis, and three perineal wound infections). Overall, 11 patients died, six patients were lost to follow-up, and 27 were long-term survivors (mean duration of 4 years). Chronic disability was common after a pelvic fracture, with problems related to physical role performance and physical functioning, and was particularly severe after an open pelvic fracture (p < 0.05 for both as measured by the SF-36). CONCLUSIONS: Patients with open pelvic fractures often survive, need to be treated with massive blood transfusions, and often require a colostomy. They are frequently left with chronic pain and residual disabilities in physical functioning and physical roles, and many remain unemployed years after injury.     

Pharmacologic treatment for children and adolescents with anxiety disorders

Pediatric anxiety disorders are common illnesses that, if left untreated, may induce academic, family, and interpersonal problems. Cognitive-behavioral techniques and other psychotherapeutic interventions may be adequate for the treatment of most anxiety disorders. For patients with severe symptoms or for whom psychotherapeutic approaches are not adequate, medications are indicated. Among the available medications, the SSRIs are currently the first choice; however, other medications, such as the benzodiazepines and the TCAs, may be used alone or sometimes in combination with the SSRIs. Caution with respect to medication interactions and side effects is indicated. In particular, long-term side effects in these medications have not been well studied.     

X-Ray Micro-Calorimeter Based on Si Thermistors for X-Ray Astronomy: Design and First Measurements

X-ray Astronomy provides a unique window on a wide variety of astrophysical phenomena. The currently operating X-ray space observatories perform X-ray spectral imaging with the use of CCDs. When available, cryogenic X-ray microcalorimeter arrays will far outperform CCDs in terms of spectral resolution, energy bandwidth and count rate. Experience has been gained with Infra-Red bolometer arrays at CEA-LETI (Grenoble) in collaboration with the CEA-SAp (Saclay); taking advantage of this background, we are now developing an X-ray spectro-imaging camera for the next generation space astronomy missions, using silicon technology (implanted and high temperature diffused thermistors). Each pixel of this array detector is made of a tantalum absorber bound, by indium bump hybridization, to a silicon thermistor. The absorber array is bound to the thermistor array in a single automatic step. The thermo-mechanical link, provided by hybridization, is being improved in terms of thermal capacitance. Finally, our main effort is in developing arrays of silicon thermistors with negligible excess 1/f noise. The thermistor has been simulated with the 2D simulator ATHENA (SILVACO International). We studied the effects of the implants and their thermal treatment on both vertical and lateral dopant distributions at the edges of the thermistor. Prototypes have been created following the procedure optimized by the ATHENA simulation. We present the status of the development and results of measurements performed on these four main building blocks required to create a detector array up to 32×32 pixels in size.      

A combined In situ grazing incidence small angle X-ray scattering and grazing incidence X-ray diffraction study of the growth of Ge Islands on pit-patterned Si(001) substrates

The growth of Ge islands on a pit-patterned Si(001) template is investigated in situ, combining grazing incidence diffraction, multiple wavelength anomalous diffraction, and small angle scattering. This allows monitoring in situ the detailed structural and morphological evolutions of the pits, of the wetting-layer and of the nucleated islands on the pit-patterned Si(001) substrate. It is shown that after Si regrowth, the Si substrate displays {107} and {1 1 11} facets. During the very first stages of Ge growth, the preliminary facets of the Si substrate are energetically unfavourable, and the pit facets break up into a rather complex pattern of {10n} and {11m} facets with n > 7 and m > 11. At 5 and 6 ML, intensity rods from {105} and {113}-type facets appear in the GISAXS images revealing the formation of pyramids and domes, respectively. The degree of ordering, the shape, strain and composition of the islands are characterized during the growth process to provide a detailed evolution of their structure and morphology.     

Dynamic Properties of Highly Organic Soils from Montezuma Slough and Clifton Court

The nonlinear dynamic properties of highly organic soils from two levee sites in the Sacramento-San Joaquin Delta in California are described. Cyclic triaxial, resonant column and torsional shear tests were performed on thin-walled tube samples obtained from beneath levee crests, beneath adjacent berms, and in the free field such that the in situ vertical effective stresses (σvo′) ranged from about 16?to?67?kPa. These highly organic soils had considerably different organic characteristics from those used in previous studies of dynamic properties. The tested samples had organic contents of 14 to 61%, initial water contents (wo) of 88 to 496%, shear wave velocities (Vs) of 20?to?130?m/s, and organic components that ranged from highly fibrous to highly decomposed and amorphous. Secant shear modulus (G), normalized secant shear modulus (G/Gmax), and equivalent damping ratio (ξ) versus cyclic shear strain amplitude (γc) relations are presented, and their dependence on variables such as consolidation stress, organic content, prior loading history, testing device, and loading frequency are illustrated. Findings are compared to previously published results.     

From Voyeur to Witness: Recapturing Symbolic Function After Massive Psychic Trauma.

Survivors of massive psychic trauma frequently experience deficits in symbolic functioning affecting the capacity to dream and to think productively. Clinicians working with survivors also find themselves struck thoughtless, unable to reflect on the horrors their patients describe. The writer argues that experiencing an initial state of incoherence might be a necessary condition of the healing process when analysts work with this population. It is in the struggle to overcome this state and to become thinking professionals again that they can start to bear witness to the patient's experience. And it is through this work with the analyst's containing presence that the survivor ceases to be a mute observer to her own loss, starts to recapture her thinking self, and begins the process of witnessing her own survival. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Probing a model of educational productivity in high school science with national assessment samples.

Tested a psychological theory of educational productivity and explored the usefulness of the National Assessment of Educational Progress data for secondary analysis for policy purposes. The science achievement scores of 3,049 17-yr-old students were regressed on indexes of their socioeconomic status, motivation, quality (of instruction), class (social psychological environment), homework, and home conditions. Findings indicate that all measures of these productivity factors are significant in ordinary multiple regression equations when controlled for one another and race and gender, and the equation coefficients conform closely in sign and magnitude to theoretical values derived from C. W. Cobb and P. H. Douglas's (1928) theory of national economic productivity. Under a stringent causal probe, however, class and didactic quality of instruction appear to be the only unequivocal and potentially manipulable causes of science learning in the data. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An active microphotodiode array of oscillating pixels for retinal stimulation

We have developed an active microphotodiode array (MPDA) for retinal stimulation. The unique feature of the device is that each pixel acts as an independent oscillator, whose frequency is controlled by the incident light intensity. The design is based on a double inverter relaxation oscillator, and the photodiodes are of PIN-type. These oscillating pixels stimulate the nervous tissue with bipolar pulses. The prototype stimulator chips are realized in standard 0.35 μm CMOS technology. The reported preliminary data and performance demonstrate the potential of the new concept for future retinal prostheses.     

Twelve years of rain attenuation statistics of Earth–space propagation experiment at Ka band in Toulouse

Since 2009, ONERA has been running Ka band propagation experiments in Toulouse (France, latitude 43.57°N, longitude 1.47°E). A rain gauge was also deployed on site to collect rainfall rate measurements concurrently to beacon data. Since April 2011, the beacon receiver has been recording the 20.2 GHz (vertical polarisation) Astra 3B beacon signal along a slant path of 35.1° of elevation angle. All years of the experiment had excellent data availability, hence giving 12 years of data at Ka band. First, the propagation experiment and the data processing methodology are described. Second, a statistical analysis of rain attenuation and rainfall rate is conducted. Comparisons are then performed with the prediction methods of Recommendations ITU-R P.837-7 (rainfall rate), P.618-13 (rain attenuation) and P.678-3 (variability of propagation phenomena).     

Spheres and cylinders in parametric nonlinear optics

We show how crystals cut as spheres or cylinders lead to new approaches in the field of optical frequency conversion. This article is a review of our research dealing with the advantage of these curve geometries for the conception of new methods of optical characterization and new tunable parametric devices.