Sample records for program fracture issues

  1. Barriers to implementation of an organized geriatric fracture program. (United States)

    Kates, Stephen L; O'Malley, Natasha; Friedman, Susan M; Mendelson, Daniel A


    There has been a recent increase in interest in implementing organized geriatric fracture programs for care of older adults with fragility fractures in order to improve both the quality and costs of care. Because such programs are relatively new, there are no standardized methods for implementation and no published descriptions of barriers to implementation. An online survey tool was sent to 185 surgeons and physicians practicing in the United States, who are involved with geriatric fracture care. Sixty-eight responses were received and evaluated. Barriers identified included lack of medical and surgical leadership, need for a clinical case manager, lack of anesthesia department support, lack of hospital administration support, operating room time availability, and difficulty with cardiac clearance for surgery. Other issues important to implementation included quality improvement, cost reductions, cost to the hospital, infection prevention, readmission prevention, and dealing with competing interest groups and competing projects mandated by the government. Physicians and surgeons felt that a site visit to a functioning program was most important when considering implementing a hip fracture program. This study provides useful insights into barriers to implementing an organized hip fracture program. The authors offer suggestions on ways to mitigate or overcome these barriers.

  2. Investigating Some Technical Issues on Cohesive Zone Modeling of Fracture (United States)

    Wang, John T.


    This study investigates some technical issues related to the use of cohesive zone models (CZMs) in modeling fracture processes. These issues include: why cohesive laws of different shapes can produce similar fracture predictions; under what conditions CZM predictions have a high degree of agreement with linear elastic fracture mechanics (LEFM) analysis results; when the shape of cohesive laws becomes important in the fracture predictions; and why the opening profile along the cohesive zone length needs to be accurately predicted. Two cohesive models were used in this study to address these technical issues. They are the linear softening cohesive model and the Dugdale perfectly plastic cohesive model. Each cohesive model constitutes five cohesive laws of different maximum tractions. All cohesive laws have the same cohesive work rate (CWR) which is defined by the area under the traction-separation curve. The effects of the maximum traction on the cohesive zone length and the critical remote applied stress are investigated for both models. For a CZM to predict a fracture load similar to that obtained by an LEFM analysis, the cohesive zone length needs to be much smaller than the crack length, which reflects the small scale yielding condition requirement for LEFM analysis to be valid. For large-scale cohesive zone cases, the predicted critical remote applied stresses depend on the shape of cohesive models used and can significantly deviate from LEFM results. Furthermore, this study also reveals the importance of accurately predicting the cohesive zone profile in determining the critical remote applied load.

  3. IPIRG programs - advances in pipe fracture technology

    Energy Technology Data Exchange (ETDEWEB)

    Wilkowski, G.; Olson, R.; Scott, P. [Batelle, Columbus, OH (United States)


    This paper presents an overview of the advances made in fracture control technology as a result of the research performed in the International Piping Integrity Research Group (IPIRG) program. The findings from numerous experiments and supporting analyses conducted to investigate the behavior of circumferentially flawed piping and pipe systems subjected to high-rate loading typical of seismic events are summarized. Topics to be discussed include; (1) Seismic loading effects on material properties, (2) Piping system behavior under seismic loads, (3) Advances in elbow fracture evaluations, and (4) {open_quotes}Real{close_quotes} piping system response. The presentation for each topic will be illustrated with data and analytical results. In each case, the state-of-the-art in fracture mechanics prior to the first IPIRG program will be contrasted with the state-of-the-art at the completion of the IPIRG-2 program.

  4. Unsolved issues in diagnostics and treatment decisions for clavicular fractures

    NARCIS (Netherlands)

    Stegeman, Sylvia Alexandra


    Clavicular fractures are among the most common fractures of the shoulder. Displacement or comminution of the fracture fragments may lead to shortening of the clavicle, but could also cause mal-union or non-union of the clavicle and might lead to poor functional outcome. These fracture

  5. Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures (United States)

    Papanastassiou, Ioannis D.; Filis, Andreas; Gerochristou, Maria A.; Vrionis, Frank D.


    Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link. PMID:24724106

  6. Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

    Directory of Open Access Journals (Sweden)

    Ioannis D. Papanastassiou


    Full Text Available Kyphoplasty (KP and vertebroplasty (VP have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures, cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration, and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV will provide the missing link.

  7. Issues Primer. EEE708 Negotiated Study Program. (United States)

    Jennings, Leonie

    This issues primer is structured around a series of 20 contemporary concerns in the changing world of work and training in Australia in the early 1990s. It is part of the study materials for the one-semester distance education unit, Negotiated Study Program, in the Open Campus Program at Deakin University (Australia). Information on each issue is…


    Energy Technology Data Exchange (ETDEWEB)

    Abbas Firoozabadi


    Numerical simulation of water injection in discrete fractured media with capillary pressure is a challenge. Dual-porosity models in view of their strength and simplicity can be mainly used for sugar-cube representation of fractured media. In such a representation, the transfer function between the fracture and the matrix block can be readily calculated for water-wet media. For a mixed-wet system, the evaluation of the transfer function becomes complicated due to the effect of gravity. In this work, they use a discrete-fracture model in which the fractures are discretized as one dimensional entities to account for fracture thickness by an integral form of the flow equations. This simple step greatly improves the numerical solution. Then the discrete-fracture model is implemented using a Galerkin finite element method. The robustness and the accuracy of the approach are shown through several examples. First they consider a single fracture in a rock matrix and compare the results of the discrete-fracture model with a single-porosity model. Then, they use the discrete-fracture model in more complex configurations. Numerical simulations are carried out in water-wet media as well as in mixed-wet media to study the effect of matrix and fracture capillary pressures.

  9. Open Issues in Object-Oriented Programming

    DEFF Research Database (Denmark)

    Madsen, Ole Lehrmann


    We discuss a number of open issues within object-oriented programming. The central mechanisms of object-oriented programming appeared with Simula, developed more than 30 years ago; these include class, subclass, virtual function, active object and the first application framework, Class Simulation....... The core parts of object-oriented programming should be well understood, but there are still a large number of issues where there is no consensus. The term object-orientation has been applied to many subjects, such as analysis, design implementation, data modeling in databases, and distribution...

  10. Handbook of critical issues in goal programming

    CERN Document Server

    Romero, C


    Goal Programming (GP) is perhaps the oldest and most widely used approach within the Multiple Criteria Decision Making (MCDM) paradigm. GP combines the logic of optimisation in mathematical programming with the decision maker's desire to satisfy several goals. The primary purpose of this book is to identify the critical issues in GP and to demonstrate different procedures capable of avoiding or mitigating the inherent pitfalls associated with these issues. The outcome of a search of the literature shows many instances where GP models produced misleading or even erroneous results simply because

  11. Addressing Dynamic Issues of Program Model Checking (United States)

    Lerda, Flavio; Visser, Willem


    Model checking real programs has recently become an active research area. Programs however exhibit two characteristics that make model checking difficult: the complexity of their state and the dynamic nature of many programs. Here we address both these issues within the context of the Java PathFinder (JPF) model checker. Firstly, we will show how the state of a Java program can be encoded efficiently and how this encoding can be exploited to improve model checking. Next we show how to use symmetry reductions to alleviate some of the problems introduced by the dynamic nature of Java programs. Lastly, we show how distributed model checking of a dynamic program can be achieved, and furthermore, how dynamic partitions of the state space can improve model checking. We support all our findings with results from applying these techniques within the JPF model checker.

  12. Discussed Issues in Preventive Intervention Programs (United States)

    Ocak, Sakire


    The growing number of studies in the field of prevention science and related advancements in evidence based programs leads to some discussions about the fundamental issues such as efficacy, effectiveness, dissemination, adaptation, fidelity and continuity in recent years. In this article it is intended to report the common views of early childhood…

  13. Summary of commercial conservation programs environmental issues and program consistency

    Energy Technology Data Exchange (ETDEWEB)

    Beachler, M.C.


    Pacific Northwest Laboratory (PNL) conducted this study for the Office of Energy Resources of the Bonneville Power Administration. The purpose of the report is to compare and contrast the environmental requirements and issues involving Bonneville's residential conservation programs. In addition to environmental issues that Bonneville has addressed in environmental documents, this report also briefly examines new issues that may affect residential conservation programs. The key environmental concern confronting each of the programs with measures aimed at reducing air leakage in houses (both new and existing) is indoor air quality. There are inconsistencies in how the Weatherization Program and the New Homes programs approach indoor air quality. However, these differences make sense, given the character and constraints affecting how each program operates. Newer issues that have arisen include global warming, potential health effects of mineral and glass fibers, and possible fire hazards associated with plastic foam and cellulose insulation. Bonneville staff are aware of these issues as they relate to conservation programs. No action appears necessary at this time.

  14. A comprehensive hip fracture program reduces complication rates and mortality

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.


    OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review...... community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach...... group (P = .02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P = .2). CONCLUSION: The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results...

  15. Issues facing the U. S. mirror program

    Energy Technology Data Exchange (ETDEWEB)

    George, T.V.


    Some of the current issues associated with the U.S. Magnetic Mirror Program are analyzed. They are presented as five separate papers entitled: (1) Relevant Issues Broughtup by the Mirror Reactor Design Studies. (2) An Assessment of the Design Study of the 1 MeV Neutral Beam Injector Required for a Tandem Mirror Reactor. (3) The Significance of the Radial Plasma Size Measured in Units of Ion Gyroradii in Tandem Mirrors and Field Reversed Mirrors. (4) Producing Field Reversed Mirror Plasmas by Methods used in Field Reversed Theta Pinch. (5) RF Stoppering of Mirror Confined Plasma.

  16. Management of vertebral compression fracture in general practice: BEACH program.

    Directory of Open Access Journals (Sweden)

    Rodrigo Z Megale

    Full Text Available The pain associated with vertebral compression fractures can cause significant loss of function and quality of life for older adults. Despite this, there is little consensus on how best to manage this condition.To describe usual care provided by general practitioners (GPs in Australia for the management of vertebral compression fractures.Data from the Bettering the Evaluation And Care of Health (BEACH program collected between April 2005 and March 2015 was used for this study. Each year, a random sample of approximately 1,000 GPs each recorded information on 100 consecutive encounters. We selected those encounters at which vertebral compression fracture was managed. Analyses of management options were limited to encounters with patients aged 50 years or over.i patient demographics; ii diagnoses/problems managed; iii the management provided for vertebral compression fracture during the encounter. Robust 95% confidence intervals, adjusted for the cluster survey design, were used to assess significant differences between group means.Vertebral compression fractures were managed in 211 (0.022%; 95% CI: 0.018-0.025 of the 977,300 BEACH encounters recorded April 2005- March 2015. That provides a national annual estimate of 26,000 (95% CI: 22,000-29,000 encounters at which vertebral fractures were managed. At encounters with patients aged 50 years or over (those at higher risk of primary osteoporosis, prescription of analgesics was the most common management action, particularly opioids analgesics (47.1 per 100 vertebral fractures; 95% CI: 38.4-55.7. Prescriptions of paracetamol (8.2; 95% CI: 4-12.4 or non-steroidal anti-inflammatory drugs (4.1; 95% CI: 1.1-7.1 were less frequent. Non-pharmacological treatment was provided at a rate of 22.4 per 100 vertebral fractures (95% CI: 14.6-30.1. At least one referral (to hospital, specialist, allied health care or other was given for 12.3 per 100 vertebral fractures (95% CI: 7.8-16.8.The prescription of oral

  17. Recommendations for the shallow-crack fracture toughness testing task within the HSST (Heavy-Section Steel Technology) Program

    Energy Technology Data Exchange (ETDEWEB)

    Theiss, T.J. (Oak Ridge National Lab., TN (USA))


    Recommendations for Heavy-Section Steel Technology Program's investigation into the influence of crack depth on the fracture toughness of a steel prototypic of those in a reactor pressure vessel are included in this report. The motivation for this investigation lies in the fact that probabilistic fracture mechanics evaluations show that shallow flaws play a dominant role in the likelihood of vessel failure, and shallow-flaw specimens have exhibited an elevated toughness compared with conventional deep-notch fracture toughness specimens. Accordingly, the actual margin of safety of vessels may be greater than that predicted using existing deep-notch fracture-toughness results. The primary goal of the shallow-crack project is to investigate the influence of crack depth on fracture toughness under conditions prototypic of a reactor vessel. A limited data base of fracture toughness values will be assembled using a beam specimen of prototypic reactor vessel material and with a depth of 100 mm (4 in.). This will permit comparison of fracture-toughness data from deep-cracked and shallow-crack specimens, and this will be done for several test temperatures. Fracture-toughness data will be expressed in terms of the stress-intensity factor and crack-tip-opening displacement. Results of this investigation are expected to improve the understanding of shallow-flaw behavior in pressure vessels, thereby providing more realistic information for application to the pressurized-thermal shock issues. 33 refs., 17 figs.

  18. Response to 'Word choice as political speech': Hydraulic fracturing is a partisan issue. (United States)

    Hopke, Jill E; Simis, Molly


    In 2015, Hopke & Simis published an analysis of social media discourse around hydraulic fracturing. Grubert (2016) offered a commentary on the research, highlighting the politicization of terminology used in the discourse on this topic. The present article is a response to Grubert (2016)'s commentary, in which we elaborate on the distinctions between terminology used in social media discourse around hydraulic fracturing (namely, 'frack,' 'fracking,' 'frac,' and 'fracing'). Additionally preliminary analysis supports the claim that industry-preferred terminology is severely limited in its reach. When industry actors opt-out of the discourse, the conversation followed by the majority of lay audiences is dominated by activists. exacerbating the political schism on the issue. © The Author(s) 2016.

  19. Fracture toughness (K{sub IC}) data reduction program

    Energy Technology Data Exchange (ETDEWEB)

    Heiman, M.R.


    This report documents the development, verification, and use instructions for an automated K{sub IC} data reduction program written in the Hewlett Packard Visual Engineering Environment (HP VEE) programming language. Currently, when the standard test method Plane-Strain Fracture Toughness of Metallic materials (K{sub IC}), is performed, the data is reduced manually. Date reduction includes 15 detailed calculations required by the American Society for Testing and Materials (ASTM) E399 to determine the validity of the computed K{sub IC} value. Manual data reduction is both time consuming, tedious, and prone to errors. Since all K{sub IC} tests are completed using a data acquisition system to digitally record time, load, and crack opening displacement (COD); automation of K{sub IC} data reduction using a computer program to perform all calculations rapidly, enables processing of a large amount of data. The K{sub IC} data reduction program reduces any computer American Standard Code for Information Interchange (ASCII) data file. Thus, the K{sub IC} data reduction program is also used to over check tests performed at other facilities. The program was qualified based on mechanical properties of commercial alloy specimens.

  20. Code quality issues in student programs

    NARCIS (Netherlands)

    Keuning, H.W.|info:eu-repo/dai/nl/411260820; Heeren, B.J.|info:eu-repo/dai/nl/304840130; Jeuring, J.T.|info:eu-repo/dai/nl/075189771


    Because low quality code can cause serious problems in software systems, students learning to program should pay attention to code quality early. Although many studies have investigated mistakes that students make during programming, we do not know much about the quality of their code. This study

  1. 75 FR 66831 - Program Integrity Issues (United States)


    ... Education (TEACH) Grant Program in part 686, the Federal Pell Grant Program, and the Academic... on satisfactory academic progress, Marty Guthrie or Marianna Deeken. Telephone: (202) 219-7031 or via... (FRS), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in an...

  2. Code quality Issues in Student Programs

    NARCIS (Netherlands)

    Keuning, Hieke|info:eu-repo/dai/nl/411260820; Heeren, Bastiaan|info:eu-repo/dai/nl/304840130; Jeuring, Johan|info:eu-repo/dai/nl/075189771


    Because low quality code can cause serious problems in software systems, students learning to program should pay attention to code quality early. Although many studies have investigated mistakes that students make during programming, we do not know much about the quality of their code. This study

  3. 76 FR 20534 - Program Integrity Issues (United States)


    ... the Federal Register and the Code of Federal Regulations is available via the Federal Digital System... educational programs or those that provide marketing, advertising, recruiting, or admissions services. We have... the institution to provide services, such as food service, other than educational programs, marketing...

  4. Issues in NASA program and project management (United States)

    Hoffman, Edward J. (Editor)


    This volume is the eighth in an ongoing series addressing current topics and lessons learned in NASA program and project management. Articles in this volume cover the following topics: (1) power sources for the Galileo and Ulysses Missions; (2) managing requirements; (3) program control of the Tropical Rainfall Measuring Mission; (4) project management method; (5) career development for project managers; and (6) resources for NASA managers.

  5. 78 FR 17598 - Program Integrity Issues (United States)


    ... Education Act of 1965, as amended (HEA) (October 29, 2010, final regulations). This document revises the...), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in an accessible..., the Federal Pell Grant Program, and the Academic Competitiveness Grant (AGC) and National Science and...

  6. Issues in NASA program and project management (United States)

    Hoban, Francis T. (Editor); Hoffman, Edward J. (Editor); Lawbaugh, William M. (Editor)


    This volume is the ninth in an ongoing series on aerospace project management at NASA. Articles in this volume cover evolution of NASA cost estimating; SAM 2; National Space Science Program: strategies to maximize science return; and human needs, motivation, and results of the NASA culture surveys. A section on resources for NASA managers rounds out the publication.

  7. Implementation issues in Inductive Logic Programming


    Kolter, Robert


    We propose several algorithms for efficient Testing of logical Implication in the case of ground objects. Because the problem of Testing a set of propositional formulas for (un)satisfiability is \\(NP\\)-complete there's strong evidence that there exist examples for which every algorithm which solves the problem of testing for (un)satisfiability has a runtime that is exponential in the length of the input. So will have our algorithms. We will therefore point out classes of logic programs for wh...

  8. Military Space Programs: Issues Concerning DOD's SBIRS and STSS Programs

    National Research Council Canada - National Science Library

    Smith, Marcia S


    The Department of Defense's (DOD's) programs to develop new satellites to alert U.S. military commanders to foreign missile launches, and to support missile defense objectives, are controversial because of cost growth and schedule slippage...

  9. Military Space Programs: Issues Concerning DOD's SBIRS and STSS Programs

    National Research Council Canada - National Science Library

    Smith, Marcia S


    The Department of Defense's (DOD's) programs to develop new satellites to alert U.S. military commanders to foreign missile launches, and to support missile defense objectives, are controversial because of cost growth and schedule slippage...

  10. Military Space Programs: Issues Concerning DOD's SBIRS and STSS Programs

    National Research Council Canada - National Science Library

    Smith, Marcia S


    The Department of Defense's (DOD's) programs to develop new satellites to alert U.S. military commanders to foreign missile launches, and to support missile defense objectives, are controversial because of cost growth and schedule slippage...

  11. The Exercise Plus Program for Older Women Post Hip Fracture: Participant Perspectives (United States)

    Resnick, Barbara; Orwig, Denise; Wehren, Lois; Zimmerman, Sheryl; Simpson, Marjorie; Magaziner, Jay


    Purpose: The purpose of this study was to explore the experiences of older women post hip fracture who were exposed to a motivational intervention, the Exercise Plus Program, intended to increase adherence to exercise. Design and Methods: This study used a naturalistic inquiry. We interviewed a total of 70 older women, 12 months post hip fracture,…

  12. 40 CFR 147.52 - State-administered program-Hydraulic Fracturing of Coal Beds. (United States)


    ... hydraulic fracturing of coal beds in the State of Alabama, except those on Indian lands, is the program..., 1999, to Dr. Donald F. Oltz, Supervisor, State Oil and Gas Board of Alabama, Subject: Attorney General...

  13. Educational fellowship programs: common themes and overarching issues. (United States)

    Gruppen, Larry D; Simpson, Deborah; Searle, Nancy S; Robins, Lynne; Irby, David M; Mullan, Patricia B


    The trend toward intensive faculty development programs has been driven by a variety of factors, including institutional needs for educational expertise and leadership, as well as individual faculty members' motivation to augment their educational expertise, teaching skills, and leadership skills. The nine programs described in this issue possess several common features that can be ascribed to shared perceptions of pervasive needs coupled with feasible educational resources and strategies to meet these needs. All programs identify a clear set of goals and objectives for their respective curricula. Curriculum domains include not only teaching skills but also educational research, curriculum development, and educational leadership. In spite of many similarities, each program reflects the unique character of its home institution, the faculty, educational resources, and the specific goals of the program. Each program has documented gains in such key outcomes as participant promotions, new leadership positions both locally and nationally, and scholarly productivity in the form of peer-reviewed papers and presentations. Evidence of institutional benefits includes the production of innovative curricula and a pool of educational leaders. The programs have also developed a community of knowledgeable scholars who interact with each other and serve as a catalyst for continuing change and educational improvement. Although each program was developed largely independently of the others, the common elements in their design provide opportunities to evaluate collaboratively the successful aspects of such programs and to share ideas and resources for program curricula between existing programs and with institutions considering implementing new programs.

  14. NDT applications in a successful fracture critical bridge inspection program and anchor bolt inspection program (United States)

    Fish, Philip E.


    In 1978, Wisconsin Department of Transportation discovered major cracking on a two-girder, fracture critical structure, just four years after it was constructed. In 1981, on the same structure, now seven years old, major cracking was discovered in the tie girder flange of the tied arch span. This is one example of the type of failures that transportation departments discovered on welded structures in the 1970's and '80's. The failures from welded details and pinned connections lead to much stricter standards for present day designs. All areas were affected: design with identification of fatigue-prone details and classification of fatigue categories; material requirements with emphasis on toughness and weldability; increased welding and fabrication standards with licensure of fabrication shops to minimum quality standards including personnel; and an increased effort on inspection of existing bridges, where critical details were overlooked or missed in the past. FHWA inspection requirements for existing structures increased through this same time period, in reaction to the failures that had occurred. Obviously, many structures in Wisconsin were not built to the standards now required, thus the importance for quality inspection techniques. The new FHWA inspection requirements now being implemented throughout the nation require an in-depth, hands-on type inspection at a specified frequency, on all fracture critical structures. Wisconsin Department of Transportation started an in-depth inspection program in 1985 and made it a full time program in 1987. This program included extensive nondestructive testing. Ultrasonic inspection has played a major role in this type of inspection. All fracture critical structures, pin and hanger systems, and pinned connections are inspected on a five-year cycle now. The program requires an experienced inspection team and a practical inspection approach. Extensive preparation is required with review of all design, construction, and

  15. Continuing Education for Lay Ministry: Providers, Beliefs, Issues, and Programs. (United States)

    English, Leona M.


    Responses from 23 of 35 leaders of lay minister education programs indicated liberal attitudes on some issues (social justice, women's ordination); 74% were hopeful about the church's future; 17% felt at risk because of their views; 32% experienced little or no congregational support; and 82% felt that the church needed to improve its acceptance…

  16. Materials Issues for Micromachines Development - ASCI Program Plan

    Energy Technology Data Exchange (ETDEWEB)



    This report summarizes materials issues associated with advanced micromachines development at Sandia. The intent of this report is to provide a perspective on the scope of the issues and suggest future technical directions, with a focus on computational materials science. Materials issues in surface micromachining (SMM), Lithographic-Galvanoformung-Abformung (LIGA: lithography, electrodeposition, and molding), and meso-machining technologies were identified. Each individual issue was assessed in four categories: degree of basic understanding; amount of existing experimental data capability of existing models; and, based on the perspective of component developers, the importance of the issue to be resolved. Three broad requirements for micromachines emerged from this process. They are: (1) tribological behavior, including stiction, friction, wear, and the use of surface treatments to control these, (2) mechanical behavior at microscale, including elasticity, plasticity, and the effect of microstructural features on mechanical strength, and (3) degradation of tribological and mechanical properties in normal (including aging), abnormal and hostile environments. Resolving all the identified critical issues requires a significant cooperative and complementary effort between computational and experimental programs. The breadth of this work is greater than any single program is likely to support. This report should serve as a guide to plan micromachines development at Sandia.

  17. Fracture


    Bourdin, Blaise; Francfort, Gilles A.


    These notes begin with a review of the mainstream theory of brittle fracture, as it has emerged from the works of Griffi th and Irwin. We propose a re-formulation of that theory within the confi nes of the calculus of variations, focussing on crack path prediction. We then illustrate the various possible minimality criteria in a simple 1d-case as well as in a tearing experiment and discuss in some details the only complete mathematical formulation so far, that is that where global minimality ...

  18. Therapist supervised clinic-based therapy versus instruction in a home program following distal radius fracture: a systematic review. (United States)

    Valdes, Kristin; Naughton, Nancy; Michlovitz, Susan


    The primary purpose of this systematic review is to determine the effectiveness of a home program or a structured therapy program for patients following distal radius fracture. A search was performed using terms wrist fracture, supervised therapy, occupational therapy, physical therapy, splint, orthosis, distal radius fracture, exercise, and home program. Studies that met the inclusion criteria were evaluated for research quality using The Structured Effectiveness for Quality Evaluation of Study (SEQES). Five of the seven trials found no difference between outcomes for their subjects that had uncomplicated distal radius fractures. The population that has complications following distal radius fractures was not represented in the studies reviewed. The available evidence from randomized controlled trials is insufficient to support a home program or therapist supervised clinic-based program as a superior method of treatment for adults following a distal radius fracture without complications or the presence of comorbidities. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  19. Tracer SWIW tests in propped and un-propped fractures: parameter sensitivity issues, revisited (United States)

    Ghergut, Julia; Behrens, Horst; Sauter, Martin


    Single-well injection-withdrawal (SWIW) or 'push-then-pull' tracer methods appear attractive for a number of reasons: less uncertainty on design and dimensioning, and lower tracer quantities required than for inter-well tests; stronger tracer signals, enabling easier and cheaper metering, and shorter metering duration required, reaching higher tracer mass recovery than in inter-well tests; last not least: no need for a second well. However, SWIW tracer signal inversion faces a major issue: the 'push-then-pull' design weakens the correlation between tracer residence times and georeservoir transport parameters, inducing insensitivity or ambiguity of tracer signal inversion w. r. to some of those georeservoir parameters that are supposed to be the target of tracer tests par excellence: pore velocity, transport-effective porosity, fracture or fissure aperture and spacing or density (where applicable), fluid/solid or fluid/fluid phase interface density. Hydraulic methods cannot measure the transport-effective values of such parameters, because pressure signals correlate neither with fluid motion, nor with material fluxes through (fluid-rock, or fluid-fluid) phase interfaces. The notorious ambiguity impeding parameter inversion from SWIW test signals has nourished several 'modeling attitudes': (i) regard dispersion as the key process encompassing whatever superposition of underlying transport phenomena, and seek a statistical description of flow-path collectives enabling to characterize dispersion independently of any other transport parameter, as proposed by Gouze et al. (2008), with Hansen et al. (2016) offering a comprehensive analysis of the various ways dispersion model assumptions interfere with parameter inversion from SWIW tests; (ii) regard diffusion as the key process, and seek for a large-time, asymptotically advection-independent regime in the measured tracer signals (Haggerty et al. 2001), enabling a dispersion-independent characterization of multiple

  20. Massive hydraulic fracture mapping and characterization program. First annual report, August 1975--July 1976

    Energy Technology Data Exchange (ETDEWEB)

    McCann, R.P.; Hay, R.G.; Bartel, L.C.


    The FY'76 major objectives of the Massive Hydraulic Fracture Mapping and Characterization Program were to assess the feasibility of the surface electrical potential and surface seismic systems to provide locational information on hydraulically created fracture systems. The surface electrical potential system has demonstrated the capability to provide information on fracture azimuthal orientation, asymmetry of fracture, and direction of major fracture wing. Assessment of the surface seismic technique for fracture characterization is not encouraging. During FY'76, Sandia participated in five MHF experiments for natural gas stimulation. Two of these were conducted by El Paso Natural Gas in the Green River Basin at Pinedale, Wyoming, and three were conducted by AMOCO in the Wattenberg field northeast of Denver, Colorado. Sandia supported all five experiments with the surface electrical potential system and three with surface seismic arrays. This report describes both fracture characterization techniques, provides an overview of the associated hardware and software development, and presents the results obtained from participation in the field tests.

  1. Study of tunnelling through water-bearing fracture zones. Baseline study on technical issues with NE-1 as reference

    Energy Technology Data Exchange (ETDEWEB)

    Yanting Chang; Swindell, Robert; Bogdanoff, Ingvar; Lindstroem, Beatrice; Termen, Jens [WSP Sweden, Stockholm (Sweden) ; Starsec, Peter [SGI, Linkoeping (Sweden)


    established, based on the review of the geological and hydrogeological characteristics of the deformation zone NE-1. In the descriptive model, the water-bearing fracture zone consists of an 8 metre wide central core zone and a 15 meter wide transition zone sited on either side of the core zone. Rock mechanical and hydrogeological properties of the rock mass as well as in situ rock stresses are assigned in the descriptive model. To highlight the important technical issues in tunnelling through water-bearing fracture zones, system analysis and problem identification based on a literature review of relevant case histories are conducted. The identified important technical issues, namely large water inflow and tunnel stability, will be the objects to be analysed in this study. Control of water inflows is the key issue for the safe passage of a tunnel through a water-bearing fracture zone with the characteristics of NE-1. Technical issues associated with the two most used methods for water inflow control, namely grouting and ground freezing are discussed. The analyses regarding water inflows associated with grouting are presented. The degree of difficulty for water inflow control increases with depth. The study indicates that control of water inflows at all the depths could be achieved by grouting with current technology. But ground freezing might be an alternative for the core zone, for instance at a depth of 600 metres. Due to the high water pressure that may be encountered at a depth of 600 metres, precautions must be taken in the decision making process in selecting the most appropriate methods of groundwater control. The deformation analysis indicates that large deformations are unlikely to occur in the transition zone, even at a depth of 600 metres. The reduction in rock mass quality in the core zone, however, is likely to result in large deformations at great depths. The estimated mean values of deformation for an unsupported tunnel in the core zone are 60 mm and 130 mm at

  2. Comprehensive care program for elderly patients over 65 years with hip fracture. (United States)

    Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R


    To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  3. Digital Diagnosis and Treatment Program for Maxillofacial Fractures: A Retrospective Analysis of 626 Cases. (United States)

    Zeng, Wei; Lian, Xiaotian; Chen, Gang; Ju, Rui; Tian, Weidong; Tang, Wei


    The purpose of this study was to evaluate the accuracy of the digital diagnosis and treatment program for maxillofacial fractures. The data of 626 patients with maxillofacial fractures were analyzed retrospectively from January 2010 to August 2016. These patients were divided into 2 groups. In the experimental group, preoperative planning was conducted and transferred to patients with guiding templates and navigation according to the digital diagnosis and treatment program for maxillofacial fractures. In the control group, postsurgical planning was performed instead of preoperative planning. To assess the accuracy of the digital diagnosis and treatment program for maxillofacial fractures, preoperative planning and postoperative computed tomographic models were superimposed and imported to dedicated software (Geomagic Studio 13.0, Geomagic, Inc, Research Triangle Park, NC) to calculate the difference between the 2 models in the 2 groups. Results of the experimental set showed that the mean error between the preoperative planning model and the postoperative model ranged from 0.65 to 0.97 mm (average, 0.89 mm). For the control group, the mean error was 0.78 to 1.45 mm (average, 1.01 mm). Thus, the mean error of the experimental group was statistically lower than that of the control group (P maxillofacial fractures was more accurate. Aided by the digital diagnosis and treatment program, the accuracy for maxillofacial fractures was notably improved. To facilitate the application and promotion of digital technology, further modification of the complete digital diagnosis and treatment pathway for maxillofacial fractures is highly desired. Copyright © 2017. Published by Elsevier Inc.

  4. Key issues in the design of pay for performance programs. (United States)

    Eijkenaar, Frank


    Pay for performance (P4P) is increasingly being used to stimulate healthcare providers to improve their performance. However, evidence on P4P effectiveness remains inconclusive. Flaws in program design may have contributed to this limited success. Based on a synthesis of relevant theoretical and empirical literature, this paper discusses key issues in P4P-program design. The analysis reveals that designing a fair and effective program is a complex undertaking. The following tentative conclusions are made: (1) performance is ideally defined broadly, provided that the set of measures remains comprehensible, (2) concerns that P4P encourages "selection" and "teaching to the test" should not be dismissed, (3) sophisticated risk adjustment is important, especially in outcome and resource use measures, (4) involving providers in program design is vital, (5) on balance, group incentives are preferred over individual incentives, (6) whether to use rewards or penalties is context-dependent, (7) payouts should be frequent and low-powered, (8) absolute targets are generally preferred over relative targets, (9) multiple targets are preferred over single targets, and (10) P4P should be a permanent component of provider compensation and is ideally "decoupled" form base payments. However, the design of P4P programs should be tailored to the specific setting of implementation, and empirical research is needed to confirm the conclusions.

  5. Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program

    Directory of Open Access Journals (Sweden)

    Barbara Resnick


    Full Text Available Barbara Resnick1, Denise Orwig2, Christopher D’Adamo2, Janet Yu-Yahiro3, William Hawkes2, Michelle Shardell2, Justine Golden2, Sheryl Zimmerman4, Jay Magaziner21University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD,21201, USA; 2University of Maryland School of Medicine, Howard Hall, Redwood Street, Baltimore MD 21201, USA; 3Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, USA; 4University of North Carolina Chapel Hill, 301 Pittsboro St., CB#3550, Chapel Hill, NC 27599-3550, USAAbstract: Using a social ecological model, this paper describes selected intra- and interpersonal factors that influence exercise behavior in women post hip fracture who participated in the Exercise Plus Program. Model testing of factors that influence exercise behavior at 2, 6 and 12 months post hip fracture was done. The full model hypothesized that demographic variables; cognitive, affective, physical and functional status; pain; fear of falling; social support for exercise, and exposure to the Exercise Plus Program would influence self-efficacy, outcome expectations, and stage of change both directly and indirectly influencing total time spent exercising. Two hundred and nine female hip fracture patients (age 81.0 ± 6.9, the majority of whom were Caucasian (97%, participated in this study. The three predictive models tested across the 12 month recovery trajectory suggest that somewhat different factors may influence exercise over the recovery period and the models explained 8 to 21% of the variance in time spent exercising. To optimize exercise activity post hip fracture, older adults should be helped to realistically assess their self-efficacy and outcome expectations related to exercise, health care providers and friends/peers should be encouraged to reinforce the positive benefits of exercise post hip fracture, and fear of falling should be addressed throughout the entire hip fracture recovery trajectory

  6. A 5-year exercise program in children improves muscle strength without affecting fracture risk. (United States)

    Fritz, Jesper; Cöster, Marcus E; Stenevi-Lundgren, Susanna; Nilsson, Jan-Åke; Dencker, Magnus; Rosengren, Björn E; Karlsson, Magnus K


    High level of physical activity (PA) is associated with great muscle strength and high fracture risk. This prospective controlled population-based study evaluated how a pediatric PA intervention program influenced muscle strength and fracture risk. We carried out a school-based exercise intervention program with 200 min of PA per week for 5 years in 335 girls and 408 boys aged 6-9 years at study start. An age-matched control cohort including 756 girls and 782 boys continued with 60 min of PA per week. We registered fractures during the study period and calculated rate ratio. In a sub-sample, including 74 girls and 107 boys in the intervention and 51 girls and 54 boys in the control group, we measured knee flexion and extension strength by a computerized dynamometer and leg composition by dual energy X-ray absorptiometry. Group comparisons were adjusted for differences in age, baseline value for the measured parameter and changes in height. Children in the intervention group had a rate ratio to sustain a fracture of 1.03 (0.78, 1.36) (mean and 95 % confidence interval) (p = 0.79). The annual gain in flexion peak torque muscle strength was greater in both girls (at 60°/s) [1.1 Nm (0.5, 1.8), p fracture risk.

  7. Risk factors for fractures in patients with rheumatoid arthritis (preliminary results of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment»

    Directory of Open Access Journals (Sweden)

    Marina Mikhailovna Podvorotova


    Full Text Available In patients with rheumatoid arthritis (RA, bone fractures occur 1.5-2 times more frequently than in the population. They often lead to reduced quality of life, to disability and death in the patients. It should be noted that risk factors (RFs for fractures have not been studied on a sufficient sample in Russia; there are no recommendations on the prevention of fractures in this category of patients. Objective: to compare groups of RA patients with and without a history of fractures to further identify possible RFs for fractures. Subjects and methods. The trial included 254 patients aged 18 to 85 years, diagnosed with RA, from the database of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment», who had been followed up in 2010 to 2011. The patients were divided into two groups: 1 101 (39.8% patients with a history of low-trauma fractures and 2 153 (60.2% patients without a history of fractures. In Group 1, the patients were older than in Group 2 (mean age 59.8 and 56.1 years, respectively. Menopause was recorded in 88.1 and 77.8% of cases, respectively. The groups differed in the duration of RA an average of 15.5 and 11.5 years, respectively Results. The fractures in the history were associated with the use of glucocorticoids (GC, their higher cumulative dose and use duration. In Group 1 patients, the bone mineral density (BMD was lower in all study skeleton portions and more frequently corresponded to osteoporosis. RA complications, such as amyloidosis and osteonecrosis, were more common in the patients with a history of fractures. Conclusion. In RA patients, the most likely RFs of fractures are age, the long-term intake of large-dose GC, low BMD, the severe course of RA, and the presence of its complications.

  8. Research program on fractured petroleum reservoirs. Final report, January 1, 1996--December 31, 1996

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, A.


    Multiphase flow in fractured porous media is a complex problem. While the study of single phase flow in a fractured or a layered medium can be pursued by some kind of averaging process, there is no meaning to averaging two-phase flow when capillarity is an active force. For a two-layer system comprised of high and low permeable layers, the performance of gas-oil gravity can be less efficient than the homogeneous low permeable medium. On the other hand, heterogeneity may enhance water imbibition due to capillarity. Due to the above and various other complexities, current tools for predicting the performance of fractured hydrocarbon reservoirs are not reliable. Based on the research work carried out at the Reservoir Engineering Research Institute, and some other Institutions, a good deal of progress has been made in recent years. But still we are a long way from good predictive reservoir models. In this final report, we summarize some of our achievements in the understanding of multiphase flow in fractured media. Since some of the features of two-phase flow in fractured and layered many are similar due to the capillary forces, the work includes progress in both types of media. There are some basic issues of flow in both fractured and unfractured media that are currently unresolved. These issues include: (1) new phase formation such as the formation of liquid phase in gas condensate reservoirs, and gas phase formation in solution gas drive process and (2) composition variation due to thermal convection and diffusion processes. In the following, a brief summary of our findings in the last three years during the course of the project is presented.

  9. Partnership for fragility bone fracture care provision and prevention program (P4Bones: study protocol for a secondary fracture prevention pragmatic controlled trial

    Directory of Open Access Journals (Sweden)

    Gaboury Isabelle


    Full Text Available Abstract Background Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs. Methods/design This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers. The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated

  10. Equal treatment: no evidence of gender inequity in osteoporosis management in a coordinator-based fragility fracture screening program. (United States)

    Ansari, H; Beaton, D E; Sujic, R; Rotondi, N K; Cullen, J D; Slater, M; Sale, J E M; Jain, R; Bogoch, E R


    We evaluated gender imbalance in osteoporosis management in a provincial coordinator-based fracture prevention program and found no difference by gender in treatment of high-risk fragility fracture patients. This establishes that a systemic approach with interventions for all fragility fracture patients can eliminate the gender inequity that is often observed. The purpose of this study was to evaluate an Ontario-based fracture prevention program for its ability to address the well-documented gender imbalance in osteoporosis (OP) management, by incorporating its integrated fracture risk assessments within a needs-based evaluation of equity. Fragility fracture patients (≥ 50 years) who were treatment naïve at screening and completed follow-up within 6 months of screening were studied. Patients who underwent bone mineral density (BMD) testing done in the year prior to their current fracture were excluded. All participants had BMD testing conducted through the Ontario OP Strategy Fracture Screening and Prevention program, thus providing us with fracture risk assessment data. Our primary study outcome was treatment initiation at follow-up within 6 months of screening. Gender differences were compared using Fisher's exact test, at p risk, study participants did not show a statistically significant gender difference in pharmacotherapy initiation at follow-up (p > 0.05). 68.4% of women and 66.2% of men at high risk were treated within 6 months of screening. Needs-based analyses show no difference by gender in treatment of high-risk fragility fracture patients. An intensive coordinator-based fracture prevention model adopted in Ontario, Canada was not associated with gender inequity in OP treatment of fragility fracture patients after fracture risk adjustment.

  11. Fractured rock modeling in the National Waste Terminal Storage Program: a review of requirements and status

    Energy Technology Data Exchange (ETDEWEB)

    St. John, C.; Krug, A.; Key, S.; Monsees, J.


    Generalized computer codes capable of forming the basis for numerical models of fractured rock masses are being used within the NWTS program. Little additional development of these codes is considered justifiable, except in the area of representation of discrete fractures. On the other hand, model preparation requires definition of medium-specific constitutive descriptions and site characteristics and is therefore legitimately conducted by each of the media-oriented projects within the National Waste Terminal Storage program. However, it is essential that a uniform approach to the role of numerical modeling be adopted, including agreement upon the contribution of modeling to the design and licensing process and the need for, and means of, model qualification for particular purposes. This report discusses the role of numerical modeling, reviews the capabilities of several computer codes that are being used to support design or performance assessment, and proposes a framework for future numerical modeling activities within the NWTS program.

  12. A 4-year exercise program in children increases bone mass without increasing fracture risk. (United States)

    Löfgren, Bjarne; Dencker, Magnus; Nilsson, Jan-Åke; Karlsson, Magnus K


    Most prospective pediatric exercise intervention studies cover fractures. This prospective controlled exercise intervention study therefore followed not only skeletal development but also fracture incidence for 4 years. Fractures were prospectively registered in a cohort of children aged 7 to 9 years, 446 boys and 362 girls in the intervention group (2675 person-years) and 807 boys and 780 girls in the control group (5661 person-years). The intervention included 40 minutes per day of school physical education for 4 years whereas the controls had 60 minutes per week. In a subsample, 73 boys and 48 girls in the intervention and 52 boys and 48 girls in the control group, bone mineral content (g) and bone width (cm) were followed by means of dual-energy radiograph absorptiometry. The rate ratio for fractures was 1.11. In the dual-energy radiograph absorptiometry-measured children, there were no group differences at baseline in age, anthropometrics, or bone traits. The mean annual gain in lumbar spine bone mineral content was 7.0% higher in girls and 3.3% higher in boys and in femoral neck width 1.7% higher in girls and 0.6% higher in boys in the intervention than in the control group. A population-based moderately intense 4-year exercise program in 7- to 9-year-old children increased bone mass and size without affecting the fracture risk.

  13. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

    Directory of Open Access Journals (Sweden)

    Lisa M Poole


    Full Text Available Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5% had a sensory deficit alone, 4 (2.9% had a motor deficit alone, and 4 (2.9% had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6% underwent formal swallow evaluation, and 4 (2.9% had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9% had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%, or to home or home with home health (n = 48, 35.3%. Seven patients (5.1% died in the hospital, and eight more (5.9% were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

  14. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. (United States)

    Krischak, Gert D; Krasteva, Anna; Schneider, Florian; Gulkin, Daniel; Gebhard, Florian; Kramer, Michael


    To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program. Randomized controlled cohort study. Hospital-based care, primary center of orthopedic surgery. Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol. Not applicable. Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE). After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (Pwrist function with a nearly 50% lower value (Pwrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.

  15. The Water Risks of Hydraulic Fracturing (Fracking): Key Issues from the New California Assessment (United States)

    Gleick, P. H.


    A key component of the Water-Energy Nexus is the effort over the past decade or so to quantify the volumes and form of water required for the energy fuel cycle from extraction to generation to waste disposal. The vast majority of the effort in this area has focused on the water needs of electricity generation, but other fuel-cycle components also entail significant water demands and threats to water quality. Recent work for the State of California (managed by the California Council on Science and Technology - CCST) has produced a new state-of-the-art assessment of a range of potential water risks associated with hydraulic fracturing and related oil and gas extraction, including volumetric water demands, methods of disposal of produced water, and aquifer contamination. For example, this assessment produced new information on the disposal of produced water in surface percolation pits and the potential for contamination of local groundwater (see Figure). Understanding these risks raises questions about current production and future plans to expand production, as well as tools used by state and federal agencies to manage these risks. This talk will summarize the science behind the CCST assessment and related policy recommendations for both water and energy managers.

  16. Farm to School Program. Nourishing News. Volume 4, Issue 2 (United States)

    Idaho State Department of Education, 2009


    The Idaho Farm to School Program works towards having Idaho grown food served to students in Idaho Child Nutrition Programs. This important program is emerging at meal times across Idaho and nationwide. Child Nutrition programs are buying fresh food directly from local farmers as a way of improving the quality and taste of their meals. These Farm…

  17. Fractured Reservoir Simulation: a Challenging and Rewarding Issue Simulation des réservoirs fracturés : un défi et un enjeu

    Directory of Open Access Journals (Sweden)

    Bourbiaux B.


    Full Text Available The recent years have seen a growing awareness of the role played by fractures in petroleum reservoirs production and recovery. Hence, much effort was devoted to the diagnosis of fracture presence and impact on production. However, turning that diagnosis into field development decisions goes through reservoir simulation. This paper addresses some of the specificities of fractured reservoirs that make that their simulation is both challenging and rewarding. Indeed, the integration of fractures into a flow simulation model is not straightforward because of the existing gap between the geological fault/fracture network and the fingerprint of that network on often-complex recovery mechanisms. Considering that fractures may impede or enhance production, fractured reservoir simulation may be seen as a technical challenge with potentially-high reward. This paper underlines that specific framework as an introduction to two technical articles dedicated to dual-porosity reservoir simulation. Although it constitutes another major aspect of any fractured reservoir study, the geological characterization of fractures is not discussed herein, but only evoked because of more and more integration of static and dynamic aspects. Au cours des années récentes, la prise de conscience du rôle des fractures sur la production et la récupération des champs est devenue de plus en plus forte au sein de la communauté pétrolière. Aussi beaucoup d’efforts ont-ils été consacrés à la détection des fractures et à l’analyse de leur impact sur la production. Toutefois, la prise en considération de ces observations dans les choix de développement des champs passe par la simulation de réservoir. Cet article traite des spécificités propres aux réservoirs fracturés et qui font de leur simulation à la fois un défi et un enjeu. En effet, l’intégration des fractures dans un modèle de simulation des écoulements n’est pas immédiate en raison du difficile

  18. EPa`s program for risk assessment guidelines: Exposure issues

    Energy Technology Data Exchange (ETDEWEB)

    Callahan, M.A. [Environmental Protection Agency, Washington, DC (United States)


    Three major issues to be dealt with over the next ten years in the exposure assessment field are: consistency in terminology, the impact of computer technology on the choice of data and modeling, and conceptual issues such as the use of time-weighted averages.

  19. Current Trends and Issues in Childhood Sexual Abuse Prevention Programs. (United States)

    Moody, Edward E., Jr.


    Focuses on trends in prevention programs for sexually abused children, first reviewing the trauma of sexual abuse. Section on prevention programs for use by elementary school counselors discusses printed materials, interventions using drama, lecture/discussion formats, audiovisual materials, teacher training models, and parental workshops.…

  20. The Role for an Evaluator: A Fundamental Issue for Evaluation of Education and Social Programs (United States)

    Luo, Heng


    This paper discusses one of the fundamental issues in education and social program evaluation: the proper role for an evaluator. Based on respective and comparative analysis of five theorists' positions on this fundamental issue, this paper reveals how different perspectives on other fundamental issues in evaluation such as value, methods, use and…

  1. Electrostatic Discharge Issues in International Space Station Program EVAs (United States)

    Bacon, John B.


    EVA activity in the ISS program encounters several dangerous ESD conditions. The ISS program has been aggressive for many years to find ways to mitigate or to eliminate the associated risks. Investments have included: (1) Major mods to EVA tools, suit connectors & analytical tools (2) Floating Potential Measurement Unit (3) Plasma Contactor Units (4) Certification of new ISS flight attitudes (5) Teraflops of computation (6) Thousands of hours of work by scores of specialists (7) Monthly management attention at the highest program levels. The risks are now mitigated to a level that is orders of magnitude safer than prior operations

  2. Required Postdoctoral Education Programs in General Dentistry: Accreditation Issues. (United States)

    Santangelo, Mario V.


    A review of the history and current status of both the predoctoral dental curriculum and general dentistry programs gives insight into the nature and scope of the movement to make postdoctoral dental education a requirement. (MSE)

  3. Trade Adjustment Assistance for Firms: Economic, Program, and Policy Issues

    National Research Council Canada - National Science Library

    Hornbeck, J. F


    .... This report focuses on the trade adjustment assistance (TAA) program for firms, which provides technical assistance to help them develop strategies to remain competitive in the changing international economy...

  4. Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Ekdahl Charlotte S


    Full Text Available Abstract Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group versus usual care (control group after plaster removal in adults with surgically treated ankle fractures. Methods In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36, timed walking tests, ankle mobility tests, muscle strength tests and radiological status. Results 52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028, muscle strength in the plantar flexors (p = 0.029 and dorsiflexors (p = 0.030. Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three

  5. SEAFRAME. Supporting Programs. Volume 2, Issue 1, Winter 2006 (United States)


    issue associated with this class is the lack of original equipment manufacturer (OEM) support for its hydraulic power unit ( HPU ), specifically on MCM 1...through 8. The HPU provides hydraulic power to the cable reels and stern cranes. The first of two engineering efforts will focus on redesign of these...ships. Once a solid design is established, S3 engineers will then begin a concurrent design for the MCM 9 through 14. In addition to the main HPU , the

  6. Old people with femoral neck fracture : delirium, malnutrition and surgical methods - an intervention program


    Olofsson, Birgitta


    Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associate...

  7. Navy John Lewis (TAO-205) Class Oiler Shipbuilding Program: Background and Issues for Congress (United States)


    Navy John Lewis (TAO-205) Class Oiler Shipbuilding Program: Background and Issues for Congress Ronald O’Rourke Specialist in Naval Affairs...January 8, 2016 Congressional Research Service 7-5700 R43546 Navy John Lewis (TAO-205) Class Oiler Shipbuilding Program...Congressional Research Service Summary The John Lewis (TAO-205) class oiler shipbuilding program, previously known as the TAO(X) program, is a program to

  8. Addressing Correctional Officer Stress: Programs and Strategies. Issues and Practices. (United States)

    Finn, Peter

    A review of the literature and interviews with over 50 people in the field revealed that job-related stress is widespread and possibly increasing among correctional officers. This publication is intended to help correctional administrators develop an effective program for preventing and treating correctional officers' stress. A variety of…

  9. Usability Issues in the Design of Novice Programming Systems, (United States)


    problem is when the programmer is checking for valid input from a menu of choices. Often nov- ices will code if (ch <> ’a’) OR (ch <> ’b’) OR (ch <> ’c...white space, and typography to carry semantic domain knowledge about the program, and at least some of these benefit novices too [Gilmore 1986, Payne...Justified by: Empirical studies, expert opinion Examples: Comments, white space, and typography are examples of secondary nota- tion that should be supported

  10. Defining and describing capacity issues in U.S. Doctor of Nursing Practice programs. (United States)

    Minnick, Ann F; Norman, Linda D; Donaghey, Beth


    Recent calls to expand the number of U.S. Doctors of Nursing Practice (DNPs) raises questions about programs' capacities, content and requirements, and their ability to expand. This paper aims to describe (1) key aspects of DNP program capacities that may provide direction for DNP program expansion plans, the timing of such expansion and program QI efforts; and (2) the impact of the DNP on faculty resources for research doctoral programs. A survey of all U.S. DNP programs (n = 130; response rate 72%) was conducted in 2011 based on previously tested items. Reviews of Web sites of nonresponding schools provided some data from all programs. Ratios of students to faculty active in advanced practice (AP) and in QI (QI) were high (AP 11.0:1, SD 10.1; QI 20.2:1, SD 17.0 respectively). There was wide variation in scholarly requirements (0-4: 50% of program had none) and program committee composition (1-5; mode=2). Almost all responding schools that offered PhD and DNP programs reported assigning research-active or potentially research-active faculty in both programs. The ability to expand programs while maintaining quality may be compromised by capacity issues. Addressing demand issues through the alignment of program requirements with societal and employment requirements may provide directions for addressing current DNP capacity issues. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Substance abuse issues among women in domestic violence programs: findings from North Carolina. (United States)

    Martin, Sandra L; Moracco, Kathryn E; Chang, Judy C; Council, Carol L; Dulli, Lisa S


    This article discusses the results of a survey of North Carolina domestic violence programs that found that substance abuse problems are common among program clients, yet only half of the programs had policies concerning substance-abusing clients, and one fourth had memoranda of agreement with substance abuse treatment providers. Most programs with shelters asked clients about substance use; however, one third of the shelters would not admit women if they were noticeably under the influence of substances while seeking shelter residence, instead referring them to substance abuse programs. Approximately one tenth of the domestic violence programs did not have any staff or volunteers with training in substance abuse issues. Implications are discussed.

  12. Enhanced oil recovery: environmental issues and state regulatory programs

    Energy Technology Data Exchange (ETDEWEB)

    Haynes, R.J.; Boggs, T.A.; Millemann, R.E.; Floran, R.J.; Hildebrand, S.G.


    Environmental assessments were prepared for nine EOR demonstration projects located in six states, and the oil regulations for all oil-producing states were reviewed. These evaluations revealed a number of potentially important environmental impacts associated with EOR, including: (1) loss of vegetation; (2) excessive air emissions from thermal operations; (3) excessive erosion and sedimentation (mostly in hilly terrain) and subsequent deterioration of surface-water quality; (4) pollution of land and surface waters from spills or leaks of oil or other chemicals; and (5) contamination of groundwater aquifers. The need for additional environmental planning and monitoring regulations specific for the oil-production industry is emphasized. States are encouraged to continue strengthening and upgrading their oil-regulatory programs to safeguard the environment. The evaluations also identified areas where additional information is needed: (1) toxicity and carcinogenicity studies of chemicals used in injection processes; (2) evaluation of groundwater monitoring methods; and (3) studies of reclamation procedures for soils contaminated by oil and brine.

  13. Fractal analysis of fractures applied to Soultz-sous-Forets hot dry rock geothermal program (United States)

    Ledésert, Béatrice; Dubois, Jacques; Genter, Albert; Meunier, Alain


    A fractal analysis has been performed on a fracture set observed on granite cores in order to determine preferential paths for fluids injected during Hot Dry Rock (HDR) geothermic experiments. This analysis was based on the sorting of fractures on criteria such as their direction according to the present stress field, their dip, their hydrothermal filling thickness (vein width) which is linked to the intensity of alteration and thus to the physico-chemical properties of the surrounding rock. The results show a global increase of the fractal dimension (D) with depth which may be related to the lithostatic pressure gradient. Analysis of the total fracture set has showed zones in which fractures are clustered (low D values) while others are characterized by regularly spaced fractures (higher D values). Fractures parallel to the maximum horizontal stress, narrow veins, and fractures with a dip greater than 40° represent 35% to 79% of the total fracture set. Their fractal dimensions are similar to those of the total fracture set. Large veins linked with high porosity zones show a cluster pattern all along the drilling. In the context of HDR geothermics, one should seek highly fractured zones especially if the fractures they contain are clustered and if they have developed wide alteration zones linked to a high porosity. These conditions may optimize the HDR heat exchanger possibilities.

  14. Media, Tourism, Environment, and Cultural Issues in Australia: A Case Study of a Study Abroad Program (United States)

    Freedman, Eric


    A multidisciplinary study abroad program developed by a U.S. journalism school and cosponsored by a college of agriculture and natural resources interweaves the themes of mass media, tourism, environment, and cultural issues in Australia. This article traces the development and evolution of the faculty-led program and discusses its curriculum,…

  15. "I Am Not a Big Man": Evaluation of the Issue Investigation Program (United States)

    Cincera, Jan; Simonova, Petra


    The article evaluates a Czech environmental education program focused on developing competence in issue investigation. In the evaluation, a simple quasi-experimental design with experimental (N = 200) and control groups was used. The results suggest that the program had a greater impact on girls than on boys, and that it increased their internal…

  16. Navy Ohio Replacement (SSBN[X]) Ballistic Missile Submarine Program: Background and Issues for Congress (United States)


    Navy Ohio Replacement (SSBN[X]) Ballistic Missile Submarine Program: Background and Issues for Congress Ronald O’Rourke Specialist in Naval...Affairs April 5, 2016 Congressional Research Service 7-5700 R41129 Navy Ohio Replacement (SSBN[X]) Ballistic Missile Submarine...Replacement (SSBN[X]) Ballistic Missile Submarine Program Congressional Research Service Contents Introduction

  17. Nose fracture (United States)

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...

  18. Emerging issues in the evaluation of energy-efficiency programs. The US experience

    Energy Technology Data Exchange (ETDEWEB)

    Vine, E. [Lawrence Berkeley National Laboratory LBNL, Berkeley, CA (United States); Hall, N.; Keating, K.M. [TecMarket Works, Oregon, WI (United States); Kushler, M. [American Council for an Energy-Efficient Economy, Washington, DC (United States); Prahl, R. [Prahl and Associates, Fremont, CA (United States)


    The evaluation, measurement, and verification (EM and V) of energy-efficiency programs has a rich and extensive history in the United States, dating back to the late 1970s. During this time, many different kinds of EM and V issues have been addressed: technical (primarily focusing on EM and V methods and protocols), policy (primarily focusing on how EM and V results will be used by energy-efficiency program managers and policymakers), and infrastructure (primarily focusing on the development of EM and V professionals and an EM and V workforce). We address the issues that are currently important and/or are expected to become more critical in the coming years. We expect many of these issues will also be relevant for a non-US audience, particularly as more attention is paid to the reliability of energy savings and carbon emissions reductions from energy-efficiency programs.

  19. Research program to develop and validate conceptual models for flow and transport through unsaturated, fractured rock; Yucca Mountain Site Characterization Project

    Energy Technology Data Exchange (ETDEWEB)

    Glass, R.J.; Tidwell, V.C.


    As part of the Yucca Mountain Project, our research program to develop and validate conceptual models for flow and transport through unsaturated fractured rock integrates fundamental physical experimentation with conceptual model formulation and mathematical modeling. Our research is directed toward developing and validating macroscopic, continuum-based models and supporting effective property models because of their widespread utility within the context of this project. Success relative to the development and validation of effective property models is predicted on a firm understanding of the basic physics governing flow through fractured media, specifically in the areas of unsaturated flow and transport in a single fracture and fracture-matrix interaction.

  20. Ethical issues in the treatment of applicants to APA-accredited Ph.D. programs. (United States)

    Dimson, C


    This paper examines some of the ethical issues involved in the treatment of applicants to highly competitive APA-accredited clinical and counseling psychology Ph.D. programs. These issues are analyzed in terms of the 1992 APA Ethics Code as well as the basic ethical principles of nonmaleficence, beneficence, justice, fidelity, and autonomy. Issues considered include the applicability of the 1992 APA Ethics Code to the selection process, the obligation to provide applicants accurate and complete information, dual relationships in the selection process, the treatment of rejected or wait-listed applicants, discrimination in the selection process, psychological assessment and research in the selection process, and legal resolutions which pertain to the selection process. In analyzing these issues, the paper calls attention to the need for psychologists functioning as admissions evaluators to be aware of and sensitive to the ethical issues relevant to the selection process.

  1. NCRP Program Area Committee 5: Environmental Radiation and Radioactive Waste Issues. (United States)

    Chen, S Y; Napier, Bruce


    Program Area Committee 5 of the National Council on Radiation Protection and Measurements (NCRP) focuses its activities on environmental radiation and radioactive waste issues. The Committee completed a number of reports in these subject areas, most recently NCRP Report No. 175, Decision Making for Late-Phase Recovery from Major Nuclear or Radiological Incidents. Historically this Committee addressed emerging issues of the nation pertaining to radioactivity or radiation in the environment or radioactive waste issues due either to natural origins or to manmade activities.

  2. Influence of a 3-year exercise intervention program on fracture risk, bone mass, and bone size in prepubertal children. (United States)

    Löfgren, Bjarne; Detter, Fredrik; Dencker, Magnus; Stenevi-Lundgren, Susanna; Nilsson, Jan-Åke; Karlsson, Magnus K


    Published prospective pediatric exercise intervention studies are short term and use skeletal traits as surrogate endpoints for fractures, whereas other reports infer exercise to be associated with more trauma and fractures. This prospective, controlled exercise intervention study therefore followed both skeletal traits and fracture risk for 36 months. Fractures were registered in children aged 7 to 9 years; there were 446 boys and 362 girls in the intervention group (2129 person-years) and 807 boys and 780 girls in the control group (4430 person-years). The intervention included school physical education of 40 minutes per day for 3 years. The control children achieved the Swedish standard of 60 minutes per week. In a subsample of 76 boys and 48 girls in the intervention group and 55 boys and 44 girls in the control group, bone mineral content (BMC, g) and bone width (cm) were followed in the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). The rate ratio (RR) for fractures was 1.08 (0.71, 1.62) [mean (95% confidence interval)]. In the DXA-measured children, there were no group differences at baseline in age, anthropometrics, or bone traits. The mean annual gain in the intervention group in lumbar spine BMC was 0.9 SD higher in girls and 0.8 SD higher in boys (both p exercise program in 7- to 9-year-old children increases bone mass and possibly also bone size without increasing fracture risk. Copyright © 2011 American Society for Bone and Mineral Research.

  3. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review

    Directory of Open Access Journals (Sweden)

    Andrea M Bruder


    Registration: CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017 Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205–220

  4. Advanced General Dentistry Education Programs: Issues and Forces That Will Shape the Future. (United States)

    VanOstenburg, Paul R.


    Issues in postdoctoral dental education and distinctions between the general practice residency and the advanced education program in general dentistry include: the need for practitioners and further specialization in the work force, society's health care needs, and changes in the health care industry, dental education, dental departments, and…

  5. School-Based Programs Addressing Gay/Lesbian/Bisexual Youth Issues. (United States)

    Rienzo, Barbara A.; And Others


    Homosexual adolescents are at risk within schools for many health problems. Hostile school environments can often exacerbate their problems. This article summarizes research on issues related to youth sexual orientation, noting controversies surrounding school involvement in the United States and describing programs instituted by school…

  6. Conducting Program Evaluation with Hispanics in Rural Settings: Ethical Issues and Evaluation Challenges (United States)

    Loi, Claudia X. Aguado; McDermott, Robert J.


    Conducting evaluations that are both valid and ethical is imperative for the support and sustainability of programs that address underserved and vulnerable populations. A key component is to have evaluators who are knowledgeable about relevant cultural issues and sensitive to population needs. Hispanics in rural settings are vulnerable for many…

  7. Second international conference on fundamentals of fracture. Program and abstract book. Summaries

    Energy Technology Data Exchange (ETDEWEB)


    The approximately 95 papers and abstracts are grouped under the following headings: atomic theory, continuum theory, experimental studies, environmental effects, fatigue, ceramics, high-temperature phenomena, and interfacial fracture. (DLC)

  8. Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai Bang; Kristensen, Billy Bjarne


    BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after...... hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second......, fourth and seventh post-operative days with the Mini Mental State Examination (MMSE) score. RESULTS: Thirty-two per cent of patients developed a significant post-operative cognitive decline, which was associated with several pre-fracture patient characteristics, including age and cognitive function...

  9. Compliance to The Joint Commission proposed Core Measure set on osteoporosis-associated fracture: review of different secondary fracture prevention programs in an open medical system from 2010 to 2015. (United States)

    Fojas, Ma Conchitina; Southerland, Lauren T; Phieffer, Laura S; Stephens, Julie A; Srivastava, Tanya; Ing, Steven W


    There are care gaps in the evaluation and treatment of osteoporosis after a fragility fracture. The Joint Commission is considering adoption of core measures. We compared compliance between two secondary fracture prevention programs in our institution. Incorporating strengths of both may provide the best outcomes for secondary fracture prevention. There are significant care gaps in the evaluation and treatment of osteoporosis after occurrence of fragility fracture. The Joint Commission is considering adoption of a core measure set on osteoporosis-associated fractures, including laboratory assessment, bone density testing, and osteoporosis pharmacologic therapy. We compared compliance to these proposed measures between two secondary fracture prevention programs in patients hospitalized for acute fracture in an open medical system. We conducted a retrospective, single center medical records review of a nurse practitioner-led Fracture Liaison Service (FLS), a physician-led Fracture Prevention Program (FPP), and a historical time without any secondary fracture prevention program (Usual Care) for baseline care. Primary outcomes were the completion of five laboratory tests (calcium, 25-hydroxy vitamin D, renal function, liver function, and complete blood count), order placement and completion of dual x-ray absorptiometry (DXA) scan within 3 months, prescription of osteoporosis medication within 3 months, and medication adherence at 6 months after hospital discharge. Completion of all five laboratory tests was higher in FPP versus FLS (84.7 vs. 36.9%, p < 0.001). DXA scan completion was higher in FPP than FLS but not statistically significant (66.7 vs. 54.9%, p = 0.11). Medication prescription at 3 months and adherence at 6 months were significantly higher in FPP versus FLS (65.3 vs. 24.0%, p < 0.001 and 70.8 vs. 27.7%, p < 0.001, respectively). Incorporating strengths of both FLS (care coordination) and FPP (physician direction) may provide the best outcomes

  10. Skull fracture (United States)

    Basilar skull fracture; Depressed skull fracture; Linear skull fracture ... Skull fractures may occur with head injuries . The skull provides good protection for the brain. However, a severe impact ...

  11. Risk Management for Study Abroad Programs: Issues and Resources to Inform Program Development, Administration, and Training (United States)

    Rhodes, Gary


    This chapter provides a practical background to the health and safety risks and challenges for U.S. colleges and universities and other program providers. Potential risks, field-based guidelines, good practices, and resources to support the management of risks by study abroad offices will be covered.

  12. Preface paper to the Semi-Arid Land-Surface-Atmosphere (SALSA) Program special issue (United States)

    Goodrich, D.C.; Chehbouni, A.; Goff, B.; MacNish, B.; Maddock, T.; Moran, S.; Shuttleworth, W.J.; Williams, D.G.; Watts, C.; Hipps, L.H.; Cooper, D.I.; Schieldge, J.; Kerr, Y.H.; Arias, H.; Kirkland, M.; Carlos, R.; Cayrol, P.; Kepner, W.; Jones, B.; Avissar, R.; Begue, A.; Bonnefond, J.-M.; Boulet, G.; Branan, B.; Brunel, J.P.; Chen, L.C.; Clarke, T.; Davis, M.R.; DeBruin, H.; Dedieu, G.; Elguero, E.; Eichinger, W.E.; Everitt, J.; Garatuza-Payan, J.; Gempko, V.L.; Gupta, H.; Harlow, C.; Hartogensis, O.; Helfert, M.; Holifield, C.; Hymer, D.; Kahle, A.; Keefer, T.; Krishnamoorthy, S.; Lhomme, J.-P.; Lagouarde, J.-P.; Lo, Seen D.; Luquet, D.; Marsett, R.; Monteny, B.; Ni, W.; Nouvellon, Y.; Pinker, R.; Peters, C.; Pool, D.; Qi, J.; Rambal, S.; Rodriguez, J.; Santiago, F.; Sano, E.; Schaeffer, S.M.; Schulte, M.; Scott, R.; Shao, X.; Snyder, K.A.; Sorooshian, S.; Unkrich, C.L.; Whitaker, M.; Yucel, I.


    The Semi-Arid Land-Surface-Atmosphere Program (SALSA) is a multi-agency, multi-national research effort that seeks to evaluate the consequences of natural and human-induced environmental change in semi-arid regions. The ultimate goal of SALSA is to advance scientific understanding of the semi-arid portion of the hydrosphere-biosphere interface in order to provide reliable information for environmental decision making. SALSA approaches this goal through a program of long-term, integrated observations, process research, modeling, assessment, and information management that is sustained by cooperation among scientists and information users. In this preface to the SALSA special issue, general program background information and the critical nature of semi-arid regions is presented. A brief description of the Upper San Pedro River Basin, the initial location for focused SALSA research follows. Several overarching research objectives under which much of the interdisciplinary research contained in the special issue was undertaken are discussed. Principal methods, primary research sites and data collection used by numerous investigators during 1997-1999 are then presented. Scientists from about 20 US, five European (four French and one Dutch), and three Mexican agencies and institutions have collaborated closely to make the research leading to this special issue a reality. The SALSA Program has served as a model of interagency cooperation by breaking new ground in the approach to large scale interdisciplinary science with relatively limited resources.

  13. Research program on fractured petroleum reservoirs. [Quarterly report], October 1--December 31, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, A.


    A number of experiments have been performed to study water injection in fractured porous media. These experiments reveal that: (1) the co-current imbibition may be the primary flow process in water-wet fractured media, and (2) the imbibition may result in over 20 percent recovery from very tight rock (Austin Chalk with K{sub ma} of the order of 0.01 md) for an imbibition period of about 2 months. Theoretical consideration reveal that the exponential function of Aronofsky et al. [``A Model for the Mechanism of Oil Recovery from Porous Matrix Due to Water Invasion In Fractured Reservoirs,`` Trans. AIME (1958) 213, 17-19] does not describe the early-time, but may represent the late-time recovery.

  14. Navy Littoral Combat Ship (LCS) Program: Background and Issues for Congress (United States)


    underlying business case. Elements of the LCS business case, including its cost, the time needed to develop and field the system, and its Comunications Seen Deficient, GAO Says,” Bloomberg News, November 19, 2013. Navy Littoral Combat Ship (LCS) Program: Background and Issues...subcontracting reports on eSRS as one method of monitoring small business participation. As of December 2012, eSRS indicated that two of the associated

  15. Evaluation of Geese Theatre's Re-Connect program: addressing resettlement issues in prison. (United States)

    Harkins, Leigh; Pritchard, Cecilia; Haskayne, Donna; Watson, Andy; Beech, Anthony R


    This study examined the impact of Geese Theatre's Re-Connect program on a sample of offenders who attended it. This program used theatre performance, experiential exercises, skills practice role-plays, and metaphors such as the masks to invite a group of offenders to consider and explore issues connected with their release and reconnecting with a life outside prison. Pre- and postprogram psychometric tests, behavior ratings, and interviews were completed to assess the effectiveness of the program. Significant changes were observed from pre- to posttreatment in terms of self-efficacy, motivation to change, and improved confidence in skills (i.e., social and friendship, occupational, family and intimacy, dealing with authority, alternatives to aggression or offending, and self-management and self-control skills). Improved behavior and engagement within the program was observed over the 3 days of the program. Interviews also revealed the positive impact the program had on the participants. This provides evidence supporting the short-term effectiveness of the Re-Connect program.

  16. Are recent graduates of orthopaedic training programs performing less fracture care? American Board of Orthopedic Surgeons part II: a quality improvement initiative. (United States)

    Koval, Kenneth J; Marsh, Larry; Anglen, Jeff; Weinstein, James; Harrast, John J


    The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time. Retrospective review. American Board of Orthopaedic Surgery (ABOS) Part II database. Candidates applying for Part II of the second part of the Orthopaedic (ABOS) certification. The ABOS Part II database was searched from years 1999 to 2008 for Current Procedural Terminology codes indicating 1) "simpler fractures" that any candidate surgeon should be able to perform; 2) "complex fractures" that are often referred to surgeons with specialty training; and 3) "emergent cases" that should be done emergently by a physician. Logistic regression and chi-square tests were used to evaluate whether there has been a change in the amount of fracture care among recent graduates of orthopaedic residency programs over time. Over the 10-year period (1999-2008), a total of 95,922 cases were in the simpler fractures category; 16,523 were classified as complex fractures and 17,789 were classified as emergent cases. The overall number of cases by fracture type increased from 1999 to 2008 as did the average number of surgery cases performed by surgeons in each category over the 6-month collection period. Simpler fracture cases increased 18% (8304-9784 cases) with the average number surgically treated by surgeons performing at least one simple fracture case also increasing 18% (14.1-16.6 cases per surgeon). Complex fracture cases increased 51% (1266-1916 cases) with the average number of these cases per surgeon operating at least one complex fracture case increasing 52% (3.3-5.0 cases per surgeon). Emergent fracture cases increased 92% (1178-2264 cases) with the average number of these cases per surgeon operating at least one emergent fracture case increasing 49% (4.5-6.7 cases per surgeon). From the data presented here, candidate orthopaedic surgeons are treating fractures as least as often as young surgeons

  17. Overview of the fatigue/fracture/life prediction working group program at the Lewis Research Center (United States)

    Mcgaw, Michael A.


    The objective is to develop and verify constitutive and life prediction models for materials typically used in hot gas path components of reusable space propulsion systems over the range of relevant operative environments. The efforts were concentrated on the development of crack initiation life prediction methods and on the development of cyclic crack propagation and fracture life prediction methods.

  18. Programmatic issues in the implementation of an HPV vaccination program to prevent cervical cancer. (United States)

    Ault, Kevin; Reisinger, Keith


    Cervical cancer remains an important health problem even in countries with effective cervical screening programs. HPV vaccines offer great potential for primary prevention of cervical cancer and other HPV-related diseases. Eventual implementation of an HPV vaccination program raises several key issues, including universal vs. targeted vaccinations, the age and gender of vaccine recipients, the acceptability of this vaccine to health care providers, adolescents, and parents, and the effect of this vaccine on cervical cancer screening. These issues were explored among symposium attendees during an interactive question-and-answer session using computerized voting pads. Preventative HPV vaccination programs should ideally be executed universally in both women and men with an emphasis on children and adolescents prior to their first sexual experience. Parent education on HPV disease and vaccine efficacy and safety will be critical to the acceptability of HPV vaccination for their children. HPV vaccination will not eliminate the need for Pap screening. Further research will be needed to develop rational and cost-effective cervical surveillance programs for women protected by HPV vaccines.

  19. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review


    Andrea M Bruder; Nora Shields; Karen J Dodd; Nicholas F Taylor


    Question: What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures? Design: Systematic review of controlled trials. Participants: Adults following an upper limb fracture. Intervention: Any exercise therapy program, including trials where exercise was delivered to both groups provided that the groups received different amounts of exercise. Outcome measures: Impairments of body st...

  20. A parallel program for numerical simulation of discrete fracture network and groundwater flow (United States)

    Huang, Ting-Wei; Liou, Tai-Sheng; Kalatehjari, Roohollah


    The ability of modeling fluid flow in Discrete Fracture Network (DFN) is critical to various applications such as exploration of reserves in geothermal and petroleum reservoirs, geological sequestration of carbon dioxide and final disposal of spent nuclear fuels. Although several commerical or acdametic DFN flow simulators are already available (e.g., FracMan and DFNWORKS), challenges in terms of computational efficiency and three-dimensional visualization still remain, which therefore motivates this study for developing a new DFN and flow simulator. A new DFN and flow simulator, DFNbox, was written in C++ under a cross-platform software development framework provided by Qt. DFNBox integrates the following capabilities into a user-friendly drop-down menu interface: DFN simulation and clipping, 3D mesh generation, fracture data analysis, connectivity analysis, flow path analysis and steady-state grounwater flow simulation. All three-dimensional visualization graphics were developed using the free OpenGL API. Similar to other DFN simulators, fractures are conceptualized as random point process in space, with stochastic characteristics represented by orientation, size, transmissivity and aperture. Fracture meshing was implemented by Delaunay triangulation for visualization but not flow simulation purposes. Boundary element method was used for flow simulations such that only unknown head or flux along exterior and interection bounaries are needed for solving the flow field in the DFN. Parallel compuation concept was taken into account in developing DFNbox for calculations that such concept is possible. For example, the time-consuming seqential code for fracture clipping calculations has been completely replaced by a highly efficient parallel one. This can greatly enhance compuational efficiency especially on multi-thread platforms. Furthermore, DFNbox have been successfully tested in Windows and Linux systems with equally-well performance.

  1. Establishing a new military sexual trauma treatment program: Issues and recommendations for design and implementation. (United States)

    Johnson, Nicole L; Robinett, Shelia; Smith, Lauren M; Cardin, Scott


    This article presents a review of issues and considerations when developing a comprehensive military sexual trauma (MST) treatment program. A review of the current literature was conducted, which we argue is the first step in informing programmatic design. Next, information on how to obtain local public data and then a description of how we used this information to design the new MST program at our facility are discussed. Our clinic design reflects best practice while simultaneously incorporating real-world information and will be more likely to positively influence overall care to patients. As such, we recommend that clinicians involved in clinic development will use this process as a model for successful clinic planning and program development. (c) 2015 APA, all rights reserved).

  2. A 5-year exercise program in pre- and peripubertal children improves bone mass and bone size without affecting fracture risk. (United States)

    Detter, Fredrik T L; Rosengren, Björn E; Dencker, Magnus; Nilsson, J-Å; Karlsson, Magnus K


    We studied the effect in children of an exercise intervention program on fracture rates and skeletal traits. Fractures were registered for 5 years in a population-based prospective controlled exercise intervention study that included children aged 6-9 years at study start, 446 boys and 362 girls in the intervention group and 807 boys and 780 girls in the control group. Intervention subjects received 40 min/school day of physical education and controls, 60 min/week. In 73 boys and 48 girls in the intervention group and 52 boys and 48 girls in the control group, bone mineral density (BMD, g/cm(2)) and bone area (mm(2)) were followed annually by dual-energy X-ray absorptiometry, after which annual changes were calculated. At follow-up we also assessed trabecular and cortical volumetric BMD (g/cm(3)) and bone structure by peripheral computed tomography in the tibia and radius. There were 20.0 fractures/1,000 person-years in the intervention group and 18.5 fractures/1,000 person-years in the control group, resulting in a rate ratio of 1.08 (0.79-1.47) (mean and 95 % CI). The gain in spine BMD was higher in both girls (difference 0.01 g/cm(2), 0.005-0.019) and boys (difference 0.01 g/cm(2), 0.001-0.008) in the intervention group. Intervention girls also had higher gain in femoral neck area (difference 0.04 mm(2), 0.005-0.083) and at follow-up larger tibial bone mineral content (difference 0.18 g, 0.015-0.35), larger tibial cortical area (difference 17 mm(2), 2.4-31.3), and larger radial cross-sectional area (difference 11.0 mm(2), 0.63-21.40). As increased exercise improves bone mass and in girls bone size without affecting fracture risk, society ought to encourage exercise during growth.

  3. Management issues related to effectively implementing a nutrition education program using peer educators. (United States)

    Taylor, T; Serrano, E; Anderson, J


    To explore the influence of administrative aspects of a nutrition education program with peer educators delivering the program. Telephone interviews with peer educators trained to deliver La Cocina Saludable, a nutrition education program for Hispanics. Open- and closed-ended questions. Abuelas (grandmothers) recruited and trained as peer educators for the program. The sample included peer educators no longer teaching (22%), currently teaching (30%), and who never taught after training. Motives and incentives for becoming peer educators, challenges for peer educators, and reasons peer educators withdrew from the program. Descriptive statistics were used to analyze quantitative data from the closed-ended questions. Qualitative analysis was applied to data from open-ended questions. Working with community and learning about nutrition were prime motivators. Recruiting participants and coordination of classes appeared to be major challenges. Personal issues and traveling in a large geographic area were cited as the main reasons for quitting. The effectiveness of using peer educators for La Cocina Saludable may be improved through empowerment, additional training, a structured and equitable reimbursement system, and assistance to carry out administrative tasks.

  4. A study on the impact of the GLOBE program on students' attitudes regarding environmental issues (United States)

    Manfready, Gary Martin

    A key objective in environmental curricula should be to instill responsible and concerned attitudes toward environmental issues. This can be accomplished through the application of innovative programs which emphasize the development of the affective domain of learning. The development of personal attitudes is one form of evidence that the affective domain is being addressed. This study was undertaken to determine the impact of the GLOBE program (Global Learning and Observation to Benefit the Environment) on the attitudes of students toward environmental issues. Three hundred and five middle and high school level students from four states were surveyed to determine their attitudes toward selected environmental statements. Results demonstrated that attitudes toward environmental issues of GLOBE students were significantly greater than non-GLOBE students. Additional analysis demonstrated that regardless of grade levels, gender, racial and ethnicity backgrounds, depth of GLOBE involvement, and degree of teachers' GLOBE experiences, GLOBE students display similar levels of attitudes toward environmental issues. Establishment of a reliable Likert scale measurement instrument was accomplished. Permission to use an existing survey was obtained. Additional items were added to increase validity. Establishment of reliability was accomplished through a Guttman split half analysis of the piloted instrument. Through the use of factor analysis, four categories or sub-groupings of attitudes were determined to exist. Reliability was established for the factors. These sub-groupings were identified as personal commitment to environmental protection, awareness of avenues for action, loci of control, and students' perception of teachers' abilities to present environmental topics. These categories were a part of the analysis of four hypotheses.

  5. Psychosocial issues of the adolescent cancer patient and the development of the Teenage Outreach Program (TOP). (United States)

    Shama, Wendy; Lucchetta, Sonia


    For young people with cancer their process through adolescence is marked with disruption. The demands of treatment and resulting social isolation combined with issues of body image/self-esteem complicate this turbulent life cycle transition. The effects of'these disruptions require psychosocial staff to utilize creative approaches to treatment. The framework of the Teen Outreach Program (TOP) is to connect teens with leukemia/lymphoma to one another, and to reconnect them back with their peers by engaging them in "normal" events. The overwhelming response highlights the positive effect on teenagers' psychosocial health, thereby solidifying the importance of providing innovative therapeutic interventions for this under-serviced population. Further studies of the long-term impact of the program's success are warranted.

  6. Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training. (United States)

    Cheng, Adam; Grant, Vincent; Dieckmann, Peter; Arora, Sonal; Robinson, Traci; Eppich, Walter


    Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?

  7. Issues in NASA Program and Project Management:: A Collection of Papers on Aerospace Management Issues (Supplement 11) (United States)

    Hoffman, Edward J. (Editor); Lawbaugh, William M. (Editor)


    Papers address the following topics: NASA's project management development process; Better decisions through structural analysis; NASA's commercial technology management system; Today's management techniques and tools; Program control in NASA - needs and opportunities; and Resources for NASA managers.

  8. Impact of an Integrated Hip Fracture Inpatient Program on Length of Stay and Costs. (United States)

    Soong, Christine; Cram, Peter; Chezar, Ksenia; Tajammal, Faiqa; Exconde, Kathleen; Matelski, John; Sinha, Samir K; Abrams, Howard B; Fan-Lun, Christopher; Fabbruzzo-Cota, Christina; Backstein, David; Bell, Chaim M


    Hip fractures are associated with significant morbidity and mortality. Co-management models pairing orthopaedic surgeons with hospitalists or geriatricians may be effective at improving processes of care and outcomes such as length of stay (LOS) and cost. We set out to determine the effect of an integrated hip fracture co-management model on LOS, cost, and process measures. We conducted a single-center pre-post study of 571 patients admitted to an academic medical center with hip fractures between January 2009 and December 2013. The group receiving an integrated medical-surgical co-management incorporating continuous improvement methodology was compared with a control population. Primary outcome was LOS. Secondary outcomes included cost per case, time to surgery, osteoporosis (OP) treatment, preoperative echocardiogram utilization, mortality, and readmission. LOS decreased from 18.2 (1.1) to 11.9 (1.5) days, a reduction of 6.3 days (P < 0.001). Mean cost decreased by $4953 (P < 0.001) per case. Mean time to surgery decreased from 45.8 (66.8) to 29.7 (17.9) hours (P < 0.001). Initiation of OP treatment increased from 55.8% to 96.4% (P < 0.001). Preoperative echocardiogram use decreased from 15.8% to 9.1% (P < 0.05). There was a nonsignificant difference in mortality rate (5.0% vs. 2.1%, P = 0.06). Readmission rate remained unchanged (4.6% vs. 6.0%, P = 0.56). An integrated medical-surgical co-management model incorporating continuous improvement methodology was associated with reduced LOS, costs, time to surgery, and increased initiation of appropriate OP treatment. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  9. Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture A Randomized Clinical Trial (United States)

    Latham, Nancy K.; Harris, Bette Ann; Bean, Jonathan F.; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M.; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M.


    IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58

  10. Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. (United States)

    Latham, Nancy K; Harris, Bette Ann; Bean, Jonathan F; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M


    For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months

  11. Queer Youth as Teachers: Dismantling Silence of Queer Issues in a Teacher Preparation Program Committed to Social Justice (United States)

    Stiegler, Sam


    This interview-based essay explores how a teacher-training program, while ostensibly dedicated to the idea of teaching for social justice, completely neglected issues of homophobia and heterosexism. How did silence around queer issues leave a dedicated group of young, queer teachers-in-training without the academic, intellectual, or psychological…

  12. Restructuring of the Electricity Industry and Environmental Issues: A California Research Program

    Directory of Open Access Journals (Sweden)

    Edward L. Vine


    Full Text Available As part of the restructuring of the electricity industry in many states, public benefits funding has emerged as a primary mechanism for supporting social benefits such as energy efficiency and research and development (R&D. In California, a Public Interest Energy Research (PIER Program was established to �conduct public interest energy research that seeks to improve the quality of life for California�s citizens by providing environmentally sound, safe, reliable, and affordable energy services and products. PIER includes the full range of research, development, and demonstration activities that will advance science or technology not adequately provided by competitive and regulated markets.� The PIER Program is comprised of six PIER Program funding areas, including the Energy-Related Environmental Research. The overall mission of the Energy-Related Environmental Research is to �Develop cost-effective approaches to evaluating and resolving environmental effects of energy production, delivery, and use in California, and explore how new energy applications and products can solve environmental problems.� This paper describes the process used in developing these approaches and identifies a set of environmental issues that the State plans to evaluate.

  13. Reactor safety issues resolved by the 2D/3D Program. International Agreement Report

    Energy Technology Data Exchange (ETDEWEB)

    Damerell, P.S.; Simons, J.W. [eds.] [MPR Associates, Inc., Washington, DC (United States)


    The 2D/3D Program studied multidimensional thermal-hydraulics in a PWR core and primary system during the end-of-blowdown and post-blowdown phases of a large-break LOCA (LBLOCA), and during selected small-break LOCA (SBLOCA) transients. The program included tests at the Cylindrical Core Test Facility (CCTF), the Slab Core Test Facility (SCTF), and the Upper Plenum Test Facility (UPTF), and computer analyses using TRAC. Tests at CCTF investigated core thermal-hydraulics and overall system behavior while tests at SCTF concentrated on multidimensional core thermal-hydraulics. The UPTF tests investigated two-phase flow behavior in the downcomer, upper plenum, tie plate region, and primary loops. TRAC analyses evaluated thermal-hydraulic behavior throughout the primary system in tests as well as in PWRs. This report summarizes the test and analysis results in each of the main areas where improved information was obtained in the 2D/3D Program. The discussion is organized in terms of the reactor safety issues investigated.

  14. Restructuring of the electricity industry and environmental issues: a California research program. (United States)

    Vine, E L


    As part of the restructuring of the electricity industry in many states, public benefits funding has emerged as a primary mechanism for supporting social benefits such as energy efficiency and research and development (RD). In California, a Public Interest Energy Research (PIER) Program was established to "conduct public interest energy research that seeks to improve the quality of life for California"s citizens by providing environmentally sound, safe, reliable, and affordable energy services and products. PIER includes the full range of research, development, and demonstration activities that will advance science or technology not adequately provided by competitive and regulated markets." The PIER Program is comprised of six PIER Program funding areas, including the Energy-Related Environmental Research. The overall mission of the Energy-Related Environmental Research is to "Develop cost-effective approaches to evaluating and resolving environmental effects of energy production, delivery, and use in California, and explore how new energy applications and products can solve environmental problems." This paper describes the process used in developing these approaches and identifies a set of environmental issues that the State plans to evaluate.

  15. Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training

    DEFF Research Database (Denmark)

    Cheng, Adan; Grant, Vincent; Dieckmann, Peter


    STATEMENT: Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings......, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape...... the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing...

  16. Field Verification Program for Small Wind Turbines, Quartelry Report: 2nd Quarter, Issue No.1, October 2000

    Energy Technology Data Exchange (ETDEWEB)

    Tu, P.; Forsyth, T.


    The Field Verification Program for Small Wind Turbines quarterly report provides industry members with a description of the program, its mission, and purpose. It also provides a vehicle for participants to report performance data, activities, and issues during quarterly test periods.

  17. Safety and licensing issues that are being addressed by the Power Burst Facility test programs. [PWR; BWR

    Energy Technology Data Exchange (ETDEWEB)

    McCardell, R.K.; MacDonald, P.E.


    This paper presents an overview of the results of the experimental program being conducted in the Power Burst Facility and the relationship of these results to certain safety and licensing issues. The safety issues that were addressed by the Power-Cooling-Mismatch, Reactivity Initiated Accident, and Loss of Coolant Accident tests, which comprised the original test program in the Power Burst Facility, are discussed. The resolution of these safety issues based on the results of the thirty-six tests performed to date, is presented. The future resolution of safety issues identified in the new Power Burst Facility test program which consists of tests which simulate BWR and PWR operational transients, anticipated transients without scram, and severe fuel damage accidents, is described.

  18. The Precision Medicine Initiative's All of Us Research Program: an agenda for research on its ethical, legal, and social issues. (United States)

    Sankar, Pamela L; Parker, Lisa S


    The Precision Medicine Initiative (PMI) is an innovative approach to developing a new model of health care that takes into account individual differences in people's genes, environments, and lifestyles. A cornerstone of the initiative is the PMI All of Us Research Program (formerly known as PMI-Cohort Program) which will create a cohort of 1 million volunteers who will contribute their health data and biospecimens to a centralized national database to support precision medicine research. The PMI All of US Research Program is the largest longitudinal study in the history of the United States. The designers of the Program anticipated and addressed some of the ethical, legal, and social issues (ELSI) associated with the initiative. To date, however, there is no plan to call for research regarding ELSI associated with the Program-PMI All of Us program. Based on analysis of National Institutes of Health (NIH) funding announcements for the PMI All of Us program, we have identified three ELSI themes: cohort diversity and health disparities, participant engagement, and privacy and security. We review All of Us Research Program plans to address these issues and then identify additional ELSI within each domain that warrant ongoing investigation as the All of Us Research Program develops. We conclude that PMI's All of Us Research Program represents a significant opportunity and obligation to identify, analyze, and respond to ELSI, and we call on the PMI to initiate a research program capable of taking on these challenges.Genet Med advance online publication 01 December 2016.

  19. Research issues and supporting research of the National Program on Carbon Dioxide, Environment and Society, fiscal year 1980

    Energy Technology Data Exchange (ETDEWEB)



    This report outlines and summarizes the research conducted in the United States under the auspices of the CO/sub 2/ program. The Program encompasses six primary categories which, in turn, are divided into 18 research subcategories and 51 research issues. The research program was designed to describe the research which should be conducted regardless of institutional or even national sponsorship. Project descriptions have been collected and classified according to the research issue to which they most directly apply and have been inserted immediately following the applicable issue description. This provides, for the first time, a detailed view of the nation's effort in addressing the carbon dioxide question in FY 1980.

  20. Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center. (United States)

    Wynkoop, Aaron; Ndubaku, Osy; Walter, Norman; Atkinson, Theresa

    Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected. The fractures were classified using the AO (Arbeitsgemeinschaft für Osteosynthesefragen), Lauge-Hansen, and Danis-Weber systems. Of these systems, the Lauge-Hansen classification system resulted in the greatest number of "unclassifiable" cases. Most ankle fractures were due to high-energy mechanisms, with motor vehicle collisions the most common high-energy mechanism. The review found that most ankle fractures were malleolar fractures, regardless of the mechanism of injury. The ankle fracture patients had greater rates of obesity, diabetes, and smoking than present in the region where the hospital is located. The fractures were most likely to occur in the afternoon, with more fractures presenting on the weekend than earlier in the week and more fractures in the fall and winter than in the spring and summer. The temporal variation of these fractures should be considered for health services planning, in particular, in regard to resident physician staffing at urban level 1 trauma centers. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Major issues regarding the efficiency of monitoring programs for nitrate contaminated groundwater. (United States)

    Stigter, T Y; Carvalho Dill, A M M; Ribeiro, L


    Major issues regarding the efficiency of moni toring programs for nitrate contaminated groundwater are analyzed in this paper: (i) representativeness of monitoring networks; (ii) correct interpretation of the monitoring data and resulting time series and trends; and (iii) differentiation among the different sources of nitrates in groundwater. Following an overview of the nitrate contamination problem and possible solutions, as well as some of the difficulties found, a relatively straightforward method for assessing monitoring network representativity is presented, namely interpolation standard error assessment. It is shown how nitrate-concentration time series resulting from periodic observations can be corrected with a conservative tracer, in order to avoid misinterpretation and confirm or correct apparent trends. Finally, coupled ¹⁵N and ¹⁸O isotope signatures of nitrate (NO₃⁻) in groundwater are used to differentiate among nitrogen (N) sources, to ensure correct targeting of restoration measures. The case study regards a Nitrate Vulnerable Zone in the south of Portugal, designated in compliance with the European Nitrates Directive, where coastal discharge of nutrient-rich groundwater threatens the good qualitative and ecological status of the Ria Formosa coastal lagoon. Results show that mineral fertilizer is the main source of N in groundwater, and that increases in N load can be masked by dilution phenomena.

  2. Key Issues for Navigation and Time Dissemination in NASA's Space Exploration Program (United States)

    Nelson, R. A.; Brodsky, B.; Oria, A. J.; Connolly, J. W.; Sands, O. S.; Welch, B. W.; Ely T.; Orr, R.; Schuchman, L.


    The renewed emphasis on robotic and human missions within NASA's space exploration program warrants a detailed consideration of how the positions of objects in space will be determined and tracked, whether they be spacecraft, human explorers, robots, surface vehicles, or science instrumentation. The Navigation Team within the NASA Space Communications Architecture Working Group (SCAWG) has addressed several key technical issues in this area and the principle findings are reported here. For navigation in the vicinity of the Moon, a variety of satellite constellations have been investigated that provide global or regional surface position determination and timely services analogous to those offered by GPS at Earth. In the vicinity of Mars, there are options for satellite constellations not available at the Moon due to the gravitational perturbations from Earth, such as two satellites in an aerostationary orbit. Alternate methods of radiometric navigation as considered, including one- and two-way signals, as well as autonomous navigation. The use of a software radio capable of receiving all available signal sources, such as GPS, pseudolites, and communication channels, is discussed. Methods of time transfer and dissemination are also considered in this paper.

  3. NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program. (United States)

    Kavic, Michael S; Mirza, Brian; Horne, Walter; Moskowitz, Jesse B


    Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for

  4. Overview of the fatigue/fracture/life working group program at the Lewis Research Center (United States)

    Mcgaw, Michael A.


    Constitutive and life prediction models are developed and verified for materials typically used in hot gas path components of reusable space propulsion systems over the range of relevant operating environments. The efforts were centered on the development of crack initiation life prediction methods, while the efforts of a counterpart group were centered on the development of cyclic crack propagation life prediction methods. The complexion of the active tasks are presented. A significant new task started this year will incorporate the various material constitutive and life prediction models developed in this program into a comprehensive creep-fatigue damage analysis and life assessment computer code. The program will function as a postprocessor to general structural analysis programs (such as finite element or boundary element codes) using the output of such analyses (stress, strain, and temperature fields as functions of time) as the input to the damage analysis and life assessment code. The code will be designed to execute on engineering/scientific workstations and will feature a windowing, mouse-driven user interface. Current plans call for the code to be finished and made available for use in mid 1991.

  5. EPA`s program for risk assessment guidelines: Cancer classification issues

    Energy Technology Data Exchange (ETDEWEB)

    Wiltse, J. [Environmental Protection Agency, Washington, DC (United States)


    Issues presented are related to classification of weight of evidence in cancer risk assessments. The focus in this paper is on lines of evidence used in constructing a conclusion about potential human carcinogenicity. The paper also discusses issues that are mistakenly addressed as classification issues but are really part of the risk assessment process. 2 figs.

  6. Bracing for thoracolumbar fractures. (United States)

    Chang, Victor; Holly, Langston T


    Traumatic fractures of the thoracolumbar spine are relatively common occurrences that can be a source of pain and disability. Similarly, osteoporotic vertebral fractures are also frequent events and represent a significant health issue specific to the elderly. Neurologically intact patients with traumatic thoracolumbar fractures can commonly be treated nonoperatively with bracing. Nonoperative treatment is not suitable for patients with neurological deficits or highly unstable fractures. The role of operative versus nonoperative treatment of burst fractures is controversial, with high-quality evidence supporting both options. Osteoporotic vertebral fractures can be managed with bracing or vertebral augmentation in most cases. There is, however, a lack of high-quality evidence comparing operative versus nonoperative fractures in this population. Bracing is a low-risk, cost-effective method to treat certain thoracolumbar fractures and offers efficacy equivalent to that of surgical management in many cases. The evidence for bracing of osteoporotic-type fractures is less clear, and further investigation will be necessary to delineate its optimal role.

  7. Ratepayer-funded energy-efficiency programs in a restructuredelectri city industry: Issues and options for regulators andlegislators

    Energy Technology Data Exchange (ETDEWEB)

    Eto, Joseph; Goldman, Charles; Nadel, Stephen


    Electric industry restructuring requires state regulators and legislators to re-examine the purposes served by and the continuing need for ratepayer-funded energy-efficiency programs, as well as the mechanisms to collect funds for these programs and the institutions appropriate to administer them. This paper offers background to these issues and a series of recommendations based on analysis of recent state experiences. Our recommendations are summarized.

  8. Hydraulic Fracture Stimulation and Acid Treatment of Well Baca 20; Geothermal Reservoir Well Stimulation Program

    Energy Technology Data Exchange (ETDEWEB)



    The U.S. Department of Energy-sponsored Geothermal Reservoir Well Stimulation Program was initiated in February 1979 to pursue industry interest in geothermal well stimulation work and to develop technical expertise in areas directly related to geothermal well stimulation activities. This report provides an overview of the two experiments conducted in the high-temperature reservoir in Baca, New Mexico. The report discusses resource and reservoir properties, and provides a description of the stimulation experiment, a description of the treatment evaluation, and a summary of the experiment costs. (DJE-2005)

  9. Timing Issues with Early Childhood Education Programs: How Effect Sizes Vary by Starting Age, Program Duration and Persistence of Effects (United States)

    Duncan, Greg J.; Leak, James A.; Li, Weilin; Magnuson, Katherine; Schindler, Holly; Yoshikawa, Hiro


    The focus of this paper centers around timing associated with early childhood education programs and interventions using meta-analytic methods. At any given assessment age, a child's current age equals starting age, plus duration of program, plus years since program ended. Variability in assessment ages across the studies should enable everyone to…

  10. Breastfeeding in infancy: identifying the program-relevant issues in Bangladesh

    Directory of Open Access Journals (Sweden)

    Hassan Nazmul


    Full Text Available Abstract Background In Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s. Breastfeeding practices, however, have not improved accordingly. Methods For identifying program-relevant issues to improve breastfeeding in infancy, quantitative data were collected through visits to households (n = 356 in rural Chittagong and urban slums in Dhaka, and qualitative data from sub-samples by applying semi-structured in-depth interviews (n = 42, focus group discussions (n = 28, and opportunistic observations (n = 21. Trials of Improved Practices (TIPs (n = 26 were conducted in the above sites and rural Sylhet to determine how best to design further interventions. Our analysis focused on five breastfeeding practices recommended by the World Health Organization: putting baby to the breast within the first hour of birth, feeding colostrum and not giving fluids, food or other substances in the first days of life, breastfeeding on demand, not feeding anything by bottle, and exclusive breastfeeding for the first six months. Results The biggest gaps were found to be in putting baby to the breast within the first hour of birth (76% gap, feeding colostrum and not giving other fluids, foods or substances within the first three days (54% gap, and exclusive breastfeeding from birth through 180 days (90% gap. Lack of knowledge about dangers of delaying initiation beyond the first hour and giving other fluids, foods or substances, and the common perception of "insufficient milk" were main reasons given by mothers for these practices. Health workers had talked to only 8% of mothers about infant feeding during antenatal and immunization visits, and to 34% of mothers during sick child visits. The major providers of infant feeding information were grandmothers (28%. Conclusions The findings showed that huge gaps continue to exist in breastfeeding behaviors, mostly due to lack of awareness as to why the recommended breastfeeding

  11. Supporting Youth Transitioning out of Foster Care. Issue Brief 3: Employment Programs. OPRE Report No. 2014-70 (United States)

    Edelstein, Sara; Lowenstein, Christopher


    This issue brief is one of three that focus on programs providing services to youth transitioning out of foster care in three common service domains: education, employment, and financial literacy and asset building. This brief highlights why employment services are important to youth currently or formerly in foster care, what we know about the…

  12. Education by the Numbers: The Fiscal Effect of School Choice Programs, 1990-2006. School Choice Issues in Depth (United States)

    Aud, Susan L.


    School choice programs, which allow students to attend the public or private school of their choice using public funds, have taken root in the U.S. and are growing rapidly both in number and size. Their fiscal impact has become an important political issue. Proponents say school choice saves money because private schooling is more efficient,…

  13. Issues in NASA Program and Project Management. Special Report: 1997 Conference. Project Management Now and in the New Millennium (United States)

    Hoffman, Edward J. (Editor); Lawbaugh, William M. (Editor)


    Topics Considered Include: NASA's Shared Experiences Program; Core Issues for the Future of the Agency; National Space Policy Strategic Management; ISO 9000 and NASA; New Acquisition Initiatives; Full Cost Initiative; PM Career Development; PM Project Database; NASA Fast Track Studies; Fast Track Projects; Earned Value Concept; Value-Added Metrics; Saturn Corporation Lessons Learned; Project Manager Credibility.

  14. Cultural Issues in Adventure Programming: Applying Hofstede's Five Dimensions to Assessment and Practice (United States)

    Chang, Te-Hsin; Tucker, Anita R.; Norton, Christine Lynn; Gass, Michael A.; Javorski, Stephen E.


    Adventure programming has seen considerable growth throughout the world. While newly established programs aim to meet the needs of their prospective clients, failing to account for cultural differences when conducting or designing programs may impede this goal. Non-western approaches to implementing adventure programs have rarely been discussed,…

  15. Tabulations of Responses from the 1999 Survey of Spouses of Active Duty Personnel. Volume 2. Programs and Services, Employment, Family, Economic Issues, and Background

    National Research Council Canada - National Science Library

    Deak, Mary


    The 1999 Active Duty Surveys (ADS) gather information on current location, spouse's military assignment, military life, programs and services, spouse employment, family information, economic issues, and background...

  16. Manual for Development of General Practice Residency Programs in Dentistry. Special Issue. (United States)

    Journal and Dental Education, 1979


    The manual for the development of general practice residency programs in dentistry is designed to be used in three regional workshops to train individuals representing institutions who wish to develop such programs. The first of three major sections in the manual reviews the historical background of general practice residency programs. In the…

  17. Resolving Issues in Innovative Graduate Degree Programs: The Metropolitan State University Doctor of Business Administration Experience (United States)

    Delmont, Tim


    Applied Master's Degree and doctoral programs have been criticized widely for their lack of relevance, rigor and quality. New graduate degree programs have responded to these criticisms by implementing innovative academic policies, program curriculum, and student services. A case study of the Metropolitan State University Doctor of Business…

  18. Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair. (United States)

    Barone, Antonella; Giusti, Andrea; Pizzonia, Monica; Razzano, Monica; Oliveri, Mauro; Palummeri, Ernesto; Pioli, Giulio


    To evaluate baseline characteristics and in-hospital factors associated with nonadherence with an immediate weight-bearing and early ambulation (IWB-EA) program after hip fracture (HF) surgery. Prospective inception cohort study. Ortho-geriatric unit in an acute care hospital. Older adults (N=469) admitted with an osteoporotic HF who underwent surgery. Immediate weight-bearing and assisted ambulation training on the first postoperative day (all patients). Proportion of subjects who adhered to the IWB-EA protocol within 48 hours of surgery. A total of 366 patients (78%) bore weight and ambulated within 48 hours (weight-bearing [WB] group) while the others did not adhere to the protocol (nonweight-bearing [NWB] group). Subjects in the NWB group were significantly older, were more cognitively and functionally impaired, and presented a higher comorbidity at baseline. A higher proportion of subjects in the NWB group (42.7%) than the WB group (23.5%; PIWB-EA protocol (odds ratio=2.5; 95% confidence interval=1.6-4.0; PIWB-EA is feasible in a high proportion of patients after surgical stabilization of HF. Neither cognitive impairment nor high comorbidity influenced significantly the adherence to the protocol, indicating that IWB-EA may be offered to an unselected population of the elderly with HF. The day of surgery (eg, preholiday or not) was the only variable influencing the participation to the IWB-EA protocol, suggesting the importance of maintaining the same standard of daytime care every day of the week.

  19. Utility Green-Pricing Programs: What Defines Success? (Topical Issues Brief)

    Energy Technology Data Exchange (ETDEWEB)

    Swezey, B.; Bird, L.


    ''Green pricing'' is an optional service through which customers can support a greater level of investment by their electric utility in renewable energy technologies. Electric utilities in 29 states are now implementing green-pricing programs. This report examines important elements of green-pricing programs, including the different types of programs offered, the premiums charged, customer response, and additional factors that experience indicates are key to the development of successful programs. The best-performing programs tend to share a number of common attributes related to product design, value creation, product pricing, and program implementation. The report ends with a list of ''best practices'' for utilities to follow when developing and implementing programs.

  20. Problems and Issues in Contemporary Evaluation with Emphasis on Systems or Programs such as Teacher Education (United States)

    Cahen, Leonard S.


    Paper covers some general evaluation issues including the relationship of evaluation and educational research. Reprints available from the author at the Educational Testing Service, Princeton, N.J. (Author/MB)

  1. What's New in USDA's Food Distribution Program for Schools? School Programs USDA Foods Update. Volume 14, Issue 1 (United States)

    US Department of Agriculture, 2009


    This paper provides an update on all the new products and projects that U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) has been working on, in its effort to help schools meet the nutritional needs of the students and to help in the President's challenge to End Childhood Hunger by 2015. This issue includes: (1) Back to…

  2. NRC Research Program on Plant Aging: Listing and summaries of reports issued through September 1993. Revision 4

    Energy Technology Data Exchange (ETDEWEB)

    Vora, J.P.


    The US Nuclear Regulatory Commission is conducting the Nuclear Plant Aging Research (NPAR) Program. This is a comprehensive hardware-oriented engineering research program focused on understanding the aging mechanisms of components and systems in nuclear power plants. The NPAR program also focuses on methods for simulating and monitoring the aging-related degradation of these components and systems. In addition, it provides recommendations for effective maintenance to manage aging and for implementation of the research results in the regulatory process. This document contains a listing and index of reports generated in the NPAR Program that were issued through September 1993 and summaries of those reports. Each summary describes the elements of the research covered in the report and outlines the significant results. For the convenience of the user, the reports are indexed by personal author, corporate author, and subject.

  3. Access to special education for exceptional students in French immersion programs: An equity issue

    Directory of Open Access Journals (Sweden)

    Nancy Wise


    Full Text Available Abstract Exceptional pupils enrolled in Canadian French immersion programs rarely have access to the same range of special education programs and services that are available to students in the regular English program. More often than not, students with special needs are encouraged to transfer to English programs to access necessary support services. This counselling-out process perpetuates the elitist status commonly attributed to French immersion programs. From a critical pedagogy perspective, this inquiry examines the lack of incentive on the part of multiple French immersion stakeholders to accommodate students with special needs. It further attempts to unveil the myths created by these stakeholders to better understand this discriminatory educational practice. The impact of federal and provincial funding models on access to special education programs and services is discussed, and the application of funding allocations by English-language district school boards is explored. The inquiry concludes with recommendations to promote more inclusionary practices.

  4. The U.S. Navy's Consultant Development and Qualification Program: origin and issues


    Burch, R. Jane


    Approved for public release; distribution unlimited The Navy's Consultant Development and Qualrf rcat ion Program (CDQP) can be considered ~o be at the midpoint of its own initial development. It presently exists in the form of two inst act icns, one for the Pacific System and one for the Atlantic System, with development of a Navy-wide program scheduled fcr September of 198U. The program is designed to describe desired performance capabilities for consultants in the N...

  5. Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. (United States)

    Niccols, Alison; Milligan, Karen; Sword, Wendy; Thabane, Lehana; Henderson, Joanna; Smith, Ainsley


    Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes. As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes. Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes. There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health. This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is

  6. Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis. (United States)

    Milligan, Karen; Niccols, Alison; Sword, Wendy; Thabane, Lehana; Henderson, Joanna; Smith, Ainsley; Liu, Jennifer


    The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment. We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates. In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively). Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy

  7. SPSS and SAS programs for addressing interdependence and basic levels-of-analysis issues in psychological data. (United States)

    O'Connor, Brian P


    Levels-of-analysis issues arise whenever individual-level data are collected from more than one person from the same dyad, family, classroom, work group, or other interaction unit. Interdependence in data from individuals in the same interaction units also violates the independence-of-observations assumption that underlies commonly used statistical tests. This article describes the data analysis challenges that are presented by these issues and presents SPSS and SAS programs for conducting appropriate analyses. The programs conduct the within-and-between-analyses described by Dansereau, Alutto, and Yammarino (1984) and the dyad-level analyses described by Gonzalez and Griffin (1999) and Griffin and Gonzalez (1995). Contrasts with general multilevel modeling procedures are then discussed.

  8. Navy Columbia Class (Ohio Replacement) Ballistic Missile Submarine (SSBN[X]) Program: Background and Issues for Congress (United States)


    nuclear deterrent force, or “triad,” which also includes land-based intercontinental ballistic missiles (ICBMs) and land-based long-range bombers. At any...any vessel owned, operated, or controlled by the Department of Defense that carries operational intercontinental ballistic missiles . Precedents for...Navy Columbia Class (Ohio Replacement) Ballistic Missile Submarine (SSBN[X]) Program: Background and Issues for Congress Ronald O’Rourke

  9. Implementing Writing Assessment in a Degree Completion Program: Key Issues and Lessons Learned (United States)

    Hoyt, Jeff E.; Allred, Ellen R.; Hunt, Rob


    This article details the advantages and challenges of implementing writing assessment in a degree completion program; it describes the steps involved in the writing assessment process. Study results demonstrate that graduates from a degree completion program generally have adequate writing skills; nevertheless, many could improve their…

  10. End-of-Life Issues in US Child Life Specialist Programs (United States)

    Parvin, Katie V.; Dickinson, George E.


    A professional outlet in most children's hospitals for seriously-ill children is the child life specialist. Our objective in this study was to determine the extent that dying and death is emphasized in child life programs in the United States. Therefore, we surveyed via snail mail the 35 child life programs on the website of the Child Life…

  11. Federal Child Nutrition Programs Are Important to Rural Households. Issue Brief No. 11 (United States)

    Wauchope, Barbara; Shattuck, Anne


    This brief, based on data from the U.S. Census Bureau, examines how rural families use four of the major federal child nutrition programs. It finds that 29 percent of rural families with children participate but that there are barriers to these nutrition programs, such as the lack of public transportation and high operating costs for rural schools…

  12. An Innovative Model to Estimate Fracture Extensions. | Adeniji ...

    African Journals Online (AJOL)

    Hydraulic fracturing is a Well intervention program, designed to create fracture(s) within a reservoir system and hopefully, extend the volumes of these fractures, to facilitate improved recovery of in-situ fluid(s). This paper presents mathematical equations in dimensionless forms, to rapidly estimate the fracture extension and ...

  13. fracture criterion

    Indian Academy of Sciences (India)

    Fracture in metallic glasses. What are the connections between nano- and micro- mechanisms and toughness? Metallic glasses are schizophrenic in the fracture sense. PDF Create! 5 Trial ...

  14. Shoulder Fractures (United States)

    ... arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus ... age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is ...

  15. Hand Fractures (United States)

    ... lead to arthritis down the road. In addition, fractures in children occasionally affect future growth of that bone. Figure 1: Examples of fractures in fingers Figure 2: Examples of plates, pins ...

  16. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios


    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  17. The Army’s Ground Combat Vehicle (GCV) Program: Background and Issues for Congress (United States)


    EFV ) has.”25 21 Unless otherwise noted, information in this section is taken from C. Todd Lopez...additional information on the Expeditionary Fighting Vehicle see CRS Report RS22947, The Marines’ Expeditionary Fighting Vehicle ( EFV ): Background and Issues

  18. Research Issues in the Study of Public Attitudes toward Ethical Problems in Television Programming. (United States)

    Rarick, David L.; Lind, Rebecca Ann

    Three empirical studies focused on viewer reactions to ethical issues in television news, and on actions audience members felt were appropriate to control possibly unethical behaviors in television broadcasting. The first study was a 12-minute telephone survey of 293 randomly selected adults in Minneapolis-St. Paul (Minnesota) in 1989 to determine…

  19. Psychiatric Training Program Engagement with the Pharmaceutical Industry: An Educational Issue, Not Strictly an Ethical One (United States)

    Mohl, Paul C.


    OBJECTIVE: To analyze the educational and ethical issues involved in interactions between departments of psychiatry and the pharmaceutical industry. METHODS: The author analyzes the history of attitudes toward pharmaceutical companies, various conflicting ethical principles that apply, and areas of confluence and conflict of interest between…

  20. Do European Banks with a Covered Bond Program still issue Asset-Backed Securities for funding?

    NARCIS (Netherlands)

    Boesel, Nils; Kool, C.J.M.; Lugo, S.

    The decline in the issuance of Asset-Backed Securities (ABS) since the financial crisis and the comparative advantage of Covered Bonds (CBs) as a funding alternative to ABS raise the question whether banks still issue ABS as a mean to receive funding. Employing double-hurdle regression models on a


    Directory of Open Access Journals (Sweden)

    A. S. Zolotov


    Full Text Available The article is devoted to the history of one of the methods of conservative treatment humeral transcondylar extensor fractures in children - a method «collar and cuff». The second and very common name of this method is connected with the name of the american orthopaedist Walter Blount. «The method of Blount» is mentioned in many domestic and foreign sources. Nevertheless the analysis of publications on the history of the discussed method of treatment indicates the priority in this matter other famous doctor - British podiatrist Robert Jones.

  2. Curriculum Design Issues in Developing a Doctor of Philosophy Program in Aeronology (United States)


    A Ph.D. degree program in the non-engineering aeronautical/aerospace sciences (aeronology) will likely be required in the near future to meet the increasing demands for qualified faculty, administrators, and industry representatives within the aviati...

  3. Navy Trident Submarine Conversion (SSGN) Program: Background and Issues for Congress

    National Research Council Canada - National Science Library

    O'Rourke, Ronald


    ...) into cruisemissile- carrying and special operations forces (SOF) support submarines (SSGNs). The total estimated cost of the program, which has been increasing over time, is now $4,018 million...

  4. Stress Fractures (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  5. The Promotion of Character through Youth Development Programs: A View of the Issues

    Directory of Open Access Journals (Sweden)

    Andrea Vest Ettekal


    Full Text Available Contemporary developmental theories suggest that out-of-school-time (OST youth development programs may be an important context for character development and education because of the positive, mutually influential relations between youth and adult leaders found in exemplary instantiations of such programs. Although still in its early stages, research about this role of OST programs, including evaluations of specific programs, is beginning to burgeon in relation to increased interest in person-context models of human development, the fact that each of tens of millions of American youth participate in several OST programs each year, and heightened emphasis among scientists, educators, and policy makers about the importance of promoting character among the diverse youth of the nation. Both to reflect the state-of-the art and in the hope of promoting further research progress, the articles in this special section describe how the attributes of young people and the features of the OST programs youth development in which they participate may link together in promotion of character development.

  6. Fourth SIAM conference on mathematical and computational issues in the geosciences: Final program and abstracts

    Energy Technology Data Exchange (ETDEWEB)



    The conference focused on computational and modeling issues in the geosciences. Of the geosciences, problems associated with phenomena occurring in the earth`s subsurface were best represented. Topics in this area included petroleum recovery, ground water contamination and remediation, seismic imaging, parameter estimation, upscaling, geostatistical heterogeneity, reservoir and aquifer characterization, optimal well placement and pumping strategies, and geochemistry. Additional sessions were devoted to the atmosphere, surface water and oceans. The central mathematical themes included computational algorithms and numerical analysis, parallel computing, mathematical analysis of partial differential equations, statistical and stochastic methods, optimization, inversion, homogenization and renormalization. The problem areas discussed at this conference are of considerable national importance, with the increasing importance of environmental issues, global change, remediation of waste sites, declining domestic energy sources and an increasing reliance on producing the most out of established oil reservoirs.

  7. Processing and sociocultural issues in the School Restaurants Program in Medellin from 1961 to 2010

    Directory of Open Access Journals (Sweden)

    Luz Marina Arboleda Montoya


    Full Text Available Introduction: Diet is a complex sociocultural act providing biological, nutritional, political and social dimensions. Interlocking them creates inequalities such as food shortages and access to food through social programs. The aim of this study is to identify the changes in the program of school restaurants in Medellin (Colombia, and to interpret the perception of the program’s beneficiaries. Material and Methods: Qualitative and historical perspectives; ethnography and history of the present time. Ethnography was conducted with school beneficiaries and their parents, councilors, program coordinators, food handlers and nutritionists. Historical Archives of Medellin and Minutes Archive Medellin Municipal Council were reviewed to collect the historical information, reports and correspondence. Results: The program has different models of service provision and different coverage; it has retained the sympathy of the mayors and officials of the various secretariats. This was set up at the beginning, in 1935, from a perspective of charity school by elite women, and then it had a hygienist and nutritional vision of right to food; and finally, a food and nutrition safety vision. In the supplied speeches and preparations, the absence of cultural references is identified. Conclusions: School Restaurants programs help to reduce the suffering caused by hunger, but they are not always designed thinking about the cultural aspects that involves food.

  8. Navy John Lewis (TAO 205) Class Oiler Shipbuilding Program: Background and Issues for Congress (United States)


    fixed price incentive block buy contract for the first six TAO-205s to GD/NASSCO, and the contract for LHA-8 to HII/Ingalls. The Navy was granted... average of about $45 million, compared to costs under the standard or default DOD approach of annual contracting. Issues for Congress for FY2017...years; the first ship in the class will reach that age in 2021. The ships are about 677 feet long and have a full load displacement of

  9. The Army Corps of Engineers’ Nationwide Permits Program: Issues and Regulatory Developments (United States)


    permits and related general conditions, issued in March 2007, is available at [ inet /functions/cw/cecwo/reg/ nationwide_permits.htm...Activities. This permit is intended to authorize activities for the restoration of coal mine sites that are causing physical and/or chemical impacts to...point out that coal mining waste contains chemicals that are toxic to aquatic life; there have been cases of spills of impounded wastes, with impacts

  10. Navy DDG-51 and DDG-1000 Destroyer Programs: Background and Issues for Congress (United States)


    O’Rourke and Moshe Schwartz . 7 “DDG 51 Multiyear Procurement Contract Awarded,” Navy News Service, June 3, 2013, accessed July 1, 2013, at http...Nunn-McCurdy Act: Background, Analysis, and Issues for Congress, by Moshe Schwartz . 28 Source: Letter to congressional offices dated February 1...40 Source: Transcript of spoken remarks of Vice Admiral Bernard McCullough at a June 16, 2009, hearing on Navy force structure shipbuilding before

  11. Laser Safety Program Development at Texas A&M University--Issues and Challenges. (United States)

    Vasudevan, Latha; Menchaca, Daniel I; Tutt, James


    Implementing a laser safety program within a University setting encompassing a wide variety of Class 3b and Class 4 lasers with varied potential uses introduces many challenges. Texas A&M University (TAMU) currently has over 310 laser units that are registered with the Texas Department of State Health Services (TDSHS). One primary task in maintaining the laser registration is to have a program that identifies the regulatory responsibilities of the registrant. The Radiological Safety Staff, a part of Environmental Health and Safety (EHS), administers the use of both ionizing and non-ionizing radiation. The Radiological Safety Officer (RSO)/Laser Safety Officer (LSO) maintains the laser registration. This article outlines key elements that were put forth in the development and implementation of the laser safety program at TAMU.

  12. Issues associated with energy efficiency programs implementation at the housing and utility enterprises

    Directory of Open Access Journals (Sweden)

    Borisova Natalia


    Full Text Available Energy saving potential is quite huge in the most sectors of the national economy, particularly in housing and utilities and industry. Due to this, energy efficiency increase at the enterprises of housing and utilities and industry through the energy efficiency programs implementation, is one of the priorities in the modern economy of Russia and its regions, and requires radical measures to improve the effectiveness of its implementation. The purpose of the authors is the scientific and practical study of the main problems of energy efficiency programs implementation at the enterprises of housing and utilities services and industry in modern conditions. To achieve this purpose the authors solved the following problems: the current state of the housing and utilities sector and industry, the relevance and the need for energy saving policy at the enterprises of housing and utilities services and industry are studied; the main problems impeding to implement the energy-saving program effectively at the enterprises of housing and utilities services and industry are determined; the possible ways of solving the problems identified in the energy efficiency programs implementation at the enterprises of housing and industry are offered. The team of authors focuses in this study on the problems of the energy audit using in practice as a basic tool for the energy saving programs development at the enterprises of housing and utilities services, industry and their subsequent implementation. The subject of author's researches is the factors that determine the energy efficiency programs implementation at the enterprises of housing and utilities services and industry at the level of individual region and the whole country, and the object is the enterprises of housing and utilities services and industry. Methodologically the scientific and practical research is based on the complex approach using the methods of comparative, statistical and logical analysis.

  13. Crushing and Fracture of Lightweight Structures

    DEFF Research Database (Denmark)

    Urban, Jesper


    . Crushing experiments conducted on full-scale aluminum plate intersections reveal that the crushing behaviour is highly affected by material fracture during the deformation. Several fracture criteria from the literature have been reviewed and three fracture models have been compared with material...... on these two fracture models a new fracture criterion, denoted RTCL fracture criterion, is proposed and the fracture criterion is implemented in the FE-program LS-DYNA as a user subroutine. The crushing behaviours of the full-scale aluminum plate intersections have been simulated with LS......-DYNA and the implemented fracture criterion and the simulations agree well with the experiments. New closed form solutions for the dissipated energy during axial compression of aluminum plate intersections have been developed and the effect of fracture is included analytically based of the fracture criterion by Cockcroft...

  14. Navy TAO(X) Oiler Shipbuilding Program: Background and Issues for Congress (United States)


    potential impacts described above can be avoided or mitigated if the CR includes special provisions (called anomalies ) for exempting individual programs...8217 capabilities and in terms of the size and shape of the workload, we’ve got parity here for a very healthy competition.” Whether to Authorize a Block

  15. Weighing the Issues and Consequences of Federal Program Termination: Administration on Aging Support for Career Preparation. (United States)

    Craig, Bruce M.


    Describes policy decisions that have acted upon the 1982 Fiscal Year budget and funding priorities of the Administration on Aging's Gerontology Career Preparation Program, and projects the probable consequences of the policy option now being weighed to eliminate all future funding. (University of Texas Press, Box 7819, Austin, TX 78712). (NJ)

  16. Environmental Issues in Brazilian Society. Fulbright-Hays Seminars Abroad Program. June 26-July 31, 1994. (United States)

    Commission for Educational Exchange between the United States and Brazil, Brasilia.

    This book contains a review of the 1994 Fulbright-Hays Seminars Abroad Program along with lesson plans from 13 of the participants. The curriculum projects contained in this book include: (1) "The Brazilian Cinema: A Critical Appreciation of An Industry in Turmoil" (Aaron Braun); (2) "Reflections on the Relationship between…

  17. F-35 Lightning II Joint Strike Fighter (JSF) Program: Background, Status, and Issues

    National Research Council Canada - National Science Library

    Bolkcom, Christopher


    The Defense Department's F-35 Lightning II Joint Strike Fighter (JSF) is one of three aircraft modernization programs in tactical aviation, the others being the Air Force F-22A fighter and the Navy F/A-18E/F fighter/attack plane...

  18. F-35 Lightning II Joint Strike Fighter (JSF) Program: Background, Status, and Issues

    National Research Council Canada - National Science Library

    Bolkcom, Christopher; Murch, Anthony


    The Defense Department's F-35 Lightning II Joint Strike Fighter (JSF) is one of three aircraft modernization programs in tactical aviation, the others being the Air Force F-22A fighter and the Navy F/A-18E/F fighter/attack plane...

  19. F-35 Lightning II Joint Strike Fighter "JSF" Program: Background, Status, and Issues

    National Research Council Canada - National Science Library

    Murch, Anthony; Bolkcom, Christopher


    The Defense Department's F-35 Lightning II Joint Strike Fighter (JSF) is one of three aircraft modernization programs in tactical aviation, the others being the Air Force F-22A fighter and the Navy F/A-18E/F fighter/attack plane...

  20. Diverse Perspectives of Creativity Testing: Controversial Issues When Used for Inclusion into Gifted Programs (United States)

    Lemons, Gay


    Although it is important to include creative potential in the criteria for gifted programs, a review of the literature reveals creativity testing for this purpose to be a controversial topic. As creativity is a complex, multifaceted construct difficult to measure and operationalize, instruments purporting to measure creative abilities may lead to…

  1. Addressing Career Success Issues of African Americans in the Workplace: An Undergraduate Business Program Intervention (United States)

    White, Belinda Johnson


    Career success as measured by the objective, traditional criteria of the composite of high number of promotions, high annual compensation, and high organizational level in corporate America has eluded the majority of African Americans. This article describes an undergraduate business program career success intervention designed to assist African…

  2. Collective dose as a performance measure for occupational radiation protection programs: Issues and recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Strom, D.J.; Harty, R.; Hickey, E.E.; Martin, J.B.; Peffers, M.S. [Pacific Northwest National Lab., Richland, WA (United States); Kathren, R.L. [Washington State Univ., Pullman, WA (United States)


    Collective dose is one of the performance measures used at many US Department of Energy (DOE) contractor facilities to quantitatively assess the objectives of the radiation protection program. It can also be used as a management tool to improve the program for keeping worker doses as low as reasonably achievable (ALARA). Collective dose is used here to mean the sum of all total effective dose equivalent values for all workers in a specified group over a specified time. It is often used as a surrogate estimate of radiological risk. In principle, improvements in radiation protection programs and procedures will result in reduction of collective dose, all other things being equal. Within the DOE, most frequently, a single collective dose number, which may or may not be adjusted for workload and other factors, is used as a performance measure for a contractor. The purpose of this report is to evaluate the use of collective dose as a performance measure for ALARA programs at DOE sites.

  3. The WIC Program: Background, Trends, and Economic Issues, 2009 Edition. Economic Research Report Number 73 (United States)

    Oliveira, Victor; Frazao, Elizabeth


    The mission of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to safeguard the health of low-income women, infants, and children through age 4 who are at nutritional risk. WIC provides nutritious foods to supplement diets, nutrition education, and referrals to health care and other social services.…

  4. Coast Guard Deepwater Acquisition Programs: Background, Oversight Issues, and Options for Congress (United States)


    industry team led by Lockheed Martin and Northrop Grumman Ship Systems ( NGSS ). ICGS was awarded an indefinite delivery, indefinite quantity (ID/IQ...the Record, Mr. James E. Anton, Vice President Deepwater Program, Northrop Grumman Ship Systems ( NGSS ), Testimony Before: The House Maritime and

  5. Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes. (United States)

    Niccols, Alison; Milligan, Karen; Smith, Ainsley; Sword, Wendy; Thabane, Lehana; Henderson, Joanna


    Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011. Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes. Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N=775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds=0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds=0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds=1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds=0.22-0.45). Available evidence supports integrated programs, as findings suggest that they are associated with

  6. Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Milligan Karen


    Full Text Available Abstract Background The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment. Methods We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d effect size estimates. Results In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively. Conclusions Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not

  7. Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes

    Directory of Open Access Journals (Sweden)

    Niccols Alison


    Full Text Available Abstract Background Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes. Objectives As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes. Methods Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes. Results There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419, most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health. Conclusions This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are

  8. Issues in Canada's Official Development Assistance Policies and Programs. A Submission to the Standing Committee on External Affairs and International Trade. (United States)

    Morrison, David

    Canada's Official Development Assistance (ODA) program is discussed, along with the contributions that universities can offer. Issues include: (1) the rationale and goals for Third World aid programs; (2) priority projects and areas of the world; (3) whether political and economic interests should be reflected in aid programs; (4) decision-making…

  9. How would we deal with radiation related issues in high school educational programs?

    Energy Technology Data Exchange (ETDEWEB)

    Saeki, Kuniko [Attached High School of Akita Keizai Houka Univ., Akita (Japan)


    Current educational curriculum will be more improved and the materials in schools will be somewhat different by the year of 2002 when students have two days off in a week. It is a well known fact that recent Japanese people's level of understanding about Science and Technology is the second from the bottom among OECD nations and, as a matter of fact, few schools are dealing with scientific issues such as atomic energy or radiation. High school teachers need to survey what students know about atomic power and radiation, how deep they studied in previous schools and what kind of interest they have in conservation of world energy sources or environmental issues discussed today. Through questionnaires to 328 students, it became clear that they were most interesting to the effect of radiation or radioactivity on any kind of things in the environment, and that they want to know solutions for those problems such as greenhouse effect, ozone layers and Garbage disposal. (M. Suetake)

  10. Hip fracture - discharge (United States)

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - ...

  11. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa


    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  12. Special issue about the ENERGIE interdisciplinary program of the CNRS; Special programme interdisciplinaire ENERGIE du CNRS

    Energy Technology Data Exchange (ETDEWEB)

    Lallemand, M.; Stitou, D. [Centre National de la Recherche Scientifique (CNRS), 75 - Paris (France); Lallemand, A. [CETHIL 69 - Villeurbanne (France); Destruel, P.; Seguy, I. [LGET, Lab. de Genie Electrique de Toulouse, 31 (France); Bock, H. [CRPP, Centre de Recherche Paul Pascal, 31 - Toulouse (France); Nierengarten, J.F. [LCC, Lab. de Chimie de Coordination, 31 - Toulouse (France); Alonso, C.; Estibals, B. [LAAS, Lab. d' Analyse et d' Architecture des Systemes, 31 - Toulouse (France); Menanteau, Ph. [Grenoble Univ. Mendes France, LEPII - EPE, Enegie et Politiques Environnement, CNRS, 38 (France); David, S. [Paris-11 Univ., UMR 8608 CNRS/IN2P3, 91 - Orsay (France). Inst. de Physique Nucleaire; Loiseaux, J.M. [Universite Joseph-Fourier, Grenoble I, Lab. de Physique Subatomique et de Cosmologie, UMR 5821 CNRS IN2P3, 38 (France); Clement, A.H. [Ecole Centrale de Nantes, Lab. de Mecanique des Fluides, 44 - Nantes (France)


    The French national center of scientific research (CNRS) has started in 2001 a huge interdisciplinary program about the development of new energy sources (solar, biomass, wind energy, geothermal energy, future nuclear systems), the mastery of energy vectors (electricity, heat, hydrogen), and the development of clean and ecological processes (combustion, fuel cells, dwellings, industrial processes etc..). The program has involved about a thousand of researchers and has led to the realization of 65 projects. This newsletter presents the results of a selection of these integrated research projects: development of thermochemical processes for solar cooling and refrigeration, two-phase refrigerants for a lower environmental impact, organic semiconductors for photovoltaic conversion, TECHPOL - an observatory for new energy technologies, scenarios for future nuclear reactors (enriched uranium cycle, regeneration, uranium cycle, thorium cycle), waves energy conversion systems. (J.S.)

  13. Housing and health—Current issues and implications for research and programs


    Matte, Thomas D.; Jacobs, David E.


    This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection ...

  14. Navy Ohio Replacement (SSBN[X]) Ballistic Missile Submarine Program: Background and Issues for Congress (United States)


    propulsion technology first occurred many years ago: To help jumpstart the UK’s nuclear - powered submarine program, the United States transferred to the UK a... nuclear - powered attack submarines (SSNs), nuclear - powered cruise missile submarines (SSGNs), and nuclear - powered ballistic missile submarines (SSBNs). 2...2 In the designations SSN, SSGN, SSBN, and SSBN(X), the SS stands for submarine, N stands for nuclear - powered (meaning the ship is

  15. Issues in NASA program and project management. Special Report: 1993 conference (United States)

    Hoffman, ED (Editor); Kishiyama, Jenny S. (Editor)


    This volume is the seventh in an ongoing series on aerospace project management at NASA. Articles in this volume cover the 1993 Conference: perspectives in NASA program/project management; the best job in aerospace; improvements in project management at NASA; strategic planning...mapping the way to NASA's future; new NASA procurement initiatives; international cooperation; and industry, government and university partnership. A section on resources for NASA managers rounds out the publication.

  16. Housing and health--current issues and implications for research and programs. (United States)

    Matte, T D; Jacobs, D E


    This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs.

  17. Measurement issues in the evaluation of chronic disease self-management programs. (United States)

    Nolte, Sandra; Elsworth, Gerald R; Newman, Stanton; Osborne, Richard H


    To provide an in-depth analysis of outcome measures used in the evaluation of chronic disease self-management programs consistent with the Stanford curricula. Based on a systematic review on self-management programs, effect sizes derived from reported outcome measures are categorized according to the quality of life appraisal model developed by Schwartz and Rapkin which classifies outcomes from performance-based measures (e.g., clinical outcomes) to evaluation-based measures (e.g., emotional well-being). The majority of outcomes assessed in self-management trials are based on evaluation-based methods. Overall, effects on knowledge--the only performance-based measure observed in selected trials--are generally medium to large. In contrast, substantially more inconsistent results are found for both perception- and evaluation-based measures that mostly range between nil and small positive effects. Effectiveness of self-management interventions and resulting recommendations for health policy makers are most frequently derived from highly variable evaluation-based measures, that is, types of outcomes that potentially carry a substantial amount of measurement error and/or bias such as response shift. Therefore, decisions regarding the value and efficacy of chronic disease self-management programs need to be interpreted with care. More research, especially qualitative studies, is needed to unravel cognitive processes and the role of response shift bias in the measurement of change.

  18. Iron supplements: scientific issues concerning efficacy and implications for research and programs. (United States)

    Allen, Lindsay H


    Iron supplementation remains an important strategy for the prevention and treatment of iron deficiency anemia and can produce substantial improvements in the functional performance of iron deficient individuals and populations. Many potential benefits of iron supplementation require further exploration, including its effect on vitamin A and iodine metabolism. There is strong evidence that vitamin A and riboflavin deficiencies affect iron utilization from supplements and are important on a global scale, but little evidence that folate and vitamin B-12 deficiencies play a major causal role in the global burden of anemia. The efficacy of multiple micronutrient supplements for the prevention and treatment of anemia must be further evaluated. Because weekly supplementation with iron is effective at improving iron status, this option should be thoroughly explored and evaluated in the context of programs for the prevention and the treatment of iron deficiency and anemia. More conformation is warranted concerning the number of tablets that must be consumed in different situations, and the efficacy of supplying other micronutrients weekly with iron. Weekly supplementation programs may improve the logistical and economic constraints that currently limit the provision of supplements to the many target population groups for whom they are recommended, but usually fail to reach. Further work is required to clarify the purpose, delivery and outcomes of iron supplementation programs.

  19. Issues Related to Technology in Teacher Education Programs and K-12 Public Schools in Texas

    Directory of Open Access Journals (Sweden)

    Jon Denton


    Full Text Available This paper describes the support systems, financial support, current use of technology, and infrastructure issues at selected institutions of higher education (IHE and in K-12 public schools in the State of Texas, United States. Discussion is provided on how current practitioners in public schools and institutions of higher education that prepare pre-service teachers for these schools match regarding technology. In depth discussion is provided on two surveys--one of higher education institutions and one of public schools--along with a discussion of the findings as they relate to the ability of institutions of higher education to support K-12 schools through the preparation of future teachers well equipped to use and comfortable with current and emerging technologies.

  20. Effects of a Rehabilitation Program on Perceived Environmental Barriers in Older Patients Recovering from Hip Fracture: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Erja Portegijs


    Full Text Available Objectives. To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. Design. Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197; secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma (n=81. Methods. Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places. Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. Results. At baseline, 48% and 37% of the patients perceived at least one entrance-related barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, (P=0.003 the number of entrance-related barriers decreased in both groups (group P=0.395; interaction P=0.571. For outdoor barriers, time (P=0.199, group (P=0.911, and interaction effect (P=0.430 were not significant. Conclusion. Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197.

  1. A 6-year exercise program improves skeletal traits without affecting fracture risk: a prospective controlled study in 2621 children. (United States)

    Detter, Fredrik; Rosengren, Björn E; Dencker, Magnus; Lorentzon, Mattias; Nilsson, Jan-Åke; Karlsson, Magnus K


    Most pediatric exercise intervention studies that evaluate the effect on skeletal traits include volunteers and follow bone mass for less than 3 years. We present a population-based 6-year controlled exercise intervention study in children with bone structure and incident fractures as endpoints. Fractures were registered in 417 girls and 500 boys in the intervention group (3969 person-years) and 835 girls and 869 boys in the control group (8245 person-years), all aged 6 to 9 years at study start, during the 6-year study period. Children in the intervention group had 40 minutes daily school physical education (PE) and the control group 60 minutes per week. In a subcohort with 78 girls and 111 boys in the intervention group and 52 girls and 54 boys in the control group, bone mineral density (BMD; g/cm(2) ) and bone area (mm(2) ) were measured repeatedly by dual-energy X-ray absorptiometry (DXA). Peripheral quantitative computed tomography (pQCT) measured bone mass and bone structure at follow-up. There were 21.7 low and moderate energy-related fractures per 1000 person-years in the intervention group and 19.3 fractures in the control group, leading to a rate ratio (RR) of 1.12 (0.85, 1.46). Girls in the intervention group, compared with girls in the control group, had 0.009 g/cm(2) (0.003, 0.015) larger gain annually in spine BMD, 0.07 g (0.014, 0.123) larger gain in femoral neck bone mineral content (BMC), and 4.1 mm(2) (0.5, 7.8) larger gain in femoral neck area, and at follow-up 24.1 g (7.6, 40.6) higher tibial cortical BMC (g) and 23.9 mm(2) (5.27, 42.6) larger tibial cross-sectional area. Boys with daily PE had 0.006 g/cm(2) (0.002, 0.010) larger gain annually in spine BMD than control boys but at follow-up no higher pQCT values than boys in the control group. Daily PE for 6 years in at study start 6- to 9-year-olds improves bone mass and bone size in girls and bone mass in boys, without affecting the fracture risk. © 2014 American Society for Bone

  2. Hip Fractures. (United States)

    Ramponi, Denise R; Kaufmann, Judith; Drahnak, Gwendolen

    Hip fractures are associated with significant morbidity and mortality and a major health problem in the United States (). Eighty percent of hip fractures are experienced by 80-year-old women. Plain radiographs usually confirm the diagnosis, but if there is a high level of suspicion of an occult hip fracture, magnetic resonance imaging or bone scan is the next step to confirm the diagnosis. Areas of the hip bone have varied bone strength and blood supply, making the femoral neck one of the most vulnerable areas for fracture. A consultation to an orthopedic surgeon will determine surgical interventions.

  3. Hamate fractures. (United States)

    Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L


    The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Colles Fracture


    Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú


    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  5. Regional Studies Program. Extraction of North Dakota lignite: environmental and reclamation issues

    Energy Technology Data Exchange (ETDEWEB)

    LaFevers, J.R.; Johnson, D.O.; Dvorak, A.J.


    This study, sponsored by the U.S. Energy Research and Development Administration, addresses the environmental implications of extraction of coal in North Dakota. These implications are supported by details of the geologic and historical background of the area of focus, the lignite resources in the Fort Union coalfield portion. The particular concentration is on the four-county area of Mercer, Dunn, McLean, and Oliver where substantial coal reserves exist and a potential gasification plant site has been identified. The purposes of this extensive study are to identify the land use and environmental problems and issues associated with extraction; to provide a base of information for assessing the impacts of various levels of extraction; to examine the economics and feasibility of reclamation; and to identify research that needs to be undertaken to evaluate and to improve reclamation practices. The study also includes a description of the physical and chemical soil characteristics and hydrological and climatic factors entailed in extraction, revegetation, and reclamation procedures.

  6. Program-oriented approach to resource saving issues in construction materials industry

    Directory of Open Access Journals (Sweden)

    Novikova Galina


    Full Text Available The construction as a sector of the economy is one of the largest consumers of energy resources, and the building materials industry is today one of the most energy-intensive construction industry. At the enterprises of the building materials industry the different approaches and methods are used to solve resource and energy problems. Energy saving is considered not as an complex approach in the enterprise activity, but as activity for the implementation of specific energy-saving projects, which have limitations in time and in resources. The authors suggest to use a softwareoriented approach to solving the problems of resource and energy saving. For practical application of program-oriented approach we offer to use a structuring method of the decision-making, not previously used to solve problems of resource and energy saving.

  7. Evaluation of regional fracture properties for groundwater ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Earth System Science; Volume 123; Issue 3. Evaluation of regional fracture properties for groundwater development using hydrolithostructural domain approach in variably fractured hard rocks of Purulia district, West Bengal, India. Tapas Acharya Rajesh Prasad S Chakrabarti. Volume 123 Issue ...

  8. What Is the Purpose of the Theses Addressing the Issue of Program Evaluation in Turkey? (The Case of Curriculum and Instruction: 1997-2015) (United States)

    Alkin-Sahin, Senar; Tunca, Nihal


    In the current study, the aim is to investigate the theses addressing the issue of program evaluation in the field of Curriculum and Instruction (C&I) in 1997-2015. The study employed the survey model. The universe of the study consists of totally 87 theses addressing the issue of program evaluation in the field of C&I in 1997-2015. As the…

  9. Observing ben wyckoff: from basic research to programmed instruction and social issues. (United States)

    Escobar, Rogelio; Lattal, Kennon A


    L. Benjamin Wyckoff's seminal contributions to both psychological theory and application are the subject of this review. Wyckoff started his academic career as a graduate student at Indiana University, where he developed the observing-response procedure under the guidance of B. F. Skinner and C. J. Burke. At the University of Wisconsin-Madison, Wyckoff refined his mathematical theory of secondary reinforcement. This theory was the impetus for his creation of an electronic simulation of a rat running a T maze, one of the first "computer models" of learning. Wyckoff next went to Emory University, leaving there to help create two of the most successful companies dedicated to the advancement of programmed instruction and teaching machines: Teaching Machines, Inc. and the Human Development Institute. Wyckoff's involvement in these companies epitomizes the application of basic behavior-analytic principles in the development of technology to improve education and human relationships. The emergent picture of Wyckoff is that of a man who, through his research, professional work in educational applications of behavioral principles, and active involvement in the civil rights movement of the 1960s, was strongly committed to applying behavioral science to positively influence human behavior change.

  10. Impact of frailty on outcomes in geriatric femoral neck fracture management: An analysis of national surgical quality improvement program dataset. (United States)

    Dayama, Anand; Olorunfemi, Odunayo; Greenbaum, Simon; Stone, Melvin E; McNelis, John


    Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set. National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders. Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group. mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities. Level II. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  11. Conservation Reserve Program (CRP) contributions to wildlife habitat, management issues, challenges and policy choices--an annotated bibliography (United States)

    Allen, Arthur W.; Vandever, Mark W.


    The following bibliography presents brief summaries of documents relevant to Conservation Reserve Program relations to wildlife habitat, habitat management in agriculturally dominated landscapes, and conservation policies potentially affecting wildlife habitats in agricultural ecosystems. Because the literature summaries furnished provide only sweeping overviews, users are urged to obtain and evaluate those papers appearing useful to obtain a more complete understanding of study findings and their implications to conservation in agricultural ecosystems. The bibliography contains references to reports that reach beyond topics that directly relate to the Conservation Reserve Program. Sections addressing grassland management and landowner surveys/opinions, for example, furnish information useful for enhancing development and administration of conservation policies affecting lands beyond those enrolled in conservation programs. Some sections of the bibliography (for example, agricultural conservation policy, economics, soils) are far from inclusive of all relevant material written on the subject. Hopefully, these sections will serve as fundamental introductions to related issues. In a few instances, references may be presented in more than one section of the bibliography. For example, individual papers specifically addressing both non-game and game birds are included in respective sections of the bibliography. Duplication of citations and associated notes has, however, been kept to a minimum.

  12. Greenstick Fractures (United States)

    ... small, "green" branch on a tree. Most greenstick fractures occur in children younger than 10 years of age. This type ... mistaken for sprains or bruises. More-severe greenstick fractures may cause an obvious ... your doctor if your child has persistent pain in an injured limb. Seek ...

  13. Lacunae in noncommunicable disease control program: Need to focus on adherence issues!

    Directory of Open Access Journals (Sweden)

    Tarundeep Singh


    Full Text Available Introduction: Chronic non communicable diseases in India have increased in magnitude with earlier onset and more likelihood of complications. Much emphasis is given to early diagnosis and timely treatment. Additionally, tertiary prevention through medication adherence is needed to limit disability and prevent early onset of complications. This study was aimed to assess the magnitude of medication and lifestyle adherence among elderly patients suffering from diabetes and hypertension in rural areas of Punjab. Methodology: This was a clinic based study in district Fatehgarh Sahib, Punjab. Patients were subjected to regular blood pressure and blood glucose monitoring. Thereafter they were offered free medications through weekly clinic held at Community Health Center, Bassi Pathana. Along with treatment, Public Health Nurse conducted counselling on diet and lifestyle. Frequency and process of taking medications was explained in local language and records duly maintained during visits. Results: Nearly 70% of study subjects were more than 50 years old. Males constituted 26% of the sample and 60% of subjects were illiterate. Large majority of study subjects did not consumed tobacco (98.08% or alcohol (89.42% in past thirty days. In-sufficient physical activity and poor compliance to diet was reported by 10.5% (Males: 7.4%, Females: 11.7% and 23.5% (Males: 31.5%, Females: 20.8% subjects. Nearly 46.15% of study subjects reported missing prescribed medications. Nearly 61.54% of study subjects were very sure that they will be able to take medicines as directed by physician. Conclusion: National Program for Control of Diabetes, Cardio-vascular Disease and Stroke relies on early diagnosis and treatment non- communicable diseases. However, with reported levels of adherence to medication and lifestyle interventions, there is an urgent need of exploring innovative ways to ensure compliance and improve treatment outcomes.

  14. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T


    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  15. Ankle fracture - aftercare (United States)

    Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture ... Some ankle fractures may require surgery when: The ends of the bone are out of line with each other (displaced). The ...

  16. Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

    Directory of Open Access Journals (Sweden)

    Thabane Lehana


    Full Text Available Abstract Background There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. Methods A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. Results A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. Conclusion A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and

  17. [Mandibular fracture in an infant]. (United States)

    Alberth, M; Szilágyi, Z; Póti, S; Redl, P


    Maxillofacial fractures under 10 years of age are uncommon, with an occurrence of 7.3%. Isolated fractures of the mandible are even more rare, due to the fact that in young children the mandible is relatively small and resilient. Some authors suggest that the occurrence of this form of fracture is about 1-5%. Different methods have been described for treatment of fractures off the mandible in children. In the therapy since the introduction of titanium mini plates the trend has been to select surgical repositioning followed by osteosynthesis. This paper describes the management of a 7-month old boy with isolated mandibular fracture, using this method to avoid the damage of the tooth germs. This particular case raises the issue of child abuse, which is on the increase in Hungary as well. To find a kind of solution would be not only a task of dentists but also of society in general.

  18. Fracture fixation. (United States)

    Taljanovic, Mihra S; Jones, Marci D; Ruth, John T; Benjamin, James B; Sheppard, Joseph E; Hunter, Tim B


    The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used. Copyright RSNA, 2003

  19. Geomechanical Simulation of Fluid-Driven Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Makhnenko, R.; Nikolskiy, D.; Mogilevskaya, S.; Labuz, J.


    The project supported graduate students working on experimental and numerical modeling of rock fracture, with the following objectives: (a) perform laboratory testing of fluid-saturated rock; (b) develop predictive models for simulation of fracture; and (c) establish educational frameworks for geologic sequestration issues related to rock fracture. These objectives were achieved through (i) using a novel apparatus to produce faulting in a fluid-saturated rock; (ii) modeling fracture with a boundary element method; and (iii) developing curricula for training geoengineers in experimental mechanics, numerical modeling of fracture, and poroelasticity.

  20. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener


    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  1. Fracture risk and zoledronic acid therapy in men with osteoporosis

    DEFF Research Database (Denmark)

    Boonen, Steven; Reginster, Jean-Yves; Kaufman, Jean-Marc


    Fractures in men are a major health issue, and data on the antifracture efficacy of therapies for osteoporosis in men are limited. We studied the effect of zoledronic acid on fracture risk among men with osteoporosis.......Fractures in men are a major health issue, and data on the antifracture efficacy of therapies for osteoporosis in men are limited. We studied the effect of zoledronic acid on fracture risk among men with osteoporosis....

  2. Fracture mechanics

    CERN Document Server

    Perez, Nestor


    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  3. Supracondylar Fracture

    Directory of Open Access Journals (Sweden)

    Jessica Andrusaitis


    Full Text Available History of present illness: A 15-year-old male presented to the emergency department with right elbow pain after falling off a skateboard. The patient denied a decrease in strength or sensation but did endorse paresthesias to his hand. On exam, the patient had an obvious deformity of his right elbow with tenderness to palpation and decreased range of motion at the elbow. Sensation, motor function, and pulses were intact. Radiographic imaging was obtained. Significant findings: The pre-reduction films show a type III supracondylar fracture. There is complete displacement of the distal humerus anteriorly. Specific findings for supracondylar fracture include: a posterior fat pad (red arrow and a displaced anterior humeral line (yellow line.1 When no fracture is present, the anterior humeral line should intersect the middle third of the capitellum; in this X-ray, it does not intersect the capitellum at all. This X-ray demonstrates a normal radiocapitellar line (blue line that intersects the capitellum. The presence of a narrow anterior fat pad aka “sail sign” can be normal. Discussion: Supracondylar fractures of the humerus occur at the distal portion of the humerus without involving the growth plate.2 This is the second most common fracture in children overall. In children, it is the most common fracture of the elbow.3 This injury has a high risk of neurovascular compromise, such as compartment syndrome or ischemic contracture, and thus the clinician must perform immediate and frequent neurovascular assessments focusing on the distributions of the brachial artery in addition to the median, ulnar, and radial nerves.4 Hyperextension injuries that typically occur following a fall onto an outstretched arm are responsible for 95% of supracondylar fractures.1 A type I supracondylar fracture is non-displaced and can be treated with immobilization through a posterior splint and sling5 with close follow-up, type II is angulated but with an intact

  4. Reconstructing the 3D fracture distribution model from core (10 cm) to outcrop (10 m) and lineament (10 km) scales (United States)

    Darcel, C.; Davy, P.; Bour, O.; de Dreuzy, J.


    Considering the role of fractures in hydraulic flow, the knowledge of the 3D spatial distribution of fractures is a basic concern for any hydrogeology-related study (potential leakages in waste repository, aquifer management, ?). Unfortunately geophysical imagery is quite blind with regard to fractures, and only the largest ones are generally detected, if they are. Actually most of the information has to be derived from statistical models whose parameters are defined from a few sparse sampling areas, such as wells, outcrops, or lineament maps. How these observations obtained at different scales can be linked to each other is a critical point, which directly addresses the issue of fracture scaling. In this study, we use one of the most important datasets that have ever been collected for characterizing fracture networks. It was collected by the Swedish company SKB for their research program on deep repository for radioactive waste, and consists of large-scale lineament maps covering about 100 km2, several outcrops of several hundreds of m2 mapped with a fracture trace length resolution down to 0.50 m, and a series of 1000m-deep cored boreholes where both fracture orientations and fracture intensities were carefully recorded. Boreholes are an essential complement to surface outcrops as they allow the sampling of horizontal fracture planes that, generally, are severely undersampled in subhorizontal outcrops. Outcrops, on the other hand, provide information on fracture sizes which is not possible to address from core information alone. However linking outcrops and boreholes is not straightforward: the sampling scale is obviously different and some scaling rules have to be applied to relate both fracture distributions; outcrops are 2D planes while boreholes are mostly 1D records; outcrops can be affected by superficial fracturing processes that are not representative of the fracturing at depth. We present here the stereology methods for calculating the 3D distribution

  5. Differences in Moral Judgment on Animal and Human Ethics Issues between University Students in Animal-Related, Human Medical and Arts Programs. (United States)

    Verrinder, Joy M; Ostini, Remo; Phillips, Clive J C


    Moral judgment in relation to animal ethics issues has rarely been investigated. Among the research that has been conducted, studies of veterinary students have shown greater use of reasoning based on universal principles for animal than human ethics issues. This study aimed to identify if this was unique to students of veterinary and other animal-related professions. The moral reasoning of first year students of veterinary medicine, veterinary technology, and production animal science was compared with that of students in non-animal related disciplines of human medicine and arts. All students (n = 531) completed a moral reasoning test, the VetDIT, with animal and human scenarios. When compared with reasoning on human ethics issues, the combined group of students evaluating animal ethics issues showed higher levels of Universal Principles reasoning, lower levels of Personal Interest reasoning and similar levels of Maintaining Norms reasoning. Arts students showed more personal interest reasoning than students in most animal-related programs on both animal and human ethics issues, and less norms-based reasoning on animal ethics issues. Medical students showed more norms-based reasoning on animal ethics issues than all of the animal-related groups. There were no differences in principled reasoning on animal ethics issues between program groups. This has implications for animal-related professions and education programs showing that students' preference for principled reasoning on animal ethics issues is not unique to animal-related disciplines, and highlighting the need to develop student (and professional) capacity to apply principled reasoning to address ethics issues in animal industries to reduce the risk of moral distress.

  6. Selective perceptions of hydraulic fracturing. (United States)

    Sarge, Melanie A; VanDyke, Matthew S; King, Andy J; White, Shawna R


    Hydraulic fracturing (HF) is a focal topic in discussions about domestic energy production, yet the American public is largely unfamiliar and undecided about the practice. This study sheds light on how individuals may come to understand hydraulic fracturing as this unconventional production technology becomes more prominent in the United States. For the study, a thorough search of HF photographs was performed, and a systematic evaluation of 40 images using an online experimental design involving N = 250 participants was conducted. Key indicators of hydraulic fracturing support and beliefs were identified. Participants showed diversity in their support for the practice, with 47 percent expressing low support, 22 percent high support, and 31 percent undecided. Support for HF was positively associated with beliefs that hydraulic fracturing is primarily an economic issue and negatively associated with beliefs that it is an environmental issue. Level of support was also investigated as a perceptual filter that facilitates biased issue perceptions and affective evaluations of economic benefit and environmental cost frames presented in visual content of hydraulic fracturing. Results suggested an interactive relationship between visual framing and level of support, pointing to a substantial barrier to common understanding about the issue that strategic communicators should consider.

  7. Flowback patterns of fractured shale gas wells

    Directory of Open Access Journals (Sweden)

    Naizhen Liu


    Full Text Available Shale gas reservoirs generally need to be fractured massively to reach the industrial production, however, the flowback ratio of fractured shale gas wells is low. In view of this issue, the effects of natural fracture spacing, fracture conductivity, fracturing scale, pressure coefficient and shut-in time on the flowback ratio were examined by means of numerical simulation and experiments jointly, and the causes of flowback difficulty of shale gas wells were analyzed. The results show that the flowback ratio increases with the increase of natural fracture spacing, fracture conductivity and pressure coefficient and decreases with the increase of fracturing scale and shut-in time. From the perspective of microscopic mechanism, when water enters micro-cracks of the matrix through the capillary self-absorbing effect, the original hydrogen bonds between the particles are replaced by the hydroxyl group, namely, hydration effect, giving rise to the growth of new micro-cracks and propagation of main fractures, and complex fracture networks, so a large proportion of water cannot flow back, resulting in a low flowback ratio. For shale gas well fracturing generally has small fracture space, low fracture conductivity and big fracturing volume, a large proportion of the injected water will be held in the very complex fracture network with a big specific area, and unable to flow back. It is concluded that the flowback ratio of fractured shale gas wells is affected by several factors, so it is not necessary to seek high flowback ratio deliberately, and shale gas wells with low flowback ratio, instead, usually have high production.

  8. Interpersonal violence and facial fractures. (United States)

    Lee, Kai H


    Interpersonal violence is a major health hazard that contributes to the high volume of trauma seen in the emergency department. It is also one of the principal causes of maxillofacial fractures. The present study was a retrospective analysis of patients referred to, and treated at, the Oral and Maxillofacial Surgery Unit at Christchurch Hospital during an 11-year period (1996 to 2006). The variables examined included patient demographics, fracture types, mode of injury, and treatment delivered. An increase was found in the number of fractures due to interpersonal violence in the second half of the study, although the proportion remained the same. The age of the patients ranged from 9 to 89 years (mean 28). The male-to-female ratio was 9:1. Of the patients, 87% had alcohol involvement. The mandible was the most common site of fracture, followed by the zygoma. Other midface fractures, including Le Fort fractures, were less frequently observed. Of the patients, 59% were hospitalized and 56% required surgery, with internal fixation necessary in 41% of patients. An increase occurred in the number of facial fractures associated with interpersonal violence during the study period. Young male adults were the most affected demographic group, with alcohol a main contributing factor. Violence-related facial fracture is a health hazard that deserves more public awareness and implementation of preventive programs.

  9. Reducing falls and resulting hip fractures among older women. (United States)

    Stevens, J A; Olson, S


    prevention approaches are needed (e.g., characterizing footwear that promotes stability), as well as secondary prevention strategies (e.g., protective hip pads) that can prevent injuries when falls occur. Finally, efforts are needed to increase collaboration among national experts from various disciplines, to reach consensus regarding priority research areas and program issues, and to work toward long-term strategies for reducing falls and fall-related injuries among older adults. Persons aged > or = 65 years constitute the fastest-growing segment of the U.S. population. Without effective intervention strategies, the number of hip fractures will increase as the U.S. population ages. Fall prevention programs have reduced falls and fall-related injuries among high-risk populations using multifaceted approaches that include education, exercise, environmental modifications, and medication review. These programs need to be evaluated among older adults aged > or = 65 years who are living independently in the community. In addition, secondary prevention strategies are needed to prevent hip fractures when falls occur. Effective public health strategies need to be implemented to promote behavioral changes, improve current interventions, and develop new fall prevention strategies to reduce future morbidity and mortality associated with hip fractures among older adults.

  10. Hydraulic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Clampitt, R.L.


    A method of fracturing a subterranean porous formation penetrated by a well bore consists of injecting down the well and into the formation, at a pressure sufficient to fracture the formation, a fracturing fluid comprising an aqueous gel. This gel is composed of water to which there has been added: a water-thickening amount of a water-dispersible polymer selected from the group consisting of polyacrylamides and polymethacrylamides; crosslinked polyacrylamides and crosslinked polyacrylamides; polyacrylic acid and polymethacrylic acid; polyacrylates; polymers of N-substituted acrylamides; copolymers of acrylamide with another ethylenically unsaturated monomer copolymerizable therewith; mixtures of the polymers; a water-soluble compound of a polyvalent metal which is capable of gelling the water when the valence of the metal is reduced to a lower valence state; and a water-soluble reducing agent. (31 claims)

  11. [Stress fractures]. (United States)

    Uhl, M


    Bone stress injuries are due to repetitive mechanical overuse of the skeleton and occur as a result of microscopic lesions sustained when bone is subjected to repeated submaximal stress. Over time accumulation of such injuries can lead to bone failure and fractures. Stress-related bone injuries are relatively common among otherwise healthy persons who have recently started new or intensified forms of physical training activities. Stress injuries lead to typical findings on radiography, bone scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) and need to be discriminated from other conditions, in particular infections and neoplasms. Stress fractures must be differentiated from insufficiency fractures that occur in bones with reduced mechanical resistance or disturbed structure.

  12. Amendments to Accreditation of Third-Party Certification Bodies To Conduct Food Safety Audits and To Issue Certifications To Provide for the User Fee Program. Final rule. (United States)


    The Food and Drug Administration (FDA, the Agency, or we) is amending its regulations on accreditation of third-party certification bodies to conduct food safety audits and to issue certifications to provide for a reimbursement (user fee) program to assess fees for the work FDA performs to establish and administer the third-party certification program under the FDA Food Safety Modernization Act (FSMA).

  13. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M


    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  14. Healing of Stress Fracture in an Animal Model

    National Research Council Canada - National Science Library

    Li, Jiliang


    .... We have successfully established a reproducible stress fracture model in the rodent. We have investigated the role of an exercise program in the prevention of stress fractures using the ulna axial compression loading model...

  15. The elastic properties of fractured rocks (United States)

    Darcel, C.; Le Goc, R.; Davy, P.


    The consequences of fracturing on rock mass strength still remain an issue for rock engineering practices, including excavation or repository design, support design, slope stability and caving in mines. The difficulty is twice and concerns both the description of the fracturing pattern, and the relationship between fracture characteristics and rock mass mechanical properties. This is generally assessed by empirical knowledge but no complete quantitative and theoretical relations are yet established. To our knowledge, the only theoretical work was to found a relationship between the elastic strength and the percolation parameter (i.e. a normalized sum of the cube of fracture radius) for 3D frictionless fracture networks. The relationship has been demonstrated for Poissonian (randomly distributed) low-density (i.e. where fractures are not almost intersecting) networks, with a narrow range of fracture radius. By means of finite-element models and Green's function methods, we extend the analysis to fracture networks with geologically realistic geometry: i.e. non-Poissonian, relatively high densities, and power-law length distributions. The elastic strength of the fractured rock mass is still found to decrease exponentially with the percolation parameter on average. But large deviations from the mean exist for heavy tailed fracture length distribution, i.e. when the probability of having fractures of the order of the system size is no more negligible. We discuss the way to ameliorate the prediction by taking into account configuration details that are not described by statistical parameters.

  16. Supporting Youth Transitioning out of Foster Care. Issue Brief 2: Financial Literacy and Asset Building Programs. OPRE Report No. 2014-69 (United States)

    Edelstein, Sara; Lowenstein, Christopher


    This issue brief is one of three that focus on programs providing services to youth transitioning out of foster care in three common service domains: education, employment, and financial literacy and asset building. This brief highlights why financial literacy and asset building services are important to youth currently or formerly in foster care,…

  17. The risk of second hip fracture is decreased with compliant and persistent use of bisphosphonates

    DEFF Research Database (Denmark)

    Hansen, Louise; Vestergaard, Peter; Petersen, Karin Dam

    BACKGROUND: Osteoporotic fractures are characterized as fractures of the hip, spine, and forearm resulting from low energy trauma. In Denmark, hip fracture is the second most prevalent fracture in persons above 50 years of age, with an estimated incidence of 5 per 1000 inhabitants in 2011. Patients...... experience a 19% increased mortality within the first year following hip fractures. Furthermore, studies have shown that within 10 years after first hip fracture 40% will experience another hip fracture. The risk for second hip fracture is markedly increased, initiating at a relative risk of 11.8 within...... the first month after fracture and does not normalise until 15 years later. Fracture prevention programs have focused on identifying patients at risk of secondary low energy trauma fractures. The secondary prevention programs for fractures begin immediately after the first fracture, through identification...

  18. Hydraulic Fracturing Fluid Analysis for Regulatory Parameters - A Progress Report (United States)

    This presentation is a progress report on the analysis of Hydraulic Fracturing Fluids for regulatory compounds outlined in the various US EPA methodologies. Fracturing fluids vary significantly in consistency and viscosity prior to fracturing. Due to the nature of the fluids the analytical challenges will have to be addressed. This presentation also outlines the sampling issues associated with the collection of dissolved gas samples.

  19. Osteo-cise: Strong Bones for Life: Protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

    Directory of Open Access Journals (Sweden)

    Gianoudis Jenny


    Full Text Available Abstract Background Osteoporosis affects over 220 million people worldwide, and currently there is no ‘cure’ for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition. Methods/design The Osteo-cise: Strong Bones for Life study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged ≥60 years will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month ‘research to practise’ translational phase. Participants will be randomly assigned to either the Osteo-cise intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test. Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back

  20. Osteo-cise: strong bones for life: protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures. (United States)

    Gianoudis, Jenny; Bailey, Christine A; Sanders, Kerrie M; Nowson, Caryl A; Hill, Keith; Ebeling, Peter R; Daly, Robin M


    Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition. The Osteo-cise: Strong Bones for Life study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged ≥60 years will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the Osteo-cise intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step

  1. Regional Issue Identification and Assessment program (RIIA). Environmental impacts and issues of the EIA MID-MID scenario: Federal Region I (New England)

    Energy Technology Data Exchange (ETDEWEB)

    Brainard, J.; Munson, J.S.


    The impacts described here for 1985 and 1990 are based on a national energy projection which assumes medium energy demand and fuel supply through 1990 but does not incorporate the policies of the National Energy Act (NEA). This scenario, referred to as the Projection Series C or the TRENDLONG MID-MID scenario, is one of six possible energy futures developed by the DOE Energy Information Administration for the Department's 1977 Annual Report to Congress. It was chosen as representative of the official DOE national energy projections when this project was initiated, prior to the passage of the National Energy Act. Since the RIIA program is part of an ongoing review of the regional impact of energy policies, the next phase will examine the National Energy Act (NEA) and initiatives suggested by the President's second National Energy Plan. However, since coal utilization increases under the NEA, in general, impacts identified in the TRENDLONG Series C Scenario should provide a framework for the discussion of impacts by NEA. The environmental impacts discussed in this volume are for Federal Region I (Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, and Connecticut). However, there are nine companion volumes, one for each of the other Federal Regions.

  2. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.


    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  3. Stress-dependent permeability of fractured rock masses: A numerical study

    Energy Technology Data Exchange (ETDEWEB)

    Min, Ki-Bok; Rutqvist, J.; Tsang, Chin-Fu; Jing, Lanru


    We investigate the stress-dependent permeability issue in fractured rock masses considering the effects of nonlinear normal deformation and shear dilation of fractures using a two-dimensional distinct element method program, UDEC, based on a realistic discrete fracture network realization. A series of ''numerical'' experiments were conducted to calculate changes in the permeability of simulated fractured rock masses under various loading conditions. Numerical experiments were conducted in two ways: (1) increasing the overall stresses with a fixed ratio of horizontal to vertical stresses components; and (2) increasing the differential stresses (i.e., the difference between the horizontal and vertical stresses) while keeping the magnitude of vertical stress constant. These numerical experiments show that the permeability of fractured rocks decreases with increased stress magnitudes when the stress ratio is not large enough to cause shear dilation of fractures, whereas permeability increases with increased stress when the stress ratio is large enough. Permeability changes at low stress levels are more sensitive than at high stress levels due to the nonlinear fracture normal stress-displacement relation. Significant stress-induced channeling is observed as the shear dilation causes the concentration of fluid flow along connected shear fractures. Anisotropy of permeability emerges with the increase of differential stresses, and this anisotropy can become more prominent with the influence of shear dilation and localized flow paths. A set of empirical equations in closed-form, accounting for both normal closure and shear dilation of the fractures, is proposed to model the stress-dependent permeability. These equations prove to be in good agreement with the results obtained from our numerical experiments.

  4. Youth with Mental Health Disorders: Issues and Emerging Responses. Also: Wraparound Milwaukee Program: Suicide Prevention in Juvenile Facilities. (United States)

    Juvenile Justice, 2000


    This issue of Juvenile Justice presents three main articles. "Youth with Mental Health Disorders: Issues and Emerging Responses" (J. J. Cocozza and K. Skowyra) discusses tragic mass homicides by juveniles, documented cases of neglect and inadequate services, and federal policy focusing on providing systems of care for at-risk juveniles that have…


    Mansoor, Kanaan; Shahnawaz, Saba; Ahmad, Ali; Arif, Muhammad Mustafa; Hamza, Muhammad


    The epidemiology of paediatric fractures is crucial for developing preventive strategies, but when it comes to developing countries, the urban scenario has rarely been studied in the context of childhood trauma. This study aims to identify the epidemiology of paediatric injuries occurring in the largest and most populated city of Pakistan, Karachi, so that a comparison to data from the developed world can be made, and appropriate precautionary measures can be devised. The data from 1,514 paediatric orthopaedic patients treated at the Accident and Emergency department of Jinnah Postgraduate Medical Centre, during the time frame ranging from January 2012 to January 2013 was studied. Survey forms were filled out by the residents on call. The patients' ages ranged from 2 months to 17 years, with males outnumbering females. The mean age of presentation was 8.8±4.6years. The number of fractures was maximal among children aged 5-11 years, after which it decreased in adolescents. Fractures of the radius and ulna were most common (16.9%), followed by the distal radius (14.6%) and humours (12.0%). Patients aged 0-2 years most commonly presented with a fracture of the femoral shaft. Falls on the same plane were responsible for the most fractures (44.2%), followed by falls from a height (21.5%) and road traffic accidents (26.7%).Incidence of fractures peaked in the summer months (p=0.007). Adequate precautionary measures and preventive programs need to be inculcated through legislation and a community based effort. In a developing nation however, unless the issues of ignorance, illiteracy and poverty are tackled by the authorities, they will continue to be a maior hindrance.

  6. A Review of Agile and Lean Manufacturing as Issues in Selected International and National Research and Development Programs and Roadmaps (United States)

    Castro, Helio; Putnik, Goran D.; Shah, Vaibhav


    Purpose: The aim of this paper is to analyze international and national research and development (R&D) programs and roadmaps for the manufacturing sector, presenting how agile and lean manufacturing models are addressed in these programs. Design/methodology/approach: In this review, several manufacturing research and development programs and…

  7. Effects of a Structured Resource-Based Web Issue-Quest Approach on Students' Learning Performances in Computer Programming Courses (United States)

    Hsu, Ting-Chia; Hwang, Gwo-Jen


    Programming concepts are important and challenging to novices who are beginning to study computer programming skills. In addition to the textbook content, students usually learn the concepts of programming from the web; however, it could be difficult for novice learners to effectively derive helpful information from such non-structured open…

  8. Development, design, and conceptual issues of project zero exposure: A program to protect young children from tobacco smoke exposure

    Directory of Open Access Journals (Sweden)

    Vardavas Constantine I


    Full Text Available Abstract Background Tobacco smoke exposure (TSE is a serious threat to child health. Roughly 40% of children worldwide are exposed to tobacco smoke, and the very young are often "captive smokers" in homes in which others smoke. The goal of this research project is to develop and evaluate an intervention to reduce young child tobacco smoke exposure. The objective of this paper is to document our approach to building the intervention, to describe the planned intervention, and to explore the conceptual issues regarding the intervention and its evaluation. Methods/Design This project is being developed using an iterative approach. We are currently in the middle of Stage 1. In this first stage, Intervention Development, we have already conducted a comprehensive search of the professional literature and internet resources, consulted with experts in the field, and conducted several Design Workshops. The planned intervention consists of parental group support therapy, a website to allow use of an "online/offline" approach, involvement of pediatricians, use of a video simulation game ("Dr. Cruz" to teach parents about child TSE, and personalized biochemical feedback on exposure levels. As part of this stage we will draw on a social marketing approach. We plan to use in-depth interviews and focus groups in order to identify barriers for behavior change, and to test the acceptability of program components. In Stage II, we plan to pilot the planned intervention with 5-10 groups of 10 parents each. In Stage III, we plan to implement and evaluate the intervention using a cluster randomized controlled trial with an estimated 540 participants. Discussion The major challenges in this research are twofold: building an effective intervention and measuring the effects of the intervention. Creation of an effective intervention to protect children from TSE is a challenging but sorely needed public health endeavor. We hope that our approach will contribute to building

  9. Methods of physiotherapy after fracture of the distal forearm


    Šaldová, Kateřina


    Name: Kateřina Šaldová Bachelor thesis supervisor: Mgr. Eva Svobodová Title: Methods of physiotherapy after fracture of the distal forearm Abstract: The thesis deals with the issue of distal forearm fractures and subsequent physical therapy. The theoretical part contains an anatomical description and the kinematics of the forearm and the hand. The next chapter is about injuries to the skeletal system - fractures and their healing and classification. The part focusing on distal forearm fractur...

  10. Addresing environmental challenges to shale gas and hydraulic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Vadillo Fernandez, L.; Rodriguez Gomez, V.; Fernadez Naranjo, F.J.


    This article reviews the main issues of unconventional gas extracted by hydraulic fracturing techniques. Topics such as technology, fracturing stages, flowback characterization and alternatives of disposal and reuse, water consumption, physicochemical features of the geological formations, development of the fractures performed by hydraulic fracturing, well flow decline, land use and occupation and induced seismicity are presented, as well as the scientific debate: the potential steps of methane gas and groundwater contamination. (Author)

  11. [The influence of timing of surgery on mortality and early complications in femoral neck fractures, by surgical procedure: an analysis of 22,566 cases from the German External Quality Assurance Program]. (United States)

    Kostuj, T; Smektala, R; Schulze-Raestrup, U; Müller-Mai, C


    The current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated. PATIENTS UND METHODS: A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.0 and 8.0) were risk-adjusted and evaluated. Surgery was performed within 48 h in 83.9% of the patients. A significant rise in general and early surgical complications was registered when the surgical treatment was delayed for more than 48 h. Mortality and general complications were significantly lower for percutaneous screw fixation. All kinds of joint replacement show significantly higher general and surgical complications. The analyzed data support the rating of femoral neck fracture as requiring the intervention of urgent early surgery, as stated in the guideline. Percutaneous screw fixation can be considered for immobile and multimorbid patients with undislocated fractures. Advantages of total hip replacement compared to hemiarthroplasty cannot be supported by the QS-NRW data.

  12. Issues in NASA Program and Project Management. Special Edition: A Collection of Papers on NASA Procedures and Guidance 7120.5A. Volume 14 (United States)

    Hoffman, Edward J. (Editor); Lawbaugh, William M. (Editor)


    A key aspect of NASA's new Strategic Management System is improving the way we plan, approve, execute and evaluate our programs and projects. To this end, NASA has developed the NASA Program and Project Management processes and Requirements-NASA Procedures and Guidelines (NPG) 7120.5A, which formally documents the "Provide Aerospace Products and Capabilities" crosscutting process, and defines the processes and requirements that are responsive to the Program/Project Management-NPD 7120.4A. The Program/Project Management-NPD 7120.4A, issued November 14, 1996, provides the policy for managing programs and projects in a new way that is aligned with the new NASA environment. An Agencywide team has spent thousands of hours developing the NASA Program and Project Management Processes and Requirements-NPG 7120.5A. We have created significant flexibility, authority and discretion for the program and project managers to exercise and carry out their duties, and have delegated the responsibility and the accountability for their programs and projects.

  13. Distal radius triplane fracture. (United States)

    Parkar, A A H; Marya, S; Auplish, S


    A triplane fracture is so named because of the three planes traversed by the fracture line. These are physeal fractures that result from injury during the final phase of maturation and cessation of growth. This fracture pattern typically involves the distal tibia. We present a rare case of a triplane fracture involving the distal radius.

  14. Parallel, Multigrid Finite Element Simulator for Fractured/Faulted and Other Complex Reservoirs based on Common Component Architecture (CCA)

    Energy Technology Data Exchange (ETDEWEB)

    Milind Deo; Chung-Kan Huang; Huabing Wang


    Black-oil, compositional and thermal simulators have been developed to address different physical processes in reservoir simulation. A number of different types of discretization methods have also been proposed to address issues related to representing the complex reservoir geometry. These methods are more significant for fractured reservoirs where the geometry can be particularly challenging. In this project, a general modular framework for reservoir simulation was developed, wherein the physical models were efficiently decoupled from the discretization methods. This made it possible to couple any discretization method with different physical models. Oil characterization methods are becoming increasingly sophisticated, and it is possible to construct geologically constrained models of faulted/fractured reservoirs. Discrete Fracture Network (DFN) simulation provides the option of performing multiphase calculations on spatially explicit, geologically feasible fracture sets. Multiphase DFN simulations of and sensitivity studies on a wide variety of fracture networks created using fracture creation/simulation programs was undertaken in the first part of this project. This involved creating interfaces to seamlessly convert the fracture characterization information into simulator input, grid the complex geometry, perform the simulations, and analyze and visualize results. Benchmarking and comparison with conventional simulators was also a component of this work. After demonstration of the fact that multiphase simulations can be carried out on complex fracture networks, quantitative effects of the heterogeneity of fracture properties were evaluated. Reservoirs are populated with fractures of several different scales and properties. A multiscale fracture modeling study was undertaken and the effects of heterogeneity and storage on water displacement dynamics in fractured basements were investigated. In gravity-dominated systems, more oil could be recovered at a given pore

  15. TOUGH-RBSN simulator for hydraulic fracture propagation within fractured media: Model validations against laboratory experiments (United States)

    Kim, Kunhwi; Rutqvist, Jonny; Nakagawa, Seiji; Birkholzer, Jens


    This paper presents coupled hydro-mechanical modeling of hydraulic fracturing processes in complex fractured media using a discrete fracture network (DFN) approach. The individual physical processes in the fracture propagation are represented by separate program modules: the TOUGH2 code for multiphase flow and mass transport based on the finite volume approach; and the rigid-body-spring network (RBSN) model for mechanical and fracture-damage behavior, which are coupled with each other. Fractures are modeled as discrete features, of which the hydrological properties are evaluated from the fracture deformation and aperture change. The verification of the TOUGH-RBSN code is performed against a 2D analytical model for single hydraulic fracture propagation. Subsequently, modeling capabilities for hydraulic fracturing are demonstrated through simulations of laboratory experiments conducted on rock-analogue (soda-lime glass) samples containing a designed network of pre-existing fractures. Sensitivity analyses are also conducted by changing the modeling parameters, such as viscosity of injected fluid, strength of pre-existing fractures, and confining stress conditions. The hydraulic fracturing characteristics attributed to the modeling parameters are investigated through comparisons of the simulation results.

  16. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  17. The influence of participation in Better Bones and Balance™ on skeletal health: evaluation of a community-based exercise program to reduce fall and fracture risk. (United States)

    McNamara, A; Gunter, K


    Older women participating in Better Bones and Balance™ (BBB) had similar bone mass at the hip compared to a sample of low active/sedentary controls. However, both groups had higher than expected hip BMD, despite higher risk for osteoporosis among BBB participants. BBB is a community-based fall and fracture risk reduction program shown to reduce bone loss at the hip in older women under controlled laboratory conditions. Whether bone benefits are derived from BBB as delivered in the community setting is unknown. The purpose of this study is to evaluate the relationship between community-based BBB participation and parameters of skeletal health in postmenopausal women. Women were recruited from BBB classes (n=69) and compared to low active/sedentary controls (n=46); total sample aged 69 + 7.7 years. Bone mineral density (BMD) of the hip and spine was measured using DXA; hip bone structure [cross-sectional area, cross-sectional moment of inertia] at the narrow neck and intertrochanter were derived using hip structural analysis software. Diet, physical activity, and health history were assessed by questionnaires. Group differences in bone outcomes were determined using ANCOVA controlling for age and body mass. While controls were heavier and exhibited greater total body BMD compared to BBB participants (p0.05) despite BBB participants reporting more frequent prior diagnoses of or risk factors for osteoporosis compared to controls. Both controls and BBB participants had higher than average T-scores at the hip (p<0.05) when compared to an age-matched cohort from NHANES. These data suggest that participation in BBB may not result in direct benefits to bone. However long-term participation may be associated with other positive outcomes.

  18. The Mexican experience in the elaboration of State Land-Use Programs, diagnostic, issues and perspectives: standpoint of UNAM's Institute of Geography

    Directory of Open Access Journals (Sweden)

    María Teresa Sánchez Salazar


    Full Text Available In Mexico, the elaboration of State Land-Use Programs (SLUP has started recently, fostered by the Ministry of Social Development. Today, 27 states have already completed their corresponding SLUP and four of them have partial results. From the experience and results of the various States a series of issues have been detected, derived from the way in which the national program was developed. These served as bases for UNAM's Institute of Geography to develop the Second Generation of Methodological Guidelines to elaborate a SLUP. The major issues detected included the gap in the incorporation to the program at a state level; the impossibility of applying the first generation of guidelines to some specific pilot cases before the program's start-up; the differences in availability of national cartographic and statistical databases needed for project development; the heterogeneous professional and technical qualifications of the consulting groups which carried out works for state governments and of those responsible for the final assessments. Altogether, these resulted in SLUP with a highly variable quality, which made impossible to incorporate results derived from them into integral projects like the Meso-regional Land-Use Management Programs.

  19. Is the Closet Door Still Closed in 2014? A CIPP Model Program Evaluation of Preservice Diversity Training Regarding LGBT Issues (United States)

    Woodruff, Joseph


    The purpose of this program evaluation was to examine the four components of the CIPP evaluation model (Context, Input, Process, and Product evaluations) in the diversity training program conceptualization and design delivered to College of Education K-12 preservice teachers at a large university in the southeastern United States (referred to in…

  20. Legal and Definitional Issues Affecting the Identification and Education of Adults with Specific Learning Disabilities in Adult Education Programs (United States)

    Taymans, Juliana M.


    Although the exact prevalence is not determined, a noticeable subset of individuals who enroll in adult education and training programs have either diagnosed or undiagnosed specific learning disabilities (SLD). Understanding SLD is important basic information for adult educators to inform program policies as well as determine effective…

  1. Hand fracture - aftercare (United States)

    ... this page: // Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...

  2. Fractured porous media

    CERN Document Server

    Adler, Pierre M; Mourzenko, Valeri V


    This monograph on fractures, fracture networks, and fractured porous media provides a systematic treatment of their geometrical and transport properties for students and professionals in geophysics, materials science, and Earth sciences.

  3. Acetabular Fracture


    Correa, Chad; Lahham, Sari


    History of present illness: A 77-year-old female presented to her primary care physician (PCP) with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows), so the patient was referred to the emergency department where a computed tomography (CT) scan was ordered. Significant findings:...

  4. Galeazzi Fracture


    Reid Honda


    History of present illness: A 19-year-old male presented to the ED with right forearm pain after being struck in the forearm by a baseball. The patient then threw the ball and felt a sharp “pop” in his arm. The patient complained of sharp pain, worse with movement. Upon examination, the patient was neurovascularly intact. Significant findings: The X-ray showed an acute comminuted fracture of the distal diaphysis of the radius with disruption of the distal radioulnar joint, consisten...

  5. Field Verification Program for Small Wind Turbines: Quarterly Report for January-March 2001; 1st Quarter, Issue No.4

    Energy Technology Data Exchange (ETDEWEB)

    Forsyth, T.; Cardinal, J.


    This newsletter provides a brief overview of the Field Verification Program for Small Wind Turbines conducted out of the NWTC and a description of current activities. The newsletter also contains case studies of current projects.

  6. Field Verification Program for Small Wind Turbines, Quarterly Report: 3rd Quarter, Issue No.2, July-September 2000

    Energy Technology Data Exchange (ETDEWEB)

    Cardinal. J.; Tu, P.


    This newsletter provides a brief overview of the Field Verification Program for Small Wind Turbines conducted out of the NWTC and a description of current activities. The newsletter also contains case studies of current projects.

  7. [5 years after the creation of the Nursing and Paramedical Hospital Research Program of the French Ministry of Health: issues and Challenges]. (United States)

    Stuwe, Louisa; Parent, Malorie; Louvet, Olivier


    since 2010, the French General Directorate for Healthcare Provision (DGOS) has launched an annual call for research projects which aims to promote the development of paramedical research: the Nursing and Paramedical Hospital Research Program (PHRIP). five years after its creation, the question arises to what extent this program has contributed to reinforce the importance of paramedical research in France. the objective of this study is to conduct a five years review of this program and to identify issues and challenges that it faces. all research projects selected in the PHRIP program from 2010 to 2014 were included. The analysis focused on quantitative (number of projects, project budget, overall budget per year, last budget share obtained as an indicator of progress of the project) and qualitative variables (profession of project leaders, themes of research, type of healthcare facility which receives funding for research project). almost €l0M were committed for 104 research projects over a five-year period. Among the strengths of the PHRIP program is the positioning of the patient at the center of its research projects and the increasing diversity in projects leaders' professions. Challenges are to prioritize research on primary care, to involve independent private practice healthcare practitioners as well as strengthened methodological support of paramedical practitioners to build and conduct research projects. a review ten years after the program launch would allow to assess, with hindsight, the impact of this program on the importance of paramedical research in France. the PHRIP program has generated considerable interest among French paramedical practitioners. These have finally identified a public funding program specifically dedicated to them, which allows them to invest themselves in their own applied research.

  8. National Service Programs and Their Effects on Military Manpower and Civilian Youth Problems. Budget Issue Paper for Fiscal Year 1979. (United States)


    Office Washington, D.C. 20402’ PREFACE The related problems of military recruitment and civilian youth unemployment and inadequate education a means of dealing with the continuing, severe problem of youth unemployment CURRENT YOUTH PROBLEMS AND POLICIES Many issues and problems...concerning youth persist. These include: requirements for military manpower, unemployment among teenagers and young adults, unequal and inadequate

  9. Probabilistic Simulation for Nanocomposite Fracture (United States)

    Chamis, Christos C.


    A unique probabilistic theory is described to predict the uniaxial strengths and fracture properties of nanocomposites. The simulation is based on composite micromechanics with progressive substructuring down to a nanoscale slice of a nanofiber where all the governing equations are formulated. These equations have been programmed in a computer code. That computer code is used to simulate uniaxial strengths and fracture of a nanofiber laminate. The results are presented graphically and discussed with respect to their practical significance. These results show smooth distributions from low probability to high.

  10. Exploring Educational Issues: International Nursing Students Enrolled in Professional Nursing Programs in South Texas and Their Perceptions of Educational Barriers (United States)

    Sparks, Wanda R.


    This qualitative study explores educational challenges as manifested in the experiences of the English language learner (ELL) nursing students enrolled in a professional nursing program in San Antonio, Texas. Eleven participants were interviewed for this study using 7 open-ended questions. The research methodology applied in this study was…

  11. Government Information Quarterly. Volume 7, no. 2: National Aeronautics and Space Administration Scientific and Technical Information Programs. Special issue (United States)

    Hernon, Peter (Editor); Mcclure, Charles R. (Editor); Pinelli, Thomas E. (Editor)


    NASA scientific and technical information (STI) programs are discussed. Topics include management of information in a research and development agency, the new space and Earth science information systems at NASA's archive, scientific and technical information management, and technology transfer of NASA aerospace technology to other industries.

  12. Research quality and efficiency: An analysis of assessments and management issues in Dutch economics and business research programs

    NARCIS (Netherlands)

    Groot, T.L.C.M.; Garcia Valderrama, T.


    Assessments of quality and productivity of academic research programs become more and more important in gaining financial support, in hiring and promoting research staff, and in building academic reputation. Most assessments are based on peer review or on bibliometric information. In this paper we

  13. Clinical Issues in Reaching Low-Income Fathers with a Program of "Information and Insights about Infants" (III). (United States)

    Honig, Alice S.; Pfannestiel, Annette

    Of a group of 67 low-income first-time fathers-to-be, half were randomly assigned during the second trimester of pregnancy to participate in an intervention program designed to acquaint them with information, insights, and clinically appropriate techniques of responsive care for infants. Fathers were videotaped in feeding interactions with infants…

  14. Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements (United States)

    Spiteri, Arian; Nepalz, Sanjay K.


    Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

  15. Hindsight Is 20/20: A Case Study of Vision and Reading Issues Sheds Light for Teacher Education Programs (United States)

    Chandler, Kristie B.; Box, Jean A.


    This paper presents a case study designed to educate students in pre-service teacher education programs about the importance of a comprehensive eye exam. The case study chronicles a family's multi-year search for solutions to their child's reading difficulties. The research supporting the case study explores the connection between vision…

  16. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. (United States)

    Giangregorio, L M; Papaioannou, A; Macintyre, N J; Ashe, M C; Heinonen, A; Shipp, K; Wark, J; McGill, S; Keller, H; Jain, R; Laprade, J; Cheung, A M


    A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended. The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s). The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations. The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training. The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral

  17. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K


    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  18. Functions of a group-based parenting program for parents of children with mental health issues-some observations from a tertiary care center

    Directory of Open Access Journals (Sweden)

    N Janardhana


    Full Text Available Child and adolescent mental health issues have a wide prevalence and cause serious burden and stress to the psychosocial health of parents and caregivers. Psychosocial interventions have proved to be useful adjuncts to pharmacological treatment in childhood psychiatric conditions because of their long standing nature and psychosocial implications. The present paper aims to identify and enlist the benefits of one such group-based parenting program practiced in a mental health services inpatient setting. The paper borrows from the experiences and observations of a psychiatric social worker who has considerable experience in conducting such group sessions. The material recorded here helps in understanding that parents and caregivers perceive benefits of significant magnitude from regular group session inputs, which help them to deal with the mental health issues of their children, and which also turn out to be a source of support.

  19. Effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older individuals after hip fracture, the SO-HIP trial: study protocol of a three-arm stepped wedge cluster randomized trial. (United States)

    Pol, Margriet C; Ter Riet, Gerben; van Hartingsveldt, Margo; Kröse, Ben; de Rooij, Sophia E; Buurman, Bianca M


    The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. The same holds for sensor monitoring-based coaching in addition to OT. Here, we describe the design of a study investigating the effect of sensor monitoring embedded in an OT rehabilitation program on the recovery of ADL among older individuals after hip fracture. Six nursing homes will be randomized in a three-arm stepped wedge cluster randomized trial. All nursing homes will initially provide standard care. At designated time points, nursing homes, successively and in random order, will cross over to the provision of OT and at the next time point, to sensor monitoring-enhanced OT. A total of 288 older individuals, previously living alone in the community, who after a hip fracture were admitted to a geriatric rehabilitation ward for a short-term rehabilitation, will be enrolled. Individuals in the first intervention group (OTc) will participate in an OT rehabilitation program with coaching based on cognitive behavioral therapy (CBT) principles. In the sensor monitoring group, sensor monitoring is added to the OT intervention (OTcsm). Participants will receive a sensor monitoring system consisting of (i) an activity monitor during nursing home stay, (ii) a sensor monitoring system at home and a (iii) a web-based feedback application. These components will be embedded in the OT. The OT consists of a weekly session with an occupational therapist during the nursing home stay followed by four home visits and four telephone consultations. The primary outcome is patient-perceived daily functioning at 6 months, assessed using the Canadian Occupational Performance Measure (COPM). As far as we know, this study is the first

  20. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. (United States)

    Gianoudis, Jenny; Bailey, Christine A; Ebeling, Peter R; Nowson, Caryl A; Sanders, Kerrie M; Hill, Keith; Daly, Robin M


    Multimodal exercise programs incorporating traditional progressive resistance training (PRT), weight-bearing impact training and/or balance training are recommended to reduce risk factors for falls and fracture. However, muscle power, or the ability to produce force rapidly, has emerged as a more crucial variable to functional decline than muscle strength or mass. The aim of this 12-month community-based randomized controlled trial, termed Osteo-cise: Strong Bones for Life, was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT, combined with an osteoporosis education and behavioral change program, on bone mineral density (BMD), body composition, muscle strength and functional muscle performance in older adults. Falls incidence was evaluated as a secondary outcome. A total of 162 older adults (mean ± SD; 67 ± 6 years) with risk factors for falls and/or low BMD were randomized to the Osteo-cise program (n = 81) or a control group (n = 81). Exercise consisted of fitness center-based HV-PRT, weight-bearing impact and challenging balance/mobility activities performed three times weekly. After 12 months, the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD (1.0% to 1.1%, p exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and/or low BMD. Although this did not translate into a reduction in the rate of falls, further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture. © 2014 American Society for Bone and Mineral Research.

  1. Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures. (United States)

    Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart


    patients with hip fracture, with or without subsequent fractures, need the same robust holistic care. The risks of subsequent fractures should be addressed in patients with hip fracture and should be reduced where possible by education regarding fracture prevention and regular rehabilitation programs. Efforts should be made to decrease the rates of major long-bone fractures and their burdens, even though such fractures have only a minor effect on survival in community-dwelling individuals.

  2. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen


    Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique...... was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion...

  3. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail:; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)


    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.


    Energy Technology Data Exchange (ETDEWEB)

    Abbas Firoozabadi


    The four chapters that are described in this report cover a variety of subjects that not only give insight into the understanding of multiphase flow in fractured porous media, but they provide also major contribution towards the understanding of flow processes with in-situ phase formation. In the following, a summary of all the chapters will be provided. Chapter I addresses issues related to water injection in water-wet fractured porous media. There are two parts in this chapter. Part I covers extensive set of measurements for water injection in water-wet fractured porous media. Both single matrix block and multiple matrix blocks tests are covered. There are two major findings from these experiments: (1) co-current imbibition can be more efficient than counter-current imbibition due to lower residual oil saturation and higher oil mobility, and (2) tight fractured porous media can be more efficient than a permeable porous media when subjected to water injection. These findings are directly related to the type of tests one can perform in the laboratory and to decide on the fate of water injection in fractured reservoirs. Part II of Chapter I presents modeling of water injection in water-wet fractured media by modifying the Buckley-Leverett Theory. A major element of the new model is the multiplication of the transfer flux by the fractured saturation with a power of 1/2. This simple model can account for both co-current and counter-current imbibition and computationally it is very efficient. It can be orders of magnitude faster than a conventional dual-porosity model. Part II also presents the results of water injection tests in very tight rocks of some 0.01 md permeability. Oil recovery from water imbibition tests from such at tight rock can be as high as 25 percent. Chapter II discusses solution gas-drive for cold production from heavy-oil reservoirs. The impetus for this work is the study of new gas phase formation from in-situ process which can be significantly

  5. California Energy Incentive Programs: An Annual Update on Key Energy Issues and Financial Opportunities for Federal Sites in California

    Energy Technology Data Exchange (ETDEWEB)



    A spate of recently enacted energy legislation and associated program changes is providing numerous opportunities to help California federal energy managers cut costs and meet their renewables, energy efficiency and GHG emissions goals. In April 2011, Governor Jerry Brown approved the nation’s most ambitious renewable portfolio standard (RPS), which requires 33% of the state’s electricity to come from renewable energy sources by 2020. Policy changes that will support the RPS include expanded eligibility rules that fill previous gaps in incentives for certain sizes of on-site renewable energy systems. Program updates described in this document include: $200 million more in funding for California Solar Initiative rebates to commercial and industrial customers; an increase in the eligible system size for the Feed-In-Tariff (FIT) from 1.5MW to 3MW; and pending changes that may allow customer-side systems to sell tradable renewable energy credits (TRECs) to entities with RPS compliance obligations in California.

  6. [The WHO age-friendly cities program raises the issue of strategic planning, coordination and local political structure]. (United States)

    Chapon, Pierre-Marie


    In 2005 the World Health Organization initiated the «global age-friendly cities project» which encourages cities to be more inclusive of older people and to develop seniors' involvement by setting up a continuous cycle of assessment and improvement of urban living. The conclusions of the first french audit, which was made in Lyon in 2011, raise the issue of the capacity of cities to implement projects in all the areas fostering active aging. The question of strategic planning and of the level of intervention is relevant for the topics selected, and especially that of health. Is the present organization between the different actors satisfactory, or should large cities have more power? Co-ordination is necessary, and the creation of «gerontopoles» could bring an answer.

  7. Aging and Elderly Care Practice in Japan: Main Issues, Policy and Program Perspective; What Lessons can be Learned from Japanese Experiences?

    Directory of Open Access Journals (Sweden)

    Pushkar Singh Raikhola


    Full Text Available This article presents an overview of the main issues, policies and programs related to aging and elderly care practice of Japan based on the available published evidence to date. The Japanese enjoy the world's longest and healthiest lives. This fortunate situation, however, is also causing concern. The rate of population aging in Japan is much greater than that in other developed countries. In Japan, the nuclear family, female employment, decreased fertility rate and changing patterns of family roles have combined to make it more difficult or less desirable to provide that care informally and there are greatly increased demands for community and institutional care. The aging process of Japan not only increased the ratio of the elderly in the population but also accompanied a fundamental change in family and community. Therefore, the various systems which are affected by these changes, such as pensions, medical care and long term care, need to be rebuilt. The aging issue requires a long term commitment with enough foresight; policies must be created as soon as possible with consideration for cultural and social conditions specific to each country and each city. I think the care of the elderly therefore involves a holistic combination of health care, socio-economic care and the provision of suitable environment. In Japan the Long Term Care Insurance Plan and the New Gold Plan alongside other policies and programs are directed towards the care and welfare of elderly people. These policies and programs are actually imitable for countries like Nepal, where are no any substantial policies and programs for caring the elderly. So that we can learn various experiences of coping aging and elderly problem from Japan both in policy and program level. However, Nepal should develop its own policies and programs based on its own cultural traditions, economic capacity and social transitions in the society. Key Words: Aging; elderly care; fertility; policy

  8. A comparative analysis of locally based conservation education programs that promote issue awareness and community solutions within Honduras and the United States (United States)

    Weber, Nicole R.

    Public understanding and concern for environment issues is critical to conservation efforts. In this study, I investigated education programs focused on the local environmental issues and their impact on sense of place, environmental knowledge, empowerment and awareness (Honduras and Boston). I hypothesized that the curriculum will have an effect on multiple student measures and teachers who participate in workshops will have greater ownership of the curriculum, influencing curriculum's effectiveness. Then I looked at the relation of environmental knowledge to environmental connection, at the regional (Honduras) and international levels (Honduras vs. United States), comparing cultural differences in same measures mentioned. I hypothesized that a population connected to their natural surroundings will have an embedded biological understanding and appreciation of their surroundings. I surveyed a total of 887 students (727 Honduras, 160 Boston) and 293 teachers (Honduras), with participant and nonparticipant teachers included, in a pre/post/follow-up survey design. To evaluate these hypotheses, I used multiple measures to assess program success and regional differences: implicit measures (general sense of place); explicit measures (knowledge of problems and solutions; degree of specificity in thinking about these issues); and affective and attitudinal components (sense of empowerment). For the exploratory study, I gathered parallel data from teachers, so that the effects of the program on both teachers and students would be evident. Our results indicate that there were significant changes in number of problem and solution types proposed by students, that students' responses matched those of their teacher on some measures (but not all) by the end of the program. In Honduras, the main effect of being in the teacher workshop appears to be in their willingness to teach environmental education. Results for student's sense of place and environmental empowerment were

  9. Modeling of flow in faulted and fractured media

    Energy Technology Data Exchange (ETDEWEB)

    Oeian, Erlend


    The work on this thesis has been done as part of a collaborative and inter disciplinary effort to improve the understanding of oil recovery mechanisms in fractured reservoirs. This project has been organized as a Strategic University Program (SUP) at the University of Bergen, Norway. The complex geometries of fractured reservoirs combined with flow of several fluid phases lead to difficult mathematical and numerical problems. In an effort to try to decrease the gap between the geological description and numerical modeling capabilities, new techniques are required. Thus, the main objective has been to improve the ATHENA flow simulator and utilize it within a fault modeling context. Specifically, an implicit treatment of the advection dominated mass transport equations within a domain decomposition based local grid refinement framework has been implemented. Since large computational tasks may arise, the implicit formulation has also been included in a parallel version of the code. Within the current limits of the simulator, appropriate up scaling techniques has also been considered. Part I of this thesis includes background material covering the basic geology of fractured porous media, the mathematical model behind the in-house flow simulator ATHENA and the additions implemented to approach simulation of flow through fractured and faulted porous media. In Part II, a set of research papers stemming from Part I is presented. A brief outline of the thesis follows below. In Chapt. 1 important aspects of the geological description and physical parameters of fractured and faulted porous media is presented. Based on this the scope of this thesis is specified having numerical issues and consequences in mind. Then, in Chapt. 2, the mathematical model and discretizations in the flow simulator is given followed by the derivation of the implicit mass transport formulation. In order to be fairly self-contained, most of the papers in Part II also includes the mathematical model

  10. The Effects of a Pilates-Based Exercise Rehabilitation Program on Functional Outcome and Fall Risk Reduction in an Aging Adult Status-Post Traumatic Hip Fracture due to Fall. (United States)

    Stivala, Adam; Hartley, Greg


    Currently, little information describing the relationship of Pilates-based strength and stability exercises with fall risk in the geriatric population exists. The purpose of this report was to examine the impact of a Pilates-based rehabilitation (PBR) program on reducing fall risk in an aging adult status postfall with resulting hip fracture and open reduction and internal fixation. The patient was an 84-year-old woman admitted to a skilled nursing facility (SNF) after a right hip fracture resulting from a fall at home. The patient's relevant medical history included frequent falls due to loss of balance, a previous left hip fracture with resultant arthroplasty, and a stroke roughly 20 years prior. The patient received physical therapy and occupational therapy 6 days per week for 26 days in an SNF. The physical therapy intervention consisted of gait and transfer training, neuromuscular reeducation, and an adjunct of specialized PBR exercises for the following impairments: decreased core strength and awareness and poor dynamic stabilization during functional activities. The patient demonstrated increases in lower extremity strength and active range of motion, ambulation distance and speed, and transfer ability. The patient was able to return home and live with her husband while requiring only incidental assistance with activities of daily living. She was able to independently ambulate around her home with her rolling walker. Her fall risk was also reduced from initial evaluation based on several fall risk assessments, including the Four Square Step Test, the Berg Balance Scale, and the Timed Up and Go. This case illustrates the benefit of integrating PBR exercises into a standard SNF rehabilitation program, which may contribute to decreased fall risk.

  11. The effects of a Pilates-based exercise rehabilitation program on functional outcome and fall risk reduction in an aging adult status-post traumatic hip fracture due to a fall. (United States)

    Stivala, Adam; Hartley, Greg


    Currently, little information describing the relationship of Pilates-based strength and stability exercises with fall risk in the geriatric population exists. The purpose of this report was to examine the impact of a Pilates-based rehabilitation (PBR) program on reducing fall risk in an aging adult status postfall with resulting hip fracture and open reduction and internal fixation. The patient was an 84-year-old woman admitted to a skilled nursing facility (SNF) after a right hip fracture resulting from a fall at home. The patient's relevant medical history included frequent falls due to loss of balance, a previous left hip fracture with resultant arthroplasty, and a stroke roughly 20 years prior. The patient received physical therapy and occupational therapy 6 days per week for 26 days in an SNF. The physical therapy intervention consisted of gait and transfer training, neuromuscular reeducation, and an adjunct of specialized PBR exercises for the following impairments: decreased core strength and awareness and poor dynamic stabilization during functional activities. The patient demonstrated increases in lower extremity strength and active range of motion, ambulation distance and speed, and transfer ability. The patient was able to return home and live with her husband while requiring only incidental assistance with activities of daily living. She was able to independently ambulate around her home with her rolling walker. Her fall risk was also reduced from initial evaluation based on several fall risk assessments, including the Four Square Step Test, the Berg Balance Scale, and the Timed Up and Go. This case illustrates the benefit of integrating PBR exercises into a standard SNF rehabilitation program, which may contribute to decreased fall risk.

  12. Introduction to a Special Issue of the Journal of Immunological Methods: Building global resource programs to support HIV/AIDS clinical trial studies. (United States)

    Sanchez, Ana M; Denny, Thomas N; O'Gorman, Maurice


    This Special Issue of the Journal of Immunological Methods includes 16 manuscripts describing quality assurance activities related to virologic and immunologic monitoring of six global laboratory resource programs that support international HIV/AIDS clinical trial studies: Collaboration for AIDS Vaccine Discovery (CAVD); Center for HIV/AIDS Vaccine Immunology (CHAVI); External Quality Assurance Program Oversight Laboratory (EQAPOL); HIV Vaccine Trial Network (HVTN); International AIDS Vaccine Initiative (IAVI); and Immunology Quality Assessment (IQA). The reports from these programs address the many components required to develop comprehensive quality control activities and subsequent quality assurance programs for immune monitoring in global clinical trials including: all aspects of processing, storing, and quality assessment of PBMC preparations used ubiquitously in HIV clinical trials, the development and optimization of assays for CD8 HIV responses and HIV neutralization, a comprehensive global HIV virus repository, and reports on the development and execution of novel external proficiency testing programs for immunophenotyping, intracellular cytokine staining, ELISPOT and luminex based cytokine measurements. In addition, there are articles describing the implementation of Good Clinical Laboratory Practices (GCLP) in a large quality assurance laboratory, the development of statistical methods specific for external proficiency testing assessment, a discussion on the ability to set objective thresholds for measuring rare events by flow cytometry, and finally, a manuscript which addresses a framework for the structured reporting of T cell immune function based assays. It is anticipated that this series of manuscripts covering a wide range of quality assurance activities associated with the conduct of global clinical trials will provide a resource for individuals and programs involved in improving the harmonization, standardization, accuracy, and sensitivity of

  13. The CASA Trauma and Attachment Group (TAG) Program for Children who have Attachment Issues Following Early Developmental Trauma. (United States)

    Ashton, Chandra K; O'Brien-Langer, Anna; Silverstone, Peter H


    There is relatively little research about effective therapeutic approaches for children in middle childhood who have attachment related diagnoses as a result of experiencing significant, early developmental trauma. This study describes findings from an intensive, dyad-based intervention, aimed at stabilizing attachment relationships with primary caregivers, increasing caregiver reflective function skills, and reducing children's trauma-related behavioural sequelae. We analyzed retrospective data from 51 caregiver/child dyads who participated in the Trauma and Attachment Group (TAG) Program from September 2011-December 2014. This data included pre- and post-intervention scores retrieved from the Parenting Relationship Questionnaire (PRQ), the Parent Report of Post-Traumatic Stress Symptoms (PROPS), and the Parental Reflective Functioning Questionnaire (PRFQ-1). The preliminary findings show statistically significant improvements in attachment, communication, discipline practices, involvement, and relational frustration. Additionally there were statistically significant improvements in parental reflective functioning, and a trend towards a reduction in symptoms typical of post-traumatic stress disorder. Poor quality or inconsistent interactions with early caregivers can lead to life-long impairments in physical and mental health. This intensive program shows potential as a way to improve longer-term outcomes for children exposed to early developmental trauma. Longer-term research is required to further substantiate outcomes, appraise cost analysis, as well as to consider evaluation with appropriate comparison groups.

  14. The CASA Trauma and Attachment Group (TAG) Program for Children who have Attachment Issues Following Early Developmental Trauma (United States)

    Ashton, Chandra K.; O’Brien-Langer, Anna; Silverstone, Peter H.


    Objective: There is relatively little research about effective therapeutic approaches for children in middle childhood who have attachment related diagnoses as a result of experiencing significant, early developmental trauma. This study describes findings from an intensive, dyad-based intervention, aimed at stabilizing attachment relationships with primary caregivers, increasing caregiver reflective function skills, and reducing children’s trauma-related behavioural sequelae. Method: We analyzed retrospective data from 51 caregiver/child dyads who participated in the Trauma and Attachment Group (TAG) Program from September 2011–December 2014. This data included pre- and post-intervention scores retrieved from the Parenting Relationship Questionnaire (PRQ), the Parent Report of Post-Traumatic Stress Symptoms (PROPS), and the Parental Reflective Functioning Questionnaire (PRFQ-1) Results: The preliminary findings show statistically significant improvements in attachment, communication, discipline practices, involvement, and relational frustration. Additionally there were statistically significant improvements in parental reflective functioning, and a trend towards a reduction in symptoms typical of post-traumatic stress disorder. Conclusion: Poor quality or inconsistent interactions with early caregivers can lead to life-long impairments in physical and mental health. This intensive program shows potential as a way to improve longer-term outcomes for children exposed to early developmental trauma. Longer-term research is required to further substantiate outcomes, appraise cost analysis, as well as to consider evaluation with appropriate comparison groups. PMID:27047555

  15. Examining Lead Exposures in California through State-Issued Health Alerts for Food Contamination and an Exposure-Based Candy Testing Program. (United States)

    Handley, Margaret A; Nelson, Kali; Sanford, Eric; Clarity, Cassidy; Emmons-Bell, Sophia; Gorukanti, Anuhandra; Kennelly, Patrick


    In California, the annual number of children under age 6 y of age with blood lead levels (BLL) ≥10μg/dL is estimated at over 1,000 cases, and up to 10,000 cases when BLL between 4.5 and 9.5 μg/dL are included. State-issued health alerts for food contamination provide one strategy for tracking sources of food-related lead exposures. As well, California passed legislation in 2006 for the Food and Drug Branch (FDB) of the state health department to test and identify lead in candy. This report presents health alert data from California over a 14-y period, compares data before and after the candy testing program began, and examines country of origin, ZIP code data, and time from candy testing to release of health alerts for lead-contaminated candies for 2011-2012. After 2007, health alerts issued for lead in candy and food increased significantly. Analysis of candy-testing data indicated that multiple counties and ZIP codes were affected. Seventeen candies with high lead concentrations were identified, resulting in rapid dissemination (lead exposures from state-based food and candy testing programs provides an opportunity to identify and immediately act to remove nonpaint sources of lead affecting children.

  16. [Arthroscopic fracture management in proximal humeral fractures]. (United States)

    Lill, H; Katthagen, C; Jensen, G; Voigt, C


    Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.

  17. Pediatric Phalanx Fractures. (United States)

    Abzug, Joshua M; Dua, Karan; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O


    Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.

  18. Theoretical Analysis of the Mechanism of Fracture Network Propagation with Stimulated Reservoir Volume (SRV Fracturing in Tight Oil Reservoirs.

    Directory of Open Access Journals (Sweden)

    Yuliang Su

    Full Text Available Stimulated reservoir volume (SRV fracturing in tight oil reservoirs often induces complex fracture-network growth, which has a fundamentally different formation mechanism from traditional planar bi-winged fracturing. To reveal the mechanism of fracture network propagation, this paper employs a modified displacement discontinuity method (DDM, mechanical mechanism analysis and initiation and propagation criteria for the theoretical model of fracture network propagation and its derivation. A reasonable solution of the theoretical model for a tight oil reservoir is obtained and verified by a numerical discrete method. Through theoretical calculation and computer programming, the variation rules of formation stress fields, hydraulic fracture propagation patterns (FPP and branch fracture propagation angles and pressures are analyzed. The results show that during the process of fracture propagation, the initial orientation of the principal stress deflects, and the stress fields at the fracture tips change dramatically in the region surrounding the fracture. Whether the ideal fracture network can be produced depends on the geological conditions and on the engineering treatments. This study has both theoretical significance and practical application value by contributing to a better understanding of fracture network propagation mechanisms in unconventional oil/gas reservoirs and to the improvement of the science and design efficiency of reservoir fracturing.

  19. [Unstable pertrochanteric fractures, biomechanic, classification and therapy.]. (United States)

    Cech, O; Kostál, R; Váchal, J


    The authors deal with unstable pertrochanteric, intertrochanteric and subtrochanteric fractures extending as far as calcar femorale. The treatment of pertrochanteric issues is a serious issue as their total number in the Czech Republic exceeds 5.000 annually and with the exception of those which are contraindicated due to their health condition, all patients are indicated to surgery. In the treatment of unstable pertrochanteric fractures there occurs failure of internal fixation also with the use of implants such as dynamic hip screw or Gamma nail. The cause of unsuccessful treatment of unstable fractures is the defect in calcar femorale - impairment of the weightbearing area of proximal femur and failure of the implant as a result of its cyclic overloading - breakage of the nail, cutting out of the screw from the head in the osteoporotic bone or breaking out of screws fixing the plate to the femoral shaft. For a causal procedure the authors consider the reconstruction of the calcar femorale by a wedge valgus osteotomy of the comminuted zone after the original design of Debrunner and Cech (1969). Simultaneously with reconstruction of the medial cortical support in the calcar femorale the 160 degrees valgization is performed. In the AO classification the authors consider for unstable the fractures of types 31.A2.1, A2.2, A3.3. Significant from the therapeutic viewpoint is the classification of stable fractures (with open reduction the anatomic reconstruction of weight-bearing calcar femorale is possible) and unstable fractures - where with open reduction the defect of calcar femorale persists. For stabilization of unstable the authors recommend fixation by DHS at 150 degrees angle. If need be, this fixation may be combined with lag screws and in case of a simultaneous fracture of greater trochanter and in reverse fractures a trochanteric buttress plate has to be added. Key words: unstable pertrochanteric fractures, nonanatomic valgus reduction, DHS fixation.

  20. A high school-based voluntary cardiovascular risk screening program: issues of feasibility and correlates of electrocardiographic outcomes. (United States)

    Dadlani, Gul H; Wilkinson, James D; Ludwig, David A; Harmon, William G; O'Brien, Robert; Sokoloski, Mary C; Epstein, Michael L; Miller, Tracie L; Messiah, Sarah E; Landy, David C; Franco, Vivian I; Jacobs, Jeffrey P; Lipshultz, Steven E


    Risk factors for adult cardiovascular events can be identified from the prenatal period through childhood. We performed a cardiovascular risk-screening program in students from grades 9-12 in 7 high schools in Hillsborough County, FL. We obtained blood pressure (BP) measurements and calculated body mass index (BMI) as risk factors for future cardiovascular events as well as obtained an electrocardiogram (ECG) for the purposes of detecting possible life-threatening arrhythmias. Of ~14,000 students contacted, 600 (4 %) participated in the screening. Of these, 517 (86 %) were diagnosed with normal, 71 (12 %) with borderline, and 12 (1 %) with abnormal ECGs. Although no participant had any cardiac history, two of the abnormal ECGs indicated a cardiac diagnosis associated with the potential for sudden cardiac death. Both systolic and diastolic BP increased as the ECG diagnosis moved from normal (115.6/73.8) through borderline (121.0/75.9) to an abnormal (125.0/80.7) diagnosis (all P ≤ .0016). An increase in BMI was only observed when an ECG diagnosis was abnormal (P = .0180). Boys had a greater prevalence (18.97 %) of borderline or abnormal ECGs compared with girls (6.75 %), whereas no discernible differences were seen in ECG diagnosis between white and nonwhite individuals (15.09 and 12.26 %, respectively). Although participation rates were low, a high school-based cardiovascular risk-screening program including ECG is feasible. Although ECG diagnosis tended to be related to other known cardiovascular risk factors (BP, BMI), the utility of an abnormal ECG in adolescence as a predictor of future cardiovascular risk will require further evaluation in more controlled settings.

  1. Hydraulic fracture model and diagnostics verification at GRI/DOE multi-site projects and tight gas sand program support. Final report, July 28, 1993--February 28, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, J.E.


    The Mesaverde Group of the Piceance Basin in western Colorado has been a pilot study area for government-sponsored tight gas sand research for over twenty years. Early production experiments included nuclear stimulations and massive hydraulic fracture treatments. This work culminated in the US Department of Energy (DOE)`s Multiwell Experiment (MWX), a field laboratory designed to study the reservoir and production characteristics of low permeability sands. A key feature of MWX was an infrastructure which included several closely spaced wells that allowed detailed characterization of the reservoir through log and core analysis, and well testing. Interference and tracer tests, as well as the use of fracture diagnostics gave further information on stimulation and production characteristics. Thus, the Multiwell Experiment provided a unique opportunity for identifying the factors affecting production from tight gas sand reservoirs. The purpose of this operation was to support the gathering of field data that may be used to resolve the number of unknowns associated with measuring and modeling the dimensions of hydraulic fractures. Using the close-well infrastructure at the Multiwell Site near Rifle, Colorado, this operation focused primarily on the field design and execution of experiments. The data derived from the experiments were gathered and analyzed by DOE team contractors.

  2. Views of supervisors of colonoscopy training on quality issues for the national bowel cancer screening program in Australia. (United States)

    Pentti, Marita; Muller, Jennifer; Janda, Monika; Newman, Beth


    To describe the views of supervisors of colonoscopy training in regard to colonoscopy training capacity and quality in Australia. Anonymous postal surveys from March to May 2007 were posted to 127 colonoscopy training supervisors (30.2% estimated response rate). The surveys queried colonoscopy training capacity and quality, supervisors' views and opinions on innovative approaches to colonoscopy training, number of colonoscopies and time required by trainees to gain competence in colonoscopy. Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the National Bowel Cancer Screening Program (NBCSP). A collaborative approach with the private sector was seen as beneficial by 65%. Non-gastroenterologists (non-GEs) were more likely than gastroenterologists (GEs) to be of the opinion that simulators are beneficial for colonoscopy training (chi(2)-test = 5.55, P = 0.026). The majority of trainers did not support training either nurses (73%) or general practitioners (GPs) in colonoscopy (71%). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that > or = 200 colonoscopies were needed. Colonoscopy training in Australia has traditionally followed the apprenticeship model. Projected increases in demand for colonoscopy with the introduction of the NBCSP may require additional training places and new and innovative approaches to training in order to ensure the provision of high-quality colonoscopy services under the NBCSP.

  3. Permeability of displaced fractures (United States)

    Kluge, Christian; Milsch, Harald; Blöcher, Guido


    Flow along fractures or in fissured systems becomes increasingly important in the context of Enhanced Geothermal Systems (EGS), shale gas recovery or nuclear waste deposit. Commonly, the permeability of fractures is approximated using the Hagen-Poiseuille solution of Navier Stokes equation. Furthermore, the flow in fractures is assumed to be laminar flow between two parallel plates and the cubic law for calculating the velocity field is applied. It is a well-known fact, that fracture flow is strongly influenced by the fracture surface roughness and the shear displacement along the fracture plane. Therefore, a numerical approach was developed which calculates the flow pattern within a fracture-matrix system. The flow in the fracture is described by a free fluid flow and the flow in the matrix is assumed to be laminar and therefore validates Darcy's law. The presented approach can be applied for artificially generated fractures or real fractures measured by surface scanning. Artificial fracture surfaces are generated using the power spectral density of the surface height random process with a spectral exponent to define roughness. For calculating the permeability of such fracture-matrix systems the mean fracture aperture, the shear displacement and the surface roughness are considered by use of a 3D numerical simulator. By use of this approach correlation between shear displacement and mean aperture, shear displacement and permeability, as well as surface roughness and permeability can be obtained. Furthermore, the intrinsic measured permeability presents a combination of matrix and fracture permeability. The presented approach allows the separation and quantification of the absolute magnitudes of the matrix and the fracture permeability and the permeability of displaced fractures can be calculated. The numerical approach which is a 3D numerical simulation of the fracture-matrix system can be applied for artificial as well as real systems.

  4. Controversies in ankle fracture treatment. Indications for fixation of stable Weber type B fractures and indications for syndesmosis stabilization. (United States)

    Miller, S D


    Although the treatment of ankle fractures is often straightforward, several controversies remain. This article reviews the need for open reduction and internal fixation of the displaced supination-external rotation fracture, and contrasts the studies that mandate anatomic reduction with clinical results. The many issues surrounding syndesmosis fixation are also reviewed, including the need for fixation of distal fractures and the timing of screw fixation.

  5. Infant skull fracture (image) (United States)

    Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent protection ... a severe impact or blow can result in fracture of the skull and may be accompanied by ...

  6. Nasal fracture (image) (United States)

    A nasal fracture is a break in the bone over the ridge of the nose. It usually results from a blunt ... and is one of the most common facial fracture. Symptoms of a broken nose include pain, blood ...

  7. Growth Plate Fractures (United States)

    .org Growth Plate Fractures Page ( 1 ) The bones of children and adults share many of the same risks for ... also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage ...

  8. Bone fracture repair - slideshow (United States)

    ... page: // Bone fracture repair - series—Indications To use the sharing features ... Go to slide 4 out of 4 Overview Fractures of the bones are classified in a number ...

  9. Femur fracture repair - discharge (United States)

    ... page: // Femur fracture repair - discharge To use the sharing features on this page, please enable JavaScript. You had a fracture (break) in the femur in your leg. It ...

  10. Rib fracture - aftercare (United States)

    ... page: // Rib fracture - aftercare To use the sharing features on this page, please enable JavaScript. A rib fracture is a crack or break in one or ...

  11. Nasal fracture - aftercare (United States)

    ... page: // Nasal fracture - aftercare To use the sharing features on this ... that gives your nose its shape. A nasal fracture occurs when the bony part of your nose ...

  12. Hip fracture surgery (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  13. Metatarsal stress fractures - aftercare (United States)

    ... page: // Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  14. Everted skull fracture. (United States)

    Balasubramaniam, Srikant; Tyagi, Devendra K; Savant, Hemant V


    Skull bone fractures are common in trauma. They are usually linear undisplaced or depressed; however, a distinct possibility of elevated fracture remains. We describe an entity of everted fracture skull in which the fracture segment is totally everted. The nature of trauma, management, and complications of this unique case are discussed. A 21-year-old woman involved in a railway accident presented to us with a primary dressing on her wound. Investigations revealed an everted fracture skull. She underwent surgery with good results. We would like to add everted fracture skull to the nomenclature describing skull fractures in addition to elevated compound fracture skull as a new entity. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Computed tomography-based virtual fracture reduction techniques in bimandibular fractures. (United States)

    Voss, Jan Oliver; Varjas, Viktor; Raguse, Jan-Dirk; Thieme, Nadine; Richards, R Geoff; Kamer, Lukas


    Computer-assisted preoperative planning (CAPP) usually relies on computed tomography (CT) or cone beam CT (CBCT) and has already become an established technique in craniomaxillofacial surgery. The purpose of this study was to implement CT-based virtual fracture reduction as a key planning feature in patients with bimandibular fractures. Nine routine preoperative CT scans of patients with bilateral mandibular fractures were acquired and post-processed using a mean model of the mandible and Amira software extended by custom-made scripting and programming modules. A computerized technique was developed that allowed three-dimensional modeling, separation of the mandible from the cranium, distinction of the fracture fragments, and virtual fracture reduction. User interaction was required to label the mandibular fragments by landmarks. Virtual fracture reduction was achieved by optionally using the landmarks or the contralateral unaffected side as anatomical references. We successfully elaborated an effective technique for virtual fracture reduction of the mandible using a standard CT protocol. It offers expanded planning options for osteosynthesis construction or the manufacturing of personalized rapid prototyping guides in fracture reduction procedures. CAPP is justified in complex mandibular fractures and may be adopted in addition to routine preoperative CT assessment. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture. (United States)

    Della Rocca, Gregory J; Uppal, Harmeeth S; Copeland, Marilyn E; Crist, Brett D; Volgas, David A


    The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P patients and of peripheral neuropathy (P = .014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P patients were also less likely to be discharged directly home from the hospital (P Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip.

  17. Colombia: Issues for Congress

    National Research Council Canada - National Science Library

    Veillette, Connie


    .... The Congress has expressed concern with respect to a number of Colombia-related issues including human rights, the aerial eradication of illicit drug crops, interdiction programs, the situation of U.S...

  18. Distal radius fractures: what determines the outcome after surgery?

    NARCIS (Netherlands)

    Teunis, T.


    This thesis addresses current issues in the outcome of operatively treated distal radius fractures. The general aim was to determine factors associated with adverse events, loss of motion, functional limitations, and opioid use after surgery. Injury In 3D complete articular distal radius fracture

  19. Management of common fractures. (United States)

    Walker, Jennie


    The incidence of fractures increases with advancing age partly due to the presence of multiple comorbidities and increased risk of falls. Common fracture sites in older people include femoral neck, distal radius and vertebral bodies. Nurses have an important role in caring for older patients who have sustained fractures, not only to maximise function and recovery, but as part of a team to minimise the morbidity and mortality associated with fractures in this group.

  20. A Year of Fractures: a snapshot analysis of the logistics, problems and outcomes of a hospital-based fracture liaison service. (United States)

    Vaile, J H; Sullivan, L; Connor, D; Bleasel, J F


    Our fracture liaison service identifies patients with low trauma fractures, determines the need for osteoporosis therapy and instigates therapy if necessary. We describe the tracking and outcome of 768 patients attending our emergency department over 1 year and discuss the problems we encountered and potential solutions. Osteoporotic fractures result in substantial morbidity, mortality and economic cost, and patients sustaining a first fracture are known to be at higher risk of sustaining future fracture. Treatment of at-risk patients has been shown to assist in prevention of future fracture including hip fracture. We established a "First Fracture Project" to identify and treat these patients in 2003. We assessed "A Year of Fractures": the logistics, outcome and problems in tracking patients presenting to our emergency department with a low trauma fracture by our fracture liaison service, over 1 year from July 2008 to June 2009. Patients were tracked by our osteoporosis nurse and offered assessment, and treatment where necessary. In 1 year, 768 patients aged 50 or over were identified from emergency department records as attending with a low trauma fracture. About 84 % of patients eventually received assessment. Of the162 patients progressing through the entire process, 74 % had osteoporosis treatment planned and/or commenced. Our fracture liaison service was effective at identifying most low trauma fracture patients at risk of further fracture and providing access to osteoporosis assessment. There were many difficulties: we outline logistic and practical issues in delivering our service and suggest potential improvements.

  1. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail:; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)


    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  2. Sprains, Strains and Fractures (United States)

    ... the bone. Causes Injuries are the most common causes of foot and ankle sprains and fractures. Many fractures and sprains occur during ... or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures. Symptoms Pain, swelling, bruising, and difficulty ...

  3. Obesity and fracture risk


    Gonnelli, S; Caffarelli, C.; Nuti, R.


    Obesity and osteoporosis are two common diseases with an increasing prevalence and a high impact on morbidity and mortality. Obese women have always been considered protected against osteoporosis and osteoporotic fractures. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures.

  4. Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program. (United States)

    Dar, Shir; Lazer, Tal; Swanson, Sonja; Silverman, Jan; Wasser, Cindy; Moskovtsev, Sergey I; Sojecki, Agata; Librach, Clifford L


    What are the medical, psychosocial and legal aspects of gestational surrogacy (GS), including pregnancy outcomes and complications, in a large series? Meticulous multidisciplinary teamwork, involving medical, legal and psychosocial input for both the intended parent(s) (IP) and the gestational carrier (GC), is critical to achieve a successful GS program. Small case series have described pregnancy rates of 17-50% for GS. There are no large case series and the medical, legal and psychological aspects of GS have not been addressed in most of these studies. To our knowledge, this is the largest reported GS case series. A retrospective cohort study was performed. Data were collected from 333 consecutive GC cycles between 1998 and 2012. There were 178 pregnancies achieved out of 333 stimulation cycles, including fresh and frozen transfers. The indications for a GC were divided into two groups. Those who have 'failed to carry', included women with recurrent implantation failure (RIF), recurrent pregnancy loss (RPL) and previous poor pregnancy outcome (n = 96; 132 cycles, pregnancy rate 50.0%). The second group consisted of those who 'cannot carry' including those with severe Asherman's syndrome, uterine malformations/uterine agenesis and maternal medical diseases (n = 108, 139 cycles, pregnancy rate 54.0%). A third group, of same-sex male couples and single men, were analyzed separately (n = 52, 62 cycles, pregnancy rate 59.7%). In 49.2% of cycles, autologous oocytes were used and 50.8% of cycles involved donor oocytes. The 'failed to carry' group consisted of 96 patients who underwent 132 cycles at a mean age of 40.3 years. There were 66 pregnancies (50.0%) with 17 miscarriages (25.8%) and 46 confirmed births (34.8%). The 'cannot carry pregnancy' group consisted of 108 patients who underwent 139 cycles at a mean age of 35.9 years. There were 75 pregnancies (54.0%) with 15 miscarriages (20.0%) and 56 confirmed births (40.3%). The pregnancy, miscarriage and live birth

  5. Heavy-Section Steel Technology Program. Semiannual progress report, October 1991--March 1992: Volume 9, No. 1

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W E [Oak Ridge National Lab., TN (United States)


    The Heavy-Section Steel Technology (HSST) Program is conducted for the Nuclear Regulatory Commission (NRC) by Oak Ridge National Laboratory (ORNL). The program focus is on the development and validation of technology for the assessment of fracture-prevention margins in commercial nuclear reactor pressure vessels. The HSST Program is organized in 11 tasks: program management, fracture methodology and analysis, material characterization and properties, special technical assistance, fracture analysis computer programs, cleavage-crack initiation, cladding evaluations, pressurized-thermal-shock technology, analysis methods validation, fracture evaluation tests, and warm prestressing. The program tasks have been structured to place emphasis on the resolution fracture issues with near-term licensing significance. Resources to execute the research tasks are drawn from ORNL with subcontract support from universities and other research laboratories. Close contact is maintained with the sister Heavy-Section Steel Irradiation (HSSI) Program at ORNL and with related research programs both in the United States and abroad. This report provides an overview of principal developments in each of the II program tasks from October 1, 1991 to March 31, 1992.

  6. Multifocal humeral fractures. (United States)

    Maresca, A; Pascarella, R; Bettuzzi, C; Amendola, L; Politano, R; Fantasia, R; Del Torto, M


    Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. 78 FR 31635 - Oil and Gas; Hydraulic Fracturing on Federal and Indian Lands (United States)


    ... (Subcommittee) of the Secretary of Energy Advisory Board to evaluate hydraulic fracturing issues. The... the Interior Bureau of Land Management 43 CFR Part 3160 Oil and Gas; Hydraulic Fracturing on Federal... [WO-300-L13100000.FJ0000] RIN 1004-AE26 Oil and Gas; Hydraulic Fracturing on Federal and Indian Lands...

  8. Stress fractures in runners. (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T


    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

  9. [Fractures of the patella]. (United States)

    Wild, M; Windolf, J; Flohé, S


    Fractures of the patella account for approximately 0.5% to 1.5% of all skeletal injuries. The diagnosis is made by means of the mechanism of injury, physical and radiological findings. The kind of treatment of patella fractures depends on the type of fracture, the size of the fragments, the integrity of the extensor mechanism and the congruity of the articular surface. Independent of the kind of treatment an early rehabilitation is recommended. Modified tension band wiring is the most commonly used surgical treatment for patella fractures and can be used for almost every type of fracture. Due the superior stability in biomechanical studies two parallel cannulated lag screws combined with a tension band wiring are the treatment of choice for horizontally displaced two-part fractures. In comminuted fractures a partial or total patellectomy may be necessary. However, since the loss of quadriceps muscle power and the poor outcome total patellectomy should be considered as a salvage procedure.

  10. Fracture in Soft Materials

    DEFF Research Database (Denmark)

    Hassager, Ole

    Fracture is a phenomenon that is generally associated with solids. A key element in fracture theory is the so-called weakest link idea that fracture initiates from the largest pre-existing material imperfection. However, recent work has demonstrated that fracture can also happen in liquids, where...... surface tension will act to suppress such imperfections. Therefore, the weakest link idea does not seem immediately applicable to fracture in liquids. This presentation will review fracture in liquids and argue that fracture in soft liquids is a material property independent of pre-existing imperfections....... The following questions then emerge: What is the material description needed to predict crack initiation, crack speed and crack shape in soft materials and liquids....

  11. Orbital fractures: a review

    Directory of Open Access Journals (Sweden)

    Jeffrey M Joseph


    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  12. Deformation, Fracture, and Fragmentation in Brittle Geologic Solids (United States)


    Deformation, Fracture, and Fragmentation in Brittle Geologic Solids by J. D. Clayton ARL-RP-299 September 2010 A...Proving Ground, MD 21005-5066 ARL-RP-299 September 2010 Deformation, Fracture, and Fragmentation in Brittle Geologic Solids J. D. Clayton...2010 4. TITLE AND SUBTITLE Deformation, Fracture, and Fragmentation in Brittle Geologic Solids 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

  13. A review on hydraulic fracturing of unconventional reservoir

    Directory of Open Access Journals (Sweden)

    Quanshu Li


    Full Text Available Hydraulic fracturing is widely accepted and applied to improve the gas recovery in unconventional reservoirs. Unconventional reservoirs to be addressed here are with very low permeability, complicated geological settings and in-situ stress field etc. All of these make the hydraulic fracturing process a challenging task. In order to effectively and economically recover gas from such reservoirs, the initiation and propagation of hydraulic fracturing in the heterogeneous fractured/porous media under such complicated conditions should be mastered. In this paper, some issues related to hydraulic fracturing have been reviewed, including the experimental study, field study and numerical simulation. Finally the existing problems that need to be solved on the subject of hydraulic fracturing have been proposed.

  14. Pediatric Distal Radius Fractures. (United States)

    Dua, Karan; Abzug, Joshua M; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O


    Distal radius fractures are the most common orthopaedic injury that occur in the pediatric population. The annual incidence of distal radius fractures has increased as a result of earlier participation in sporting activities, increased body mass index, and decreased bone mineral density. Most distal radius fractures are sustained after a fall onto an outstretched arm that results in axial compression on the extremity or from direct trauma to the extremity. Physeal fractures of the distal radius are described based on the Salter-Harris classification system. Extraphyseal fractures of the distal radius are described as incomplete or complete based on the amount of cortical involvement. A thorough physical examination of the upper extremity is necessary to rule out any associated injuries. PA and lateral radiographs of the wrist usually are sufficient to diagnose a distal radius fracture. The management of distal radius fractures is based on several factors, including patient age, fracture pattern, and the amount of growth remaining. Nonsurgical management is the most common treatment option for patients who have distal radius fractures because marked potential for remodeling exists. If substantial angulation or displacement is present, closed reduction maneuvers with or without percutaneous pinning should be performed. Patients with physeal fractures of the distal radius that may result in malunion who present more than 10 days postinjury should not undergo manipulation of any kind because of the increased risk for physeal arrest.

  15. Odontoid Fracture: Computed Tomography

    Directory of Open Access Journals (Sweden)

    Jonathan Peña


    Full Text Available History of present illness: An 84-year-old male presented with left-sided posterior head, neck, and back pain after a ground level fall. Exam was notable for left parietal scalp laceration and midline cervical spine tenderness with no obvious deformities. He was neurovascularly intact, and placed in an Aspen Collar with strict spine precautions. Significant findings: Computed Tomography (CT of the cervical spine showed a stable, acute, non-displaced fracture of the odontoid process extending into the body of C2, consistent with a Type III Odontoid Fracture. He was evaluated by orthopedic spine service who recommended conservative, non-operative management. Discussion: The cervical spine is composed of seven vertebrae, with C1 and C2 commonly referred to as the Atlas and Axis, respectively. Unique to C2 is a bony prominence, the Odontoid Process (Dens. Hyperextension or hyperflexion injuries can induce significant stress causing fractures. Odontoid fractures comprise approximately 10% of vertebral fractures, and there are three types with varying stability.1 Type 1 is the rarest and is a fracture involving the superior segment of the Dens. It is considered a stable fracture. Type 2 is the most common and is a fracture involving the base of the odontoid process, below the transverse component of the cruciform ligament. This fracture is unstable and requires operative stabilization. 2 Type 3 odontoid fractures are classified by a fracture of the Odontoid process, as well as the lateral masses of the C2. Determining the stability of a Type III Odontoid fracture requires radiographic evaluation. Strict cervical spine precautions must be adhered to until adequate imaging and surgical consultation is obtained. CT of the of cervical spine fractures poses several advantages to plain film radiography due to the ability to view the anatomy in three planes. 3 However, if there is concern for ligamentous injury, MRI is the preferred modality.3

  16. Investigating the effect of fractures on unusual gas emission in coal mines; case study of Parvadeh coal mine, Iran

    Directory of Open Access Journals (Sweden)

    Ehsan Farahbakhsh


    Full Text Available In the present study, an investigation was carried out on Parvadeh coal mine in Tabas, Iran, to survey the effect of fractures on unusual methane gas emission in coal mines. This coal mine was chosen for investigating because of its high methane gas content in the coal body and available data from sensors in desired locations. Gas concentration monitoring programs were carried out at the mine site and a large amount of data were collected and analyzed. It is revealed that there is a good correlation between excavating fracture-bearing faces and high methane gas emission events at the mine site. High gas emissions have been observed before, during, or after excavating fracture-bearing faces. When gas content is high and all boundary conditions are met, rockbursts, faults movement and also mining activities can trigger unusual gas emission, and sometimes the gas gushes are violent enough to fit into the category of gas outbursts. Since the fracture generation is happening before the increase of gas concentration in the air, a sensitive and highly accurate microseismic monitoring system can be used to detect locations of rock fracturing, thus provide an effective means to issue warnings of high gas emission in the working area.

  17. Results of ASTM round robin testing for mode 1 interlaminar fracture toughness of composite materials (United States)

    Obrien, T. Kevin; Martin, Roderick H.


    The results are summarized of several interlaboratory 'round robin' test programs for measuring the mode 1 interlaminar fracture toughness of advanced fiber reinforced composite materials. Double Cantilever Beam (DCB) tests were conducted by participants in ASTM committee D30 on High Modulus Fibers and their Composites and by representatives of the European Group on Fracture (EGF) and the Japanese Industrial Standards Group (JIS). DCB tests were performed on three AS4 carbon fiber reinforced composite materials: AS4/3501-6 with a brittle epoxy matrix; AS4/BP907 with a tough epoxy matrix; and AS4/PEEK with a tough thermoplastic matrix. Difficulties encountered in manufacturing panels, as well as conducting the tests are discussed. Critical issues that developed during the course of the testing are highlighted. Results of the round robin testing used to determine the precision of the ASTM DCB test standard are summarized.

  18. Redevelopment of the Arctic Area of Russia as an Objective of Systems Research and Special-Purpose Program Management Methodological Issues

    Directory of Open Access Journals (Sweden)

    Vladimir Nikolayevich Leksin


    Full Text Available The paper substantiates the methodological foundations of implementation of the rules and regulations of the development of the Arctic region of Russia, which relies on the hypothesis interpreting such development as the biggest integrated megaproject in the history of Russia. The substantiation involves both the project-oriented approach to identify the subject-matter of the research and the systems approach to assess the key opportunities of providing the integrative structure of the megaproject in the conditions of drastic differences between the areal components of the Arctic region, and to study the internal and external factors’ impact on the character, drivers and pace of the region redevelopment. The set of consistent methodological positions concerning their policy implementation by responsible governmental agencies in the foreseeable future of the Arctic is developed. The most important position involves the identification of the objective of the public administration of the Arctic region development as a systemically organized entity of multiple coordinated actions of the federal, regional and municipal authorities, corporations and civil society institutions integrated by the unique policy target and economic, social and infrastructure links. Implementation of the public administration requires the principles of systems approach, the reasonable trade-off between centralization, decentralization and continuity of governance focused exclusively on the Arctic issues. At the same time, the integration of the projects of the region’s areal components development to insure the common targets of the Arctic’s megaproject accompanied by the reconsideration of the earlier developed programs turns into a genuinely new methodological issue. In the article, recommendations to provide such integration are introduced.

  19. Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis

    Directory of Open Access Journals (Sweden)

    Henderson Joanna


    Full Text Available Abstract Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. Methods In a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system. Results On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. Conclusions As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations

  20. Humerus shaft fractures - where are we today? (United States)

    Strohm, P C; Reising, K; Hammer, T; Sudkamp, N P; Jaeger, M; Schmal, H


    Humeral shaft fractures account for about 1-3% of all fractures. These fractures are regarded as the domain of non-surgical management. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. In particular, a new generation of nails that general permit immediate mobilization have become available for improved management of longitudinal and multi-segmental fractures. Retrograde and antegrade nails have advantages and disadvantages and selection procedure is often based on the distal or proximal location of the fracture. Plates also offer an alternative for certain indications and have advantages at the proximal and distal shaft in particular. If there is primary lesion of the radial nerve, exploration is not very advisable, but in the absence of remission exploration can be conducted after several months with the same degree of success. Since the published literature offers no comparative studies with a high level of evidence, our statement can only be regarded as an up-to-date recommendation in the hope that future prospective randomized studies will address this issue.

  1. FMG, RENUM, LINEL, ELLFMG, ELLP and DIMES: Chain of programs for calculating and analyzing fluid flow through two-dimensional fracture networks: Users manuals and listings

    Energy Technology Data Exchange (ETDEWEB)

    Billaux, D.; Peterson, J.; Bodea, S.; Long, J.


    The purpose of this report is to provide the user with sufficient information to run the programs FMG, RENUM, LINEL, and ELLFMG. A previous report explained the theory and the design of these programs, so that by using the two reports, a thorough understanding of the codes is possible. This report should familiarize the user with program options and modes of operation, input variables, input and output files. Information not strictly needed to run the programs, but useful in understanding their internal structure is provided in appendices. The appendices cover program variables and arrays, subroutine outlines, a short description of each subroutine, and finally listings of codes. The additional information on FMG, RENUM, LINEL, and ELLFMG is in Appendices A, C, E, G respectively, and the listings are in Appendices B, D, F, and H.

  2. -Lesser known stress fractures-. (United States)

    Wybier, M; Hamze, B; Champsaur, P; Parlier, C


    Stress fractures of the tibia may disclose a longitudinal orientation which is obvious at bone scanning; a mild periostosis may appear on plain films; CT demonstrates a radially-oriented fracture in one aspect of the diaphyseal cortex. A cortical dissection-like vertically oriented insufficiency fracture may involve the medial aspect of the femoral shaft underlying the lesser trochanter; the fracture is concentric to the femoral cortex at CT. Insufficiency fractures of the sacrum may be misdiagnosed on plain films; bone scanning displays a typical H-shaped increased uptake which is a specific pattern. Insufficiency fractures of the pubis may appear as tumoral bone destruction; however no soft tissue mass is present at CT which in addition demonstrates normal fat tissue abutting the osseous lesion.

  3. Discrete Fracture Network Characterization of Fractured Shale Reservoirs with Implications to Hydraulic Fracturing Optimization (United States)

    Jin, G.


    Shales are important petroleum source rocks and reservoir seals. Recent developments in hydraulic fracturing technology have facilitated high gas production rates from shale and have had a strong impact on the U.S. gas supply and markets. Modeling of effective permeability for fractured shale reservoirs has been challenging because the presence of a fracture network significantly alters the reservoir hydrologic properties. Due to the frequent occurrence of fracture networks, it is of vital importance to characterize fracture networks and to investigate how these networks can be used to optimize the hydraulic fracturing. We have conducted basic research on 3-D fracture permeability characterization and compartmentization analyses for fractured shale formations, which takes the advantages of the discrete fracture networks (DFN). The DFN modeling is a stochastic modeling approach using the probabilistic density functions of fractures. Three common scenarios of DFN models have been studied for fracture permeability mapping using our previously proposed techniques. In DFN models with moderately to highly concentrated fractures, there exists a representative element volume (REV) for fracture permeability characterization, which indicates that the fractured reservoirs can be treated as anisotropic homogeneous media. Hydraulic fracturing will be most effective if the orientation of the hydraulic fracture is perpendicular to the mean direction of the fractures. A DFN model with randomized fracture orientations, on the other hand, lacks an REV for fracture characterization. Therefore, a fracture permeability tensor has to be computed from each element. Modeling of fracture interconnectivity indicates that there exists no preferred direction for hydraulic fracturing to be most effective oweing to the interconnected pathways of the fracture network. 3-D fracture permeability mapping has been applied to the Devonian Chattanooga Shale in Alabama and the results suggest that an

  4. Proximal humeral fractures


    Mauro, Craig S.


    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  5. Sphenotemporal buttress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Jend-Rossmann, I.


    A new fracture type visible of CT images of the base of the skull is described. In this fracture the sphenoidal connection to the zygomatic and temporal bone breaks off all its three extensions. It was recognized in five patients with severe head injuries. In three surviving patients it was associated with ipsilateral persistent amaurosis. This fracture should alert the investigator to the possible sequelae of the head injury.

  6. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe


    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  7. Hip fracture after hemiplegia. (United States)

    Mulley, G.; Espley, A. J.


    In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke. Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb. PMID:471862

  8. [Fractures of the midfoot]. (United States)

    Boack, D H


    The immediate reduction of luxations and severe dislocations is necessary to protect the soft tissue. The soft tissue lesions determine the timing and partially the options of the operative treatment too. The conventional standard X-rays are sufficient to classify most of the fractures. Conservative treatment or minimal-invasive intramedullary techniques of fixation are sufficient in the treatment in most of the fractures. Screw- and plate-osteosynthesis are a good choice only in intra-articular fractures or sometimes in fractures of the first or fifth metatarsals. The clinical outcome is almost good and the rate of complications is low.

  9. Pathological fractures in children (United States)

    De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.


    Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

  10. Treatment of forearm fractures

    National Research Council Canada - National Science Library

    Macintyre, N R; Ilyas, A M; Jupiter, J B


    Fractures of the forearm represent common injuries. Understanding the anatomy and function of the radius, ulna, interosseous membrane, proximal and distal radioulnar joints is critical to appropriate management...

  11. Pediatric Scaphoid Fractures. (United States)

    Ting, Beverlie; Sesko Bauer, Andrea; Abzug, Joshua M; Cornwall, Roger; Wyrick, Theresa O; Bae, Donald S


    Scaphoid fractures are the most common type of carpal injuries that occur in children and adolescents. The injury pattern seen in children and adolescents who have scaphoid fractures has recently shifted to resemble that of adults who have scaphoid fractures, with scaphoid waist fractures being the most common injury pattern. This shift has been attributed to increased body mass index in children and adolescents as well as more intense participation in extreme sports by both children and adolescents. The diagnosis of scaphoid fractures is based on both a clinical examination and radiographic fi ndings. If a scaphoid fracture is clinically suspected but initial radiographs are negative, cast immobilization followed by repeat imaging can lead to accurate diagnosis of the injury. MRI can aid in the diagnosis of a scaphoid injury in pediatric patients with incomplete ossifi cation of the scaphoid. Acute nondisplaced scaphoid fractures have a high rate of healing with cast immobilization; however, surgery should be considered in patients who have displaced scaphoid fractures with delayed presentation. In general, patients with scaphoid fractures who undergo appropriate treatment and achieve successful union have excellent long-term functional outcomes.

  12. Transport of Particle Swarms Through Fractures (United States)

    Boomsma, E.; Pyrak-Nolte, L. J.


    slows the swarm, and a cohesive force that prevents swarm expansion and the corresponding decrease in particle density. For apertures >15mm, though the drag force is small, the loss of swarm cohesion dominates. In small apertures (swarm velocities was not observed. For the funnel shaped aperture, the swarm was observed to bifurcate immediately upon reaching the intersection between the converging aperture and the uniform aperture portions of the fracture. Furthermore, converging apertures resulted in the deceleration of a swarm. Thus, the rate of transport of particle swarms is strongly affected by fracture aperture. Acknowledgment: The authors wish to acknowledge support of this work by the Geosciences Research Program, Office of Basic Energy Sciences US Department of Energy (DE-FG02-09ER16022).

  13. Fracture of the styloid process associated with the mandible fracture

    Directory of Open Access Journals (Sweden)

    K N Dubey


    Full Text Available Fracture of the styloid process (SP of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  14. Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-2022: Part 1: Framework of Water-Quality Issues and Potential Approaches (United States)

    Rowe, Gary L.; Belitz, Kenneth; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lynch, Dennis D.; Munn, Mark D.; Wolock, David W.


    In 1991, the U.S. Congress established the U.S. Geological Survey (USGS) National Water-Quality Assessment (NAWQA) Program to develop long-term, nationally consistent information on the quality of the Nation's streams and groundwater. Congress recognized the critical need for this information to support scientifically sound management, regulatory, and policy decisions concerning the increasingly stressed water resources of the Nation. The long-term goals of NAWQA are to: (1) assess the status of water-quality conditions in the United States, (2) evaluate long-term trends in water-quality conditions, and (3) link status and trends with an understanding of the natural and human factors that affect water quality. These goals are national in scale, include both surface water and groundwater, and include consideration of water quality in relation to both human uses and aquatic ecosystems. Since 1991, NAWQA assessments and findings have fostered and supported major improvements in the availability and use of unbiased scientific information for decisionmaking, resource management, and planning at all levels of government. These improvements have enabled agencies and stakeholders to cost-effectively address a wide range of water-quality issues related to natural and human influences on the quality of water and potential effects on aquatic ecosystems and human health ( NAWQA, like all USGS programs, provides policy relevant information that serves as a scientific basis for decisionmaking related to resource management, protection, and restoration. The information is freely available to all levels of government, nongovernmental organizations, industry, academia, and the public, and is readily accessible on the NAWQA Web site and other diverse formats to serve the needs of the water-resource community at different technical levels. Water-quality conditions in streams and groundwater are described in more than 1,700 publications (available

  15. Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Sherburn Margaret


    Full Text Available Abstract Background This randomised, single-blind controlled pilot trial aimed to determine the effectiveness of a physiotherapy program, including exercise and manual therapy, in reducing impairments and improving physical function and health-related quality of life in people with a history of painful osteoporotic vertebral fracture. Methods 20 participants were randomly allocated to an intervention (n = 11 or control (n = 9 group. The intervention group attended individual sessions with an experienced clinician once a week for 10 weeks and performed daily home exercises with adherence monitored by a self-report diary. The control group received no treatment. Blinded assessment was conducted at baseline and 11 weeks. Questionnaires assessed self-reported changes in back pain, physical function, and health-related quality of life. Objective measures of thoracic kyphosis, back and shoulder muscle endurance (Timed Loaded Standing Test, and function (Timed Up and Go test were also taken. Results Compared with the control group, the intervention group showed significant reductions in pain during movement (mean difference (95% CI -1.8 (-3.5 to -0.1 and at rest (-2.0 (-3.8 to -0.2 and significantly greater improvements in Qualeffo physical function (-4.8 (-9.2 to -0.5 and the Timed Loaded Standing test (46.7 (16.1 to 77.3 secs. For the perceived change in back pain over the 10 weeks, 9/11 (82% participants in the intervention group rated their pain as 'much better' compared with only 1/9 (11% participants in the control group. Conclusion Despite the modest sample size, these results support the benefits of exercise and manual therapy in the clinical management of patients with osteoporotic vertebral fractures, but need to be confirmed in a larger sample. Trail registration NCT00638768

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative Issues Regulatory Issues Regulatory Issues Regulatory Issues EHR Incentive Program Global Codes and Data Collection New Medicare Card Project Medicare Enrollment and Participation ...

  17. Heavy-section steel technology program. Semiannual progress report, October 1994--March 1995

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.E.


    The Heavy-Section Steel Technology (HSST) Program is conducted for the Nuclear Regulatory Commission (NRC) by Oak Ridge National Laboratory (ORNL). The program focus is on the development and validation of technology for the assessment of fracture-prevention margins in commercial nuclear reactor pressure vessels. The HSST Program is organized in seven tasks: (1) program management (2) constraint effects analytical development and validation, (3) evaluation of cladding effects, (4) ductile-to-cleavage fracture-mode conversion, (5) fracture analysis methods development and applications, (6) material property data and test methods, and (7) integration of results. The program tasks have been structured to place emphasis on the resolution of fracture issues with near-term licensing significance. Resources to execute the research tasks are drawn from ORNL with subcontract support from universities and other research laboratories. Close contact is maintained with the sister Heavy-Section Steel Irradiation Program at ORNL and with related research programs both in the United States and abroad. This report provides an overview of principal developments in each of the seven program tasks from October 1994-March 1995.

  18. Hip Fractures among Older Adults (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  19. Compression fractures of the back (United States)

    ... most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss. Alternative Names Vertebral compression fractures Images Compression fracture References Cosman F, de Beur ...

  20. The Process of Hydraulic Fracturing (United States)

    Hydraulic fracturing, know as fracking or hydrofracking, produces fractures in a rock formation by pumping fluids (water, proppant, and chemical additives) at high pressure down a wellbore. These fractures stimulate the flow of natural gas or oil.

  1. Stress Fracture and Nonunion of Coronoid Process in a Gymnast

    Directory of Open Access Journals (Sweden)

    T. Hetling


    Full Text Available Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

  2. Experimental investigation of heat transport through single synthetic fractures (United States)

    Pastore, Nicola; Cherubini, Claudia; Giasi, Concetta I.; Redondo, Jose M.


    In fractured geothermal reservoirs, heat transport is highly influenced by the presence of the fractures, so appropriate knowledge of heat behaviour in fractured porous media is essential for accurate prediction of the energy extraction in geothermal reservoirs. The present study focuses on the study of heat transport within single synthetic fractures. In particular manner several tests have been carried out in order to explore the role of fracture roughness, aperture variability and the fracture-matrix ratio on the heat transport dynamics. The Synfrac program together with a 3d printer have been used to build several fracture planes having different geometrical characteristics that have been moulded to generate concrete porous fractured blocks. The tests regard the observation of the thermal breakthrough curves obtained through a continuous flow injection in correspondence of eight thermocouples located uniformly on the fractured blocks. The physical model developed permits to reproduce and understand adequately some features of heat transport dynamics in fractured media. The results give emphasis on the errors of the assumptions commonly used in heat transport modelling.

  3. Particle Swarm Transport in Fracture Networks (United States)

    Pyrak-Nolte, L. J.; Mackin, T.; Boomsma, E.


    intersections were larger in width than the individual fractures, enabling the swarm to expand freely because of less confinement from the fracture walls. When swarms were released in a fracture network supporting an ambient flow rate, the ability to transport cohesive swarms through the fracture network was a function of the flow rate and swarm volume. For low ambient flow rates ( 4 μl/min, large swarms (30 μl) remained cohesive (i.e. low loss of particles) as swarms were driven through the network both in the direction of and opposite to the direction of gravity. These experiments demonstrate conditions under which colloidal-size contaminants can be driven through a fracture network. High-speed transport of cohesive swarms depends on the volume of the swarm and the ambient flow rates that provide a balance of forces that prevents significant loss of particle from the swarm or deposition of particles along the flow path. Swarms that are transported cohesively travel along a highly localized path through a fracture network. Acknowledgment: The authors wish to acknowledge support of this work by the Geosciences Research Program, Office of Basic Energy Sciences US Department of Energy (DE-FG02-09ER16022) and NSF REU program in the Physics Department at Purdue University.

  4. Post-discharge management following hip fracture - get you back to B4: A parallel group, randomized controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Brown Roy A


    Full Text Available Abstract Background Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence to improve outcomes. Methods/Design This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture. We will enrol 130 older adults (65 years+ who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service. Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility

  5. El tratamiento de las fracturas de columna: un estudio de caso ciencia- tecnología- sociedad Treatment of vertebral column fractures: a study on this science-technology-society issue

    Directory of Open Access Journals (Sweden)

    Marco Antonio Moras Hernández


    fractures as a health problem and the consequent historical evolution of orthopedic surgery to facilitate a bigger understanding of the investigation project will be analyzed. Finally, a deep analysis on the conditions that has determined the social necessity of this project in Cuba and specifically in Camagüey

  6. Exercise and fractures in postmenopausal women: 12-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). (United States)

    Kemmler, W; von Stengel, S; Bebenek, M; Engelke, K; Hentschke, C; Kalender, W A


    This trial is the first exercise study that focuses on fracture incidence as a primary study endpoint. Although we marginally failed to determine significant effects on "overall" fracture risk (p = .074) or rate ratio (p = .095), our findings further increased the evidence that exercise relevantly prevents fractures in the elderly. The purpose of this study is to determine the effect of strictly supervised long-term exercise training on "overall" fracture incidence and bone mineral density (BMD) in postmenopausal osteopenic women. Eighty-five early postmenopausal (1-8 years), osteopenic women living in the area of Erlangen-Nuremberg, Germany without any medication or diseases affecting bone metabolism were assessed after 12 years of supervised exercise (EG) or unvarying lifestyle (control, CG). Exercisers were encouraged to perform two group sessions/week and two home training sessions/week. Calcium and vitamin D supplementation was provided for both groups. "Overall" fractures were determined by questionnaires and structured interviews. The BMD was assessed at lumbar spine and proximal femur by dual-energy X-ray absorptiometry. "Overall" fracture risk ratio in the EG was 0.32 (95% confidence interval (CI), 0.08 to 1.05; p = .074), and the rate ratio for "overall" fractures was 0.38 (95% CI, 0.11 to 1.15; p = .095). BMD changes at lumbar spine (EG, -0.8%; 95% CI, 0.8% to -2.7% vs. CG, -4.0%; 95% CI, -2.4% to -5.7%; p = .011) and femoral neck (EG, -3.7%; 95% CI, -2.4% to -5.0% vs. CG, -6.7%; 95% CI, -5.3% to -8.2%; p = .003) significantly differed between both groups. Although we marginally failed to determine significant effects on overall fracture risk or rate ratio, our study increased the body of evidence for the fracture prevention efficiency of exercise programs, with special regard on bone strength (as assessed by bone mineral density measurement). Future studies should focus on subjects more prone to fractures to generate enough

  7. Research on fracture analysis, groundwater flow and sorption processes in fractured rocks

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dae Ha [Korea Institute of Geology Mining and Materials, Taejon (Korea)


    Due to increasing demand for numerous industrial facilities including nuclear power plants and waste repositories, the feasibility of rocks masses as sites for the facilities has been a geological issue of concern. Rock masses, in general, comprises systems of fractures which can provide pathways for groundwater flow and may also affect the stability of engineered structures. such properties of fractures stimulate a synthetic study on (1) analyses of fracture systems, and (2) characterization of groundwater flow and sorption processes in fractured rocks to establish a preliminary model for assessing suitable sites for industrial facilities. The analyses of fracture systems cover (1) reconstruction of the Cenozoic tectonic movements and estimation of frequency indices for the Holocene tectonic movements, (2) determination of distributions and block movements of the Quaternary marine terraces, (3) investigation of lithologic and geotechnical nature of study area, and (4) examination of the Cenozoic volcanic activities and determination of age of the dike swarms. Using data obtained from above mentioned analyses along with data related to earthquakes and active faults, probabilistic approach is performed to determine various potential hazards which may result from the Quaternary or the Holocene tectonic movements. In addition, stepwise and careful integration of various data obtained from field works and laboratory experiments are carried out to analyze groundwater flow in fractures rocks as follows; (1) investigation of geological feature of the site, (2) identification and characterization of fracture systems using core and televiewer logs, (3) determination of conductive fractures using electrical conductivity, temperature, and flow logs, (4) identification of hydraulic connections between fractures using televiewer logs with tracer tests within specific zones. The results obtained from these processes allow a qualitative interpretation of groundwater flow patterns

  8. Displaced patella fractures. (United States)

    Della Rocca, Gregory J


    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)


    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...

  10. Atypical femoral fractures

    African Journals Online (AJOL)


    Jan 24, 2013 ... A 73 year-old female patient was admitted to the orthogeriatrics unit at Helen Joseph Hospital in 2012 with a fracture of her right femur, following a fall from standing height. She was known to have severe osteoporosis, having sustained multiple previous fragility fractures involving her right distal radius, left ...

  11. Fracture, failure, and fragmentation

    Energy Technology Data Exchange (ETDEWEB)

    Dienes, J.K.


    Though continuum descriptions of material behavior are useful for many kinds of problems, particularly those involving plastic flow, a more general approach is required when the failure is likely to involve growth and coalescence of a large number of fractures, as in fragmentation. Failures of this kind appear frequently in rapid dynamic processes such as those resulting from impacts and explosions, particularly in the formation of spall fragments. In the first part of this paper an approach to formulating constitutive relations that accounts for the opening, shear and growth of an ensemble of cracks is discussed. The approach also accounts for plastic flow accompanying fragmentation. The resulting constitutive relations have been incorporated into a Lagrangean computer program. In the second part of this paper a theoretical approach to coalescence is described. The simplest formulation makes use of a linear Liouville equation, with crack growth limited by the mean free path of cracks, assumed constant. This approach allows for an anisotropic distribution of cracks. An alternative approach is also described in which the decrease of the mean free path with increasing crack size is accounted for, but the crack distribution is assumed isotropic. A reduction of the governing Liouville equation to an ordinary differential equation of third order is possible, and the result can be used to determine how mean-free-path decreases with increasing crack size.

  12. Mandibular Condyle Fractures and Treatment Modalities

    Directory of Open Access Journals (Sweden)

    Halil ibrahim Kisa


    Full Text Available Maxillofacial injuries are most commonly associated with falls, motor and vehicle accidents, sports-related trauma, and interpersonel violence. The complexity of mandibular condyle region and its anatomic proximity to other craniofacial structures complicate diagnosis and treatment. Thus, treatment approaches of mandibular condyle fracture are still controversial. In the literature, different success rates are reported about observation versus treatment, closed reduction versus open reduction and fixation methods. In the present article, controversial issues related to mandibular condyle fractures were reviewed under the light of current literature. In conclusion, the simplest way that can be done with the least risk of complication should be chosen during treatment planning. In addition, current adjunctive treatment methods accelerating healing of fracture should be considered. [Archives Medical Review Journal 2014; 23(4.000: 658-671

  13. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N.J.; Somers, J.M. [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R. [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)


    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  14. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi


    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  15. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  16. Bone fractures after menopause. (United States)


    Every year 30% of individuals above age 65 fall, and falls are the principal cause of bone fractures. To reduce fracture incidence requires both prevention of falls and maintenance of bone strength. PubMed searches were performed, for studies of the epidemiology of fractures, bone physiology, endocrine effects, osteoporosis measurement, genetics, prevention and effectiveness. Topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion. Ageing reduces bone strength in post-menopausal women because estrogen deficiency causes accelerated bone resorption. Bone mineral density (BMD) decreased more than 2.5 standard deviation below the mean of healthy young adults defines osteoporosis, a condition associated with an increased risk of fractures. Risk factors such as age and previous fracture are combined with BMD for a more accurate prediction of fracture risk. The most widely used assessment tool is FRAX™ which combines clinical risk factors and femoral neck BMD. General preventive measures include physical exercise to reduce the risk of falling and vitamin D to facilitate calcium absorption. Pharmacological interventions consist mainly in the administration of inhibitors of bone resorption. Randomized controlled trials show treatment improves BMD, and may reduce the relative fracture risk by about 50% for vertebral, 20-25% for non-vertebral and up to 40% for hip fractures although the absolute risk reductions are much lower. Although diagnosis of osteoporosis is an important step, the threshold for treatment to prevent fractures depends on additional clinical risk factors. None of the presently available treatment options provide complete fracture prevention.

  17. Fracturing tests on reservoir rocks: Analysis of AE events and radial strain evolution

    CERN Document Server

    Pradhan, S; Fjær, E; Stenebråten, J; Lund, H K; Sønstebø, E F; Roy, S


    Fracturing in reservoir rocks is an important issue for the petroleum industry - as productivity can be enhanced by a controlled fracturing operation. Fracturing also has a big impact on CO2 storage, geothermal installation and gas production at and from the reservoir rocks. Therefore, understanding the fracturing behavior of different types of reservoir rocks is a basic need for planning field operations towards these activities. In our study, the fracturing of rock sample is monitored by Acoustic Emission (AE) and post-experiment Computer Tomography (CT) scans. The fracturing experiments have been performed on hollow cylinder cores of different rocks - sandstones and chalks. Our analysis show that the amplitudes and energies of acoustic events clearly indicate initiation and propagation of the main fractures. The amplitudes of AE events follow an exponential distribution while the energies follow a power law distribution. Time-evolution of the radial strain measured in the fracturing-test will later be comp...

  18. Femoral Neck Fracture

    Directory of Open Access Journals (Sweden)

    Jonathan Lee


    Full Text Available History of present illness: A 74-year-old male presented to the emergency department with left hip pain after falling off his bicycle. Pain is 3/10 in severity and exacerbated by movement. Patient denied head trauma. Exam showed left hip tenderness, 3/5 left lower extremity strength secondary to pain, and 5/5 right lower extremity strength. Sensation and pulses were intact in bilateral lower extremities. Left hip X-ray and pelvic CT revealed comminuted, impacted transcervical and subcapital fracture of the left femoral neck. Significant findings: In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left (red line when compared to the normal right (white line, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture (blue arrow and transcervical fracture (yellow arrow. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum. Discussion: Femoral neck fractures are one of the most common types of hip fractures, accounting for 49.4% of all hip fractures.1 Diagnosing a femoral neck fracture can be made with plain x-ray, CT, or MRI. Plain film radiographs have been found to be at least 90% sensitive for hip fractures CT’s have been found to be 87%-100% sensitive and 100% specific for occult hip fractures in which plain radiographs were read as negative, but the patient still complained of hip pain Although MRI is currently the gold standard for detecting occult hip fractures (sensitivity and specificity = 100%, given MRI’s limited accessibility in the ED as well as the high sensitivity and specificity of CT scans for occult hip fractures, it is generally recommended to obtain CT scans for patients with suspected occult hip fractures as a first-line investigation

  19. Fracture healing in HIV-positive populations. (United States)

    Richardson, J; Hill, A M; Johnston, C J C; McGregor, A; Norrish, A R; Eastwood, D; Lavy, C B D


    Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between HIV infection and poor fracture healing. The increased prevalence of osteoporosis and fragility fractures in HIV patients is well recognised. The suggestion that this may be purely as a result of highly active anti-retroviral therapy has been largely rejected. Apart from directly impeding cellular function in bone remodelling, HIV infection is known to cause derangement in the levels of those cytokines involved in fracture healing (particularly tumour necrosis factor-alpha) and appears to impair the blood supply of bone. Many other factors complicate this issue, including a reduced body mass index, suboptimal nutrition, the effects of anti-retroviral drugs and the avoidance of operative intervention because of high rates of wound infection. However, there are sound molecular and biochemical hypotheses for a direct relationship between HIV infection and impaired fracture healing, and the rewards for further knowledge in this area are extensive in terms of optimised fracture management, reduced patient morbidity and educated resource allocation. Further investigation in this area is overdue.

  20. Building Pipelines for Information: Developing Partnerships Between Scientists, Educators, and Community Groups to Learn More About Hydraulic Fracturing in Colorado (United States)

    Hafich, K. A.; Hannigan, M.; Martens, W.; McDonald, J. E.; Knight, D.; Gardiner, L. S.; Collier, A. M.; Fletcher, H.; Polmear, M.


    Hydraulic fracturing is a highly contentious issue, and trusted sources of information about the impacts and benefits are difficult to find. Scientific research is making strides to catch up with rapidly expanding unconventional oil and gas development, in part, to meet the need for information for policy, regulation, and public interest. A leader in hydraulic fracturing research, the AirWaterGas Sustainability Research Network is a multi-institution, multi-disciplinary team of researchers working to understand the environmental, economic, and social tradeoffs of oil and gas development. AirWaterGas recently restructured and implemented our education and outreach program around a partnership with the CU-Boulder Office for Outreach and Engagement that leverages existing campus infrastructure, networks, and expertise to disseminate research results and engage the public. The education and outreach team is working with formal and informal K-12 educators through several programs: a yearlong teacher professional development program, a rural classroom air quality monitoring program, and a community partnership grant program. Each program brings together scientists and educators in different environments such as the classroom, online learning, in-person workshops, and community lectures. We will present best practices for developing and implementing a viable outreach and education program through building and fostering mutually beneficial partnerships that bridge the gap between scientists and the public.


    Directory of Open Access Journals (Sweden)

    Stefan Karlsson


    Full Text Available Thermal strengthening of glass is common for many different purposes including architecture, automotive, glasses for solar energy, tableware and occasionally also containers. It is an easy and relatively cheap method to make glasses stronger, however, with an Achilles heel that it can spontaneously fracture without the slightest applied external force. Though, fracture due to applied external force is the most common case, spontaneous fracture is rare. The current paper reviews the literature of spontaneous fracture and NiS inclusions and what kind of mitigation measures that have been done in order to reduce the frequency of spontaneous fracture. Finally is also an outlook for the alternative mitigation measures and their advantages as well as disadvantages. A personal perspective is given in discussions and gives an outlook to the most promising alternative methods to reduce and hopefully eliminate the NiS inclusions. These include multi-functional methods where not only the NiS inclusion issue is solved.

  2. Spontaneous rib fractures. (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber


    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  3. Pediatric Supracondylar Fracture

    Directory of Open Access Journals (Sweden)

    Jonathan Peña


    Full Text Available History of present illness: A 7-year-old left-handed male presented with left arm pain and deformity after being tackled while playing. On exam, there appeared to be dorsal displacement of the distal segment of the upper extremity. He had two-plus radial and ulnar pulses, and normal capillary refill. Sensation was intact to axillary, radial, ulnar, and median nerve distributions. Compartments were soft. Significant findings: Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture. Discussion: Supracondylar fractures are the most common pediatric elbow fracture.1 Approximately 95% are due to a fall onto an outstretched hand while the elbow is in extension. Direct trauma to the posterior aspect of a flexed elbow accounts for the remainder.2 There are three classifications of supracondylar fractures: type 1 is non-displaced, type 2 is displaced, but has an intact posterior periosteum, and type 3 is displaced with disrupted anterior and posterior periostea. Careful examination assessing for pulses, perfusion, neurologic integrity, and elevated compartment pressures are important in the evaluation.3 The brachial artery is often injured in posterior lateral displaced fractures.4 Neurologic deficits to the median, ulnar, or radial nerves are seen in as many of 49% of Type 3 supracondylar fractures; however, neuropraxias often resolve within two to three months.5 Untimely treated compartment syndrome may lead to Volkmann ischemic contractors, which are characterized by flexion of the elbow, pronation of the forearm, flexion of the wrist, and extension of the metacarpal phalangeal joints.6 Plain film radiography oriented in the anterior-posterior (AP and lateral fashions are typically sufficient for diagnosis; however, a fracture may exist without overt signs on X-ray.7 Given the high morbidity associated with Type 3 fractures, emergent Orthopedic

  4. Mixed-Mode Fracture Behavior and Related Surface Topography Feature of a Typical Sandstone (United States)

    Ren, L.; Xie, L. Z.; Xie, H. P.; Ai, T.; He, B.


    The geo-mechanical properties of reservoirs, especially the morphology of the rock surface and the fracture properties of rocks, are of great importance in the modeling and simulation of hydraulic processes. To better understand these fundamental issues, five groups of mixed-mode fracture tests were conducted on sandstone using edge-cracked semi-circular bend specimens. Accordingly, the fracture loads, growth paths and fracture surfaces for different initial mixities of the mixed-mode loadings from pure mode I to pure mode II were then determined. A surface topography measurement for each rough fracture surface was conducted using a laser profilometer, and the fractal properties of these surfaces were then investigated. The fracture path evolution mechanism was also investigated via optical microscopy. Moreover, the mixed-mode fracture strength envelope and the crack propagation trajectories of sandstone were theoretically modeled using three widely accepted fracture criteria (i.e., the MTS, MSED and MERR criterions). The published test results in Hasanpour and Choupani (World Acad Sci Eng Tech 41:764-769, 2008) for limestone were also theoretically investigated to further examine the effectiveness of the above fracture criteria. However, none of these criteria could accurately predict the fracture envelopes of both sandstone and limestone. To better estimate the fracture strength of mixed-mode fractures, an empirical maximum tensile stress (EMTS) criterion was proposed and found to achieve good agreement with the test results. Finally, a uniformly pressurized fracture model was simulated for low pressurization rates using this criterion.

  5. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk


    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  6. Fracture eponyms: personal names

    Directory of Open Access Journals (Sweden)

    A. S. Zolotov


    Full Text Available The paper describes the origin of bone fracture eponyms. The authors compiled a list of 60 most established fracture names proposed by physicians in 16th-20th centuries who mainly were skilled, mature and outstanding experts from countries with advanced conventional medicine and often represented the recognized surgical schools. Eponym records are important for understanding the history and subject of the chosen profession as well as knowledge of eponymic fractures facilitates communication between physicians of allied disciplines.

  7. Studies of Transport Properties of Fractures: Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Stephen R. Brown


    We proposed to study several key factors controlling the character and evolution of fracture system permeability and transport processes. We suggest that due to surface roughness and the consequent channeling in single fractures and in fracture intersections, the tendency of a fracture system to plug up, remain permeable, or for permeability to increase due to chemical dissolution/precipitation conditions will depend strongly on the instantaneous flow channel geometry. This geometry will change as chemical interaction occurs, thus changing the permeability through time. To test this hypothesis and advance further understanding toward a predictive capability, we endeavored to physically model and analyze several configurations of flow and transport of inert and chemically active fluids through channels in single fractures and through fracture intersections. This was an integrated program utilizing quantitative observations of fractures and veins in drill core, quantitative and visual observations of flow and chemical dissolution and precipitation within replicas of real rough-walled fractures and fracture intersections, and numerical modeling via lattice Boltzmann methods.

  8. Research Article Special Issue

    African Journals Online (AJOL)



    Oct 17, 2017 ... (9). 2.1.5 Proposed Log-Normal Evolutionary Programming to solve ED Problem. Log-Normal EP (LNEP) is proposed to improve the Classical EP (CEP) to address the ED issues. The algorithm is presented in the form of flow chart as shown in Figure 2. The mutation process has been improved by applying ...

  9. Addressing Social Issues. (United States)

    Schoebel, Susan


    Maintains that advertising can help people become more aware of social responsibilities. Describes a successful nationwide newspaper advertising competition for college students in which ads address social issues such as literacy, drugs, teen suicide, and teen pregnancy. Notes how the ads have helped grassroots programs throughout the United…

  10. Advanced Hydraulic Fracturing Technology for Unconventional Tight Gas Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Stephen Holditch; A. Daniel Hill; D. Zhu


    issues in tight gas fracturing, in particular the roles of gel damage, polymer loading (water-frac versus gel frac), and proppant concentration on the created fracture conductivity. To achieve this objective, we have designed the experimental apparatus to conduct the dynamic fracture conductivity tests. The experimental apparatus has been built and some preliminary tests have been conducted to test the apparatus.

  11. Emergency management of hemodynamically unstable pelvic fractures

    Directory of Open Access Journals (Sweden)

    ZHAO Xiao-gang


    Full Text Available 【Abstract】Pelvic fractures are serious injuries. Death within 24 hours is most often a result of acute blood loss. The emergency management of these patients is challenging and controversial. The key issues in its management are identifying the site(s of hemorrhage and then controlling the bleeding. Management of hemodynamically unstable patients with pelvic fracture requires a multidisci- plinary team. The issues addressed in this management algorithm are diagnostic evaluation, damage control resuscitation, indications for noninvasive pelvic stabilization, preperitoneal pelvic packing and the critical decisions concerning surgical options and angiography. This review article focuses on the recent body of know- ledge on those determinations. Key words: Pelvis; Hemodynamic; Emergencies; Practice management

  12. Staff Report to the Senior Department Official on Recognition Compliance Issues. Recommendation Page: Council on Accreditation of Nurse Anesthesia Educational Programs (United States)

    US Department of Education, 2010


    The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accredits institutions and programs that prepare nurses to become practicing nurse anesthetists. Currently the agency accredits 105 programs located in 35 states, the District of Columbia and Puerto Rico, including three single purpose freestanding institutions. The…

  13. Many Eligible Children Don't Participate in School Nutrition Programs: Reauthorization Offers Opportunities to Improve. National Issue Brief Number 85 (United States)

    Carson, Jessica A.


    This brief uses data from the 2013 Current Population Survey's Food Security Supplement to document levels of participation in two of the largest programs authorized by the Healthy, Hunger-Free Kids Act of 2010--the National School Lunch Program and the School Breakfast Program--by region and place type (rural, suburban, and city), to identify…

  14. Heavy-section steel technology program: Semiannual progress report for April--September 1996. Volume 13, Number 2

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.E. [Oak Ridge National Lab., TN (United States)


    The Heavy-Section Steel Technology (HSST) Program is conducted for the US Nuclear Regulatory Commission (NRC) by the Oak Ridge National Laboratory (ORNL). The program focus is on the development and validation of technology for the assessment of fracture-prevention margins in commercial nuclear reactor pressure vessels. The HSST Program is organized in seven tasks: (1) program management, (2) constraint effects analytical development and validation, (3) evaluation of cladding effects, (4) ductile to cleavage fracture mode conversion, (5) fracture analysis methods development and applications, (6) material property data and test methods, and (7) integration of results into a state-of-the-art methodology. The program tasks have been structured to place emphasis on the resolution fracture issues with near-term licensing significance. Resources to execute the research tasks are drawn from ORNL with subcontract support from universities and other research laboratories. Close contact is maintained with the sister Heavy-Section Steel irradiation Program at ORNL and with related research programs both in the US and abroad. This report provides an overview of principal developments in each of the seven program tasks from April 1996--September 1996.

  15. Heavy-section steel technology program. Semiannual progress report, April--September 1995 Vol. 12, No. 2

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.E.


    The Heavy-Section Steel Technology (HSST) Program is conducted for the Nuclear Regulatory Commission by Oak Ridge National Laboratory (ORNL). The program focus is on the development and validation of technology for the assessment of fracture-prevention margins in commercial nuclear reactor pressure vessels. The HSST Program is organized in seven tasks: (1) program management, (2) constraint effects analytical development and validation, (3) evaluation of cladding effects, (4) ductile-to-cleavage fracture-mode conversion, (5) fracture analysis methods development and applications, (6) material property data and test methods, and (7) integration of results. The program tasks have been structured to place emphasis on the resolution of fracture issues with near-term licensing significance. Resources to execute the research tasks are drawn from ORNL with subcontract support from universities and other research laboratories. Close contact is maintained with the sister Heavy-Section Steel Irradiation Program at ORNL and with related research programs both in the United States and abroad. This report provides an overview of principal developments in each of the seven program tasks from April 1995 to September 1995.

  16. Heavy-section steel technology program: Semiannual progress report, October 1993--March 1994. Volume 11, No. 1

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.E. [Oak Ridge National Lab., TN (United States)


    The Heavy-Section Steel Technology (HSST) Program is conducted for the US Nuclear Regulatory Commission (NRC) by Oak Ridge National Laboratory (ORNL). The Program focus is on the development and validation of technology for the assessment Of fracture-prevention margins in commercial nuclear reactor pressure vessels. The HSST Program is organized in seven tasks: (1) program management (2) constraint effects analytical development and validation, (3) evaluation of cladding effects, (4) ductile to cleavage fracture mode conversion, (5) fracture analysis methods development and applications, (6) material Property data and test methods, and (7) integration of results into a state-of-the-art methodology. The program tasks have been structured to place emphasis on the resolution fracture issues with near-term licensing significance. Resources to execute the research tasks are drawn from ORNL with subcontract support from universities and other research laboratories. Close contact is maintained with the sister Heavy-Section Steel Irradiation Program at ORNL and with related research programs both in the United States and abroad. This report provides an overview of principal developments in each of the seven program tasks from October 1993--March 1994.

  17. Exploring pain management in older people with hip fracture. (United States)

    Layzell, Mandy

    Pain following a fractured neck of femur can be severe; in addition patients often have underlying medical problems. This article examines the problems associated with good pain control for older patients following fractured neck of femur. It introduces a Changing Practice article, due to be published in next week's issue, which outlines the development of a nurse-led service to provide preoperative femoral nerve blocks.

  18. Use of Oral Corticosteroids and Risk of Hip Fracture in the Elderly in a Case-Control Study

    Directory of Open Access Journals (Sweden)

    Shih-Wei Lai


    Full Text Available Aim: Little is known regarding the relationship between use of oral corticosteroids and hip fracture in the elderly in Taiwan. The aim of the study was to examine this issue.Methods: A retrospective population-based case-control study using the database of the Taiwan National Health Insurance Program (2000–2013 was conducted. We identified 4538 individuals aged ≥ 65 years with newly diagnosed hip fracture as the cases. We randomly selected 4538 individuals without hip fracture as the control subjects. The cases and the control subjects were matched with sex, age, comorbidities, and the year of index date. Individuals who never had a prescription for oral corticosteroids were defined as never use. Individuals who ever had at least one prescription for oral corticosteroids were defined as ever use. The odds ratio (OR and 95% confidence interval (CI of hip fracture associated with oral corticosteroids use was estimated by a multivariable unconditional logistic regression analysis.Results: After adjustments for potential confounding factors, the multivariable logistic regression model showed that the adjusted OR of hip fracture was 1.17 for individuals with ever use of oral corticosteroids (95%CI 1.08, 1.28, compared to those with never use of oral corticosteroids. An sub-analysis showed that for every 1-mg increase in cumulative dose of oral corticosteroids, the adjusted OR of hip fracture was 1.01 (95% CI 1.01, 1.02. The adjusted ORs were 1.31 (95% CI 1.17, 1.47 for cumulative exposure to oral corticosteroids ≥ 3 months and 1.09 (95% CI 0.98, 1.20 for cumulative exposure < 3 months.Conclusion: We conclude that oral corticosteroids use is associated with a trivial but statistically significant increase in risk of hip fracture in Taiwan. Additionally, the results suggest that there are dose-response and duration-response effects of oral corticosteroids on the risk of hip fracture. The results confirm our understanding of oral corticosteroid

  19. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    The overall purpose of the present PhD thesis was to provide up-to-date information of the epidemiology of tibial shaft fractures and to investigate the development in quality of life, pain and functional outcomes from surgery and onwards, following a tibial shaft fracture treated...... with intramedullary nailing. Study I reported an incidence of 16.9/100,000/year from a complete population. Study II reported the long-term patient-reported outcomes and showed that approximately 8 years after the fracture patients reported significantly worse outcome for 4 of the 5 KOOS subscales compared...... suggested that regaining pre injured QOL and muscle strength following a tibial shaft fracture takes considerable time....

  20. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria


    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  1. Clavicle Fracture (Broken Collarbone) (United States)

    ... birth canal. Symptoms Clavicle fractures can be very painful and may make it hard to move your arm. Additional symptoms include: • Sagging shoulder (down and forward) • Inability to li the arm ...

  2. Radial head fracture - aftercare (United States)

    ... begin using your elbow. You may need physical therapy if you have a severe fracture. Your doctor or physical therapist will tell you when you can start playing sports or using your elbow for other activities.

  3. Geothermal Ultrasonic Fracture Imager

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, Doug [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States); Leggett, Jim [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States)


    The Geothermal Ultrasonic Fracture Imager project has a goal to develop a wireline ultrasonic imager that is capable of operating in temperatures up to 300°C (572°F) and depths up to 10 km (32,808 ft). This will address one of the critical needs in any EGS development of understanding the hydraulic flow paths in the reservoir. The ultrasonic imaging is well known in the oil and gas industry as one of the best methods for fracture evaluation; providing both high resolution and complete azimuthal coverage of the borehole. This enables fracture detection and characterization, both natural and induced, providing information as to their location, dip direction and dip magnitude. All of these factors are critical to fully understand the fracture system to enable the optimization of the thermal drainage through injectors and producers in a geothermal resource.


    Directory of Open Access Journals (Sweden)

    S. Saakyan


    Full Text Available Until present no data was available inArmeniain respect of incidence of low energy fractures that are typical of osteoporotic locations which consequently did not allow to evaluate the scope of this problem across the country.Purpose of the study – to identify the incidence of low energy fractures in proximal femur, in distal forearm, in proximal humerus and in distal tibia across population ofArmenia aged 50 years and older.Materials and methods. An observing population study was performed in two regions of Armenia during 2011-2013 where the frequency of selected locations in cases of moderate trauma was identified. During 2011-2012 the information was collected based on traumatology service records adding in 2013 other sources including primary level of healthcare due to observed infrequent applications for medical help in cases of trauma. Results. In 2013 the incidence of proximal femur fractures in men was reported as 136 cases per 100 000 of population aged 50 years and older, in women – 201 cases per 100 000. At the same time only 57.7% of patients with proximal femur fractures were admitted to hospital. Distal forearm fractures incidence in men and women was observed correspondingly 56/100 000 and 176/100 000 cases, proximal humerus fractures – 39/100 000 and 86/100 000 cases and distal tibia fractures – 39/100 000 and 86/100 000 cases. The predicted annual number of proximal femur fracture in Armenia amounts to 2067 cases, distal forearm fractures – 1205, proximal humerus fractures – 640.Conclusion. Epidemiological data that was collected for the first time on low energy fractures incidence confirmed the acute osteoporosis issue inArmenia and revealed the problems in organization of medical care for the group of senior patients with injuries.

  5. Relative permeability through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Diomampo, Gracel, P.


    The mechanism of two-phase flow through fractures is of importance in understanding many geologic processes. Currently, two-phase flow through fractures is still poorly understood. In this study, nitrogen-water experiments were done on both smooth and rough parallel plates to determine the governing flow mechanism for fractures and the appropriate methodology for data analysis. The experiments were done using a glass plate to allow visualization of flow. Digital video recording allowed instantaneous measurement of pressure, flow rate and saturation. Saturation was computed using image analysis techniques. The experiments showed that gas and liquid phases flow through fractures in nonuniform separate channels. The localized channels change with time as each phase path undergoes continues breaking and reforming due to invasion of the other phase. The stability of the phase paths is dependent on liquid and gas flow rate ratio. This mechanism holds true for over a range of saturation for both smooth and rough fractures. In imbibition for rough-walled fractures, another mechanism similar to wave-like flow in pipes was also observed. The data from the experiments were analyzed using Darcy's law and using the concept of friction factor and equivalent Reynold's number for two-phase flow. For both smooth- and rough-walled fractures a clear relationship between relative permeability and saturation was seen. The calculated relative permeability curves follow Corey-type behavior and can be modeled using Honarpour expressions. The sum of the relative permeabilities is not equal one, indicating phase interference. The equivalent homogeneous single-phase approach did not give satisfactory representation of flow through fractures. The graphs of experimentally derived friction factor with the modified Reynolds number do not reveal a distinctive linear relationship.

  6. Radial Head Fractures


    Jordan, Robert W.; Jones, Alistair DR.


    Background: Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries. Methods: A literature search was performed and the authors’ personal experiences are reported. Results: Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-arti...


    Energy Technology Data Exchange (ETDEWEB)

    Subhash Shah


    Hydraulic fracturing technology has been successfully applied for well stimulation of low and high permeability reservoirs for numerous years. Treatment optimization and improved economics have always been the key to the success and it is more so when the reservoirs under consideration are marginal. Fluids are widely used for the stimulation of wells. The Fracturing Fluid Characterization Facility (FFCF) has been established to provide the accurate prediction of the behavior of complex fracturing fluids under downhole conditions. The primary focus of the facility is to provide valuable insight into the various mechanisms that govern the flow of fracturing fluids and slurries through hydraulically created fractures. During the time between September 30, 1992, and March 31, 2000, the research efforts were devoted to the areas of fluid rheology, proppant transport, proppant flowback, dynamic fluid loss, perforation pressure losses, and frictional pressure losses. In this regard, a unique above-the-ground fracture simulator was designed and constructed at the FFCF, labeled ''The High Pressure Simulator'' (HPS). The FFCF is now available to industry for characterizing and understanding the behavior of complex fluid systems. To better reflect and encompass the broad spectrum of the petroleum industry, the FFCF now operates under a new name of ''The Well Construction Technology Center'' (WCTC). This report documents the summary of the activities performed during 1992-2000 at the FFCF.

  8. A Fracture Decoupling Experiment (United States)

    Stroujkova, A. F.; Bonner, J. L.; Leidig, M.; Ferris, A. N.; Kim, W.; Carnevale, M.; Rath, T.; Lewkowicz, J.


    Multiple observations made at the Semipalatinsk Test Site suggest that conducting nuclear tests in the fracture zones left by previous explosions results in decreased seismic amplitudes for the second nuclear tests (or "repeat shots"). Decreased seismic amplitudes reduce both the probability of detection and the seismically estimated yield of a "repeat shot". In order to define the physical mechanism responsible for the amplitude reduction and to quantify the degree of the amplitude reduction in fractured rocks, Weston Geophysical Corp., in collaboration with Columbia University's Lamont Doherty Earth Observatory, conducted a multi-phase Fracture Decoupling Experiment (FDE) in central New Hampshire. The FDE involved conducting explosions of various yields in the damage/fracture zones of previously detonated explosions. In order to quantify rock damage after the blasts we performed well logging and seismic cross-hole tomography studies of the source region. Significant seismic velocity reduction was observed around the source regions after the initial explosions. Seismic waves produced by the explosions were recorded at near-source and local seismic networks, as well as several regional stations throughout northern New England. Our analysis confirms frequency dependent seismic amplitude reduction for the repeat shots compared to the explosions in un-fractured rocks. The amplitude reduction is caused by pore closing and/or by frictional losses within the fractured media.

  9. Emotional Issues (United States)

    ... Daily Life Handling His Questions Related links The psychology of Duchenne Muscular Dystrophy (download) Connect Quick Links ... MD PPMD Merchandise Host an Event Create a Personal Page Sponsor Programs Other Ways to Help About ...

  10. Poromechanical response of naturally fractured sorbing media (United States)

    Kumar, Hemant

    The injection of CO2 in coal seams has been utilized for enhanced gas recovery and potential CO2 sequestration in unmineable coal seams. It is advantageous because as it enhances the production and significant volumes of CO2 may be stored simultaneously. The key issues for enhanced gas recovery and geologic sequestration of CO2 include (1) Injectivity prediction: The chemical and physical processes initiated by the injection of CO2 in the coal seam leads to permeability/porosity changes (2) Up scaling: Development of full scale coupled reservoir model which may predict the enhanced production, associated permeability changes and quantity of sequestered CO2. (3) Reservoir Stimulation: The coalbeds are often fractured and proppants are placed into the fractures to prevent the permeability reduction but the permeability evolution in such cases is poorly understood. These issues are largely governed by dynamic coupling of adsorption, fluid exchange, transport, water content, stress regime, fracture geometry and physiomechanical changes in coals which are triggered by CO 2 injection. The understanding of complex interactions in coal has been investigated through laboratory experiments and full reservoir scale models are developed to answer key issues. (Abstract shortened by ProQuest.).

  11. Plating of pilon fractures based on the orientation of the fibular shaft component: A biomechanical study evaluating plate stiffness in a cadaveric fracture model. (United States)

    Busel, Gennadiy A; Watson, J Tracy


    To evaluate mechanically superior method of pilon fracture fixation by comparing axial stiffness between anterolateral and medial tibial locking plates in a cadaveric fracture model. Eight matched pairs of fresh frozen cadaver specimens (lower limb after through-knee disarticulation) were used to eliminate confounder of bone quality. Simulated pilon fractures were created so that each pair represented either varus or valgus fracture pattern (AO 43-A2) with associated fibular fractures (transverse or comminuted). Specimens were plated with DePuy anterolateral or medial locking plate and axial load applied, measuring displacement at the fracture site. Each lower extremity was tested with a fracture wedge in place and removed to mimic comminution. Average force at which failure occurred was compared between the two fixation methods, for varus and valgus fracture pattern respectively, with the use of a Mann-Whitney U test. On average, medial plate fixation of varus fractures resulted in 2.27 times (range of 1.6-3.9) greater load prior to failure as compared to anterolateral plate. Similarly, valgus simulated fractures tolerated 1.6 times (range 1.12-2.34) higher force prior to failure if anterolateral plate was applied versus medial plate. Analysis utilizing the Mann-Whitney U test for fracture patterns vs plate configuration approached statistical significance (p = 0.081 varus failure and p = 0.386 valgus failure). Lateral plate fixation is biomechanically superior for pilon fractures resulting from valgus force as evident by comminuted fibular fracture. Similarly, medial plate location resulted in improved stiffness in compression for varus type fractures, evident by transverse fibular fracture. We approached statistical significance, however our lack of power regarding adequate sample size is an issue that is consistent with other biomechanical studies in this area.

  12. Simultaneous bilateral tibal tubercle avulsion: A rare fracture

    Directory of Open Access Journals (Sweden)

    Hasan Metineren


    Full Text Available Tibial tuberosity avulsion is a rare fracture in adolescence.Due to the shear forces on the immature epiphysis. Thirteenyears old girl was admitted to the emergency departmentwith knee pain and tenderness in both knees afterjumping from a height of about one meter. İn examinationshe had tenderness and swelling over both tibial tuberosities.The patient could not do active knee extension. TypeIIA fracture on the left and type IIIA fracture on the rightknee were detected. For the patient’s fractures, closedreduction and fixation with 3 smooth Kirschner wires wasperformed. After immobilization in long-leg brace for threeweeks the brace was removed and she include in therehabilitation program. In this report, we discuss similarcases in the literature and the results of the treatment appliedto our patient.Key words: Tuberositas tibia, avulsion fracture, percutaneouspinning

  13. Predictors of treatment preference for mandibular fracture. (United States)

    Der-Martirosian, Claudia; Gironda, Melanie W; Black, Edward E; Belin, Thomas R; Atchison, Kathryn A


    Patient treatment preferences do not necessarily remain stable over time. This study focuses on predictors of patient treatment choice and on the extent to which patients are willing to take risks by choosing surgical versus nonsurgical treatment for mandibular fracture. Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either a mandibular fracture (n = 98) or third-molar removal (n = 105) were used to investigate patterns of patient preference over the course of a 4-month study period using generalized estimating equations controlling for age, gender, income, and fracture versus third-molar patient. The study examined the effects of symptom rating and a"standard gamble" measure reflecting a patient's willingness to accept scarring or nerve damage. This analysis is based on 169 patients who participated in four waves of data collection. The most salient predictor of patient treatment was the standard gamble measure at 1-month follow-up. Subjects with higher risk tolerance were more likely to select surgery versus jaw wiring. A higher likelihood of choosing surgery was associated with higher income and greater symptom severity. Fracture patients were more likely to select surgery compared with third-molar patients. The significance of symptom severity 1-month post-surgery raises an important issue regarding the healing process. Moreover, the significance of standard gamble as a predictor of treatment choice for mandibular fracture should encourage other researchers to use this measure of willingness to accept risk when studying acute conditions such as jaw fracture.

  14. Open tibia fractures in HIV positive patients. (United States)

    Harrison, W J


    Open tibia fractures are common injuries, particularly in developing countries.Pedestrian or bicycle to motor car contact is the most common mechanism. These injuries result in high morbidity and often long-term disability. HIV infection complicates open fractures by raising the incidence of infectionin the open wound (5 of 7 patients in our series). This risk may be compounded if internal fixation techniques are used (5 of 12 HIV patients with internal fixation of any open fracture). There is also a suggestion that HIV may delay bone union (4 of 7 patients united at 6 months). External fixation offers an alternative method of fracture stabilisation. It avoids the risks associated with putting metal-ware in the wound, but creates a new issue of pin track sepsis. We found that pin track infection was more common in patients with HIV, but the rate at which pins required removal was 7%. We consider external fixation to be a lower-risk strategy than internal fixation in such patients but open fracture wound sepsis remains a problem. We have not yet demonstrated a difference in severity or frequency of complications in patients of low CD4 count, but logically one expects septic complications to increase as CD4 count falls. Antiretroviral medication decreases viral load and elevates the CD4 count. Research is underway regarding potential effectiveness of such drugs in reducing wound and fracture healing complications. Above all, meticulous and timely all-round care is required to achieve satisfactory results in immune-compromised patients. This includes, debridement, bony stability, and soft-tissue reconstruction.


    Energy Technology Data Exchange (ETDEWEB)

    A.S. Grader; D. Elsworth; P.M. Halleck; F. Alvarad; H. Yasuhara; A. Alajmi


    The main objectives of this project are to quantify the changes in fracture porosity and multi-phase transport properties as a function of confining stress. These changes will be integrated into conceptual and numerical models that will improve our ability to predict and optimize fluid transport in fractured system. This report details our progress on: (1) developing the direct experimental measurements of fracture aperture and topology using high-resolution x-ray micro-tomography, (2) modeling of fracture permeability in the presence of asperities and confining stress, and (3) simulation of two-phase fluid flow in a fracture and a layered matrix. The three-dimensional surface that describes the large-scale structure of the fracture in the porous medium can be determined using x-ray micro-tomography with significant accuracy. The distribution of fracture aperture is a difficult issue that we are studying and developing methods of quantification. The difficulties are both numerical and conceptual. Numerically, the three-dimensional data sets include millions, and sometimes, billions of points, and pose a computational challenge. The conceptual difficulties derive from the rough nature of the fracture surfaces, and the heterogeneous nature of the rock matrix. However, the high-resolution obtained by the imaging system provides us a much needed measuring environment on rock samples that are subjected to simultaneous fluid flow and confining stress. The absolute permeability of a fracture depends on the behavior of the asperities that keep it open. A model is being developed that predicts the permeability and average aperture of a fracture as a function of time under steady flow of water including the pressure solution at the asperity contact points. Several two-phase flow experiments in the presence of a fracture tip were performed in the past. At the present time, we are developing an inverse process using a simulation model to understand the fluid flow patterns in

  16. Stress-Induced Fracturing of Reservoir Rocks: Acoustic Monitoring and μCT Image Analysis (United States)

    Pradhan, Srutarshi; Stroisz, Anna M.; Fjær, Erling; Stenebråten, Jørn F.; Lund, Hans K.; Sønstebø, Eyvind F.


    Stress-induced fracturing in reservoir rocks is an important issue for the petroleum industry. While productivity can be enhanced by a controlled fracturing operation, it can trigger borehole instability problems by reactivating existing fractures/faults in a reservoir. However, safe fracturing can improve the quality of operations during CO2 storage, geothermal installation and gas production at and from the reservoir rocks. Therefore, understanding the fracturing behavior of different types of reservoir rocks is a basic need for planning field operations toward these activities. In our study, stress-induced fracturing of rock samples has been monitored by acoustic emission (AE) and post-experiment computer tomography (CT) scans. We have used hollow cylinder cores of sandstones and chalks, which are representatives of reservoir rocks. The fracture-triggering stress has been measured for different rocks and compared with theoretical estimates. The population of AE events shows the location of main fracture arms which is in a good agreement with post-test CT image analysis, and the fracture patterns inside the samples are visualized through 3D image reconstructions. The amplitudes and energies of acoustic events clearly indicate initiation and propagation of the main fractures. Time evolution of the radial strain measured in the fracturing tests will later be compared to model predictions of fracture size.

  17. Theoretical Issues

    Energy Technology Data Exchange (ETDEWEB)

    Marc Vanderhaeghen


    The theoretical issues in the interpretation of the precision measurements of the nucleon-to-Delta transition by means of electromagnetic probes are highlighted. The results of these measurements are confronted with the state-of-the-art calculations based on chiral effective-field theories (EFT), lattice QCD, large-Nc relations, perturbative QCD, and QCD-inspired models. The link of the nucleon-to-Delta form factors to generalized parton distributions (GPDs) is also discussed.


    Energy Technology Data Exchange (ETDEWEB)

    Mukul M. Sharma


    predicted by fracture models. There was no accepted optimal method for conducting hydraulic fracturing in the Bossier. Each operator used a different approach. Anadarko, the most active operator in the play, had tested at least four different kinds of fracture treatments. The ability to arrive at an optimal fracturing program was constrained by the lack of adequate fracture models to simulate the fracturing treatment, and an inability to completely understand the results obtained in previous fracturing programs. This research aimed at a combined theoretical, experimental and field-testing program to improve fracturing practices in the Bossier and other tight gas plays.

  19. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures. (United States)

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon; Oh, Joo Han


    The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.

  20. Coincidence of mandibular fractures with isolated posterior maxillary sinus fractures. (United States)

    Blatt, Sebastian; Rahimi-Nedjat, Roman; Sagheb, Keyvan; Piechowiak, Lisa; Walter, Christian; Brüllmann, Dan


    There are no data available to show whether there is a relationship between mandibular fractures and isolated fractures of the posterior and/or lateral walls of the maxillary sinus. The aim of this study was to determine whether there is a coincidence between these fracture patterns. Four hundred large volume cone beam computed tomography scans (CBCT) of patients with a fracture of the mandible between 2008 and 2013 were analyzed retrospectively. Patients with multiple midfacial fractures were excluded. The radiographic findings were correlated with epidemiological and clinical data of the patients such as gender, age, treatment methods, or complications. The most frequent fracture sites of the mandible were the jaw angle, the parasymphysis region, and the condyle. Nineteen of the 400 patients (4.75%) had an isolated fracture of the lateral and/or posterior maxillary sinus. Odds-ratio analysis revealed a high tendency for significant correlation of condylar process fractures with isolated maxillary sinus fractures. Chi-square test demonstrated a P-value near statistical significance (P=.054). No other fracture site of the mandible could be associated with an isolated fracture of the maxillary sinus. A condylar process fracture of the mandible after trauma without any further injury of the midface may be associated with an isolated fracture of the lateral and/or posterior maxillary sinus. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Fuels planning: science synthesis and integration; social issues fact sheet 01: Developing personal responsibility for fuels reduction: Building a successful program to engage property owners (United States)

    Rocky Mountain Research Station USDA Forest Service


    In the course of work as a land manager, you will no doubt be involved in developing programs to achieve various objectives, including the improvement of fuels management on private lands. This fact sheet describes six steps that will help you plan and conduct a successful program.

  2. Microscopic Pattern of Bone Fractures as an Indicator of Blast Trauma: A Pilot Study. (United States)

    Pechníková, Marketa; Mazzarelli, Debora; Poppa, Pasquale; Gibelli, Daniele; Scossa Baggi, Emilio; Cattaneo, Cristina


    The assessment of fractures is a key issue in forensic anthropology; however, very few studies deal with the features of fractures due to explosion in comparison with other traumatic injuries. This study focuses on fractures resulting from blast trauma and two types of blunt force trauma (manual compression and running over), applied to corpses of pigs; 163 osteons were examined within forty fractures by the transmission light microscopy. Blast lesions showed a higher percentage of fracture lines through the Haversian canal, whereas in other types of trauma, the fractures went across the inner lamellae. Significant differences between samples hit by blast energy and those runover or manually compressed were observed (pbones than in runover and compressed. Microscopic analysis of the fracture line may provide information about the type of trauma, especially for what concerns blast trauma. © 2015 American Academy of Forensic Sciences.

  3. Polymer liquids fracture like solids

    DEFF Research Database (Denmark)

    Huang, Qian; Hassager, Ole


    While fracture in brittle solids has been studied for centuries until today, there are few studies on fracture in polymer liquids. Recent developments in experimental techniques, especially the combination of controlled filament stretching rheometry and high speed imaging, have opened new windows...... into the detailed study of fracture processes for polymer liquids. High speed imaging shows that polymer liquids fracture like solids with initiation and propagation of an edge fracture. However, remarkable features such as highly reproducible critical stress, independent appearance of multiple fractures...

  4. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.


    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  5. Fracture of the patella after the anterior cruciate ligament reconstruction. (United States)

    Milankov, Miroslav; Rasović, Predrag; Kovacev, Nemanja; Milović, Milan; Bojat, Veselin


    Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.

  6. Physical model studies of dispersion in fracture systems

    Energy Technology Data Exchange (ETDEWEB)

    Hull, L.C.


    The purposes of the laboratory-scale fracture network experiments are to study mechanisms controlling solute transport under conditions of known fracture parameters, to evaluate injection-backflow test procedures under conditions of known reservoir parameters, and to acquire data for validation of numerical models. Validation of computer codes against laboratory data collected under controlled conditions provides reassurance that the codes deal with important processes in a realistic manner. Preliminary simulations of the dual-permeability physical model have been made using the FRACSL reservoir code. These simulations permit locating electrodes and piezometers in the most advantageous positions to record tracer migration and pressure response. Much of the physical modeling effort this year was oriented towards validating the particle tracking algorithm used in FRACSL, and developing a better theoretical understanding of transport processes in fractures. Experiments were conducted in single fractures and single fracture junctions, and data on tracer migration collected. The Prickett, Naymik, and Lonnquist Random Walk aquifer simulation program has been modfied to simulate flow in single fractures. The particle tracking algorithm was also used to simulate infinite parallel plates under conditions where analytical solutions to the transport equation could be derived. The first case is for zero diffusion in the fracture, and transport based on a parabolic velocity profile. The second case is for diffusion homogenizing the tracer solution across the fracture. The particle tracking algorithm matched both analytical solutions quite well, with the same grid for both simulations. 48 refs., 41 figs., 2 tabs.


    Directory of Open Access Journals (Sweden)

    R. R. Khodjayev


    Full Text Available Treatment of diaphyseal fractures of the forearm: among children is an urgent and complex issue. Results of treatment of closed fractures of the forearm in 43 children who have used surgical treatment using the existing (open reduction, intramedullary fixation combined with external fixation by Ilizarov ring of the two towers methods. The main principles of treatment of forearm fractures in children the correct mapping of one fragments, their reliable fixation, early adequate functional load.

  8. Research on fracture analysis, groundwater flow and sorption processes in fractured rocks

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dae-Ha; Kim, Won-Young; Lee, Seung-Gu [Korea Institute of Geology Mining and Materials, Taejon (KR)] (and others)


    Due to increasing demand for numerous industrial facilities including nuclear power plants and waste repositories, the feasibility of rocks masses as sites for the facilities has been a geological issue of concern. Rock masses, in general, comprises systems of fractures which can provide pathways for groundwater flow and may also affect the stability of engineered structures. For the study of groundwater flow and sorption processes in fractured rocks, five boreholes were drilled. A stepwise and careful integration of various data obtained from field works and laboratory experiments were carried out to analyze groundwater flow in fractured rocks as follows; (1) investigation of geological feature of the site, (2) identification and characterization of fracture systems using core and televiewer logs, (3) determination of hydrogeological properties of fractured aquifers using geophysical borehole logging, pumping and slug tests, and continuous monitoring of groundwater level and quality, (4) evaluation of groundwater flow patterns using fluid flow modeling. The results obtained from these processes allow a qualitative interpretation of fractured aquifers in the study area. Column experiments of some reactive radionuclides were also performed to examine sorption processes of the radionuclides including retardation coefficients. In addition, analyses of fracture systems covered (1) reconstruction of the Cenozoic tectonic movements and estimation of frequency indices for the Holocene tectonic movements, (2) determination of distributions and block movements of the Quaternary marine terraces, (3) investigation of lithologic and geotechnical nature of study area, and (4) examination of the Cenozoic volcanic activities and determination of age of the dike swarms. Using data obtained from above mentioned analyses along with data related to earthquakes and active faults, probabilistic approach was performed to determine various potential hazards which may result from the

  9. Fracture Mechanics of Concrete

    DEFF Research Database (Denmark)

    Ulfkjær, Jens Peder

    Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high-strength......Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high......-strength concrete. Chapter 2 A description of the factors which influence the strength and cracking of concrete and high strength concrete is made. Then basic linear fracture mechanics is outlined followed by a description and evaluation of the models used to describe concrete fracture in tension. The chapter ends...... to describe fracture in concrete are presented. Two of the methods are combined into a power method which is stable for all brittleness numbers and which is able of calculating the entire load-displacement curve even for very ductile beams. This method is used extensively in the rest of the thesis. Chapter 4...

  10. Pediatric calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Hobie Summers


    Full Text Available Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular and severity (displaced vs. nondisplaced have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35 compared to 31° (range: +22 - +47 on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years. Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49. We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

  11. Frontal bone fractures. (United States)

    Marinheiro, Bruno Henrique; de Medeiros, Eduardo Henrique Pantosso; Sverzut, Cássio Edvard; Trivellato, Alexandre Elias


    The aim of this retrospective study was to evaluate the epidemiology, treatment, and complications of frontal bone fractures associated, or not, with other facial fractures. This evaluation also sought to minimize the influence of the surgeon's skills and the preference for any rigid internal fixation system. The files from 3758 patients who attended the Oral and Maxillofacial Surgery Department of the School of Dentistry of Ribeirao Preto, University of Sao Paulo, from March 2004 to November 2011 and presented with facial trauma were scanned, and 52 files were chosen for the review. Eleven (21.15%) of these patients had pure fractures of the frontal bone, and trauma incidence was more prevalent in men (92.3%), whites (61.53%), and adults (50%). Despite the use of helmets at the moment of the trauma, motorcycle crashes were the most common etiological factor (32.69%). Fracture of the anterior wall of the frontal sinus with displacement was the main injury observed (54.9%), and the most common treatment was internal fixation with a plate and screws (45.09%). Postoperative complications were observed in 35.29% of the cases. The therapy applied was effective in handling this type of fracture, and the success rate was comparable to that reported in other published studies.

  12. Development of a binder fracture test to determine fracture energy. (United States)


    It has been found that binder testing methods in current specifications do not accurately predict cracking performance at intermediate temperatures. Fracture energy has been determined to be strongly correlated to fracture resistance of asphalt mixtu...

  13. A case study review of technical and technology issues for transition of a utility load management program to provide system reliability resources in restructured electricity markets

    Energy Technology Data Exchange (ETDEWEB)

    Weller, G.H.


    Utility load management programs--including direct load control and interruptible load programs--were employed by utilities in the past as system reliability resources. With electricity industry restructuring, the context for these programs has changed; the market that was once controlled by vertically integrated utilities has become competitive, raising the question: can existing load management programs be modified so that they can effectively participate in competitive energy markets? In the short run, modified and/or improved operation of load management programs may be the most effective form of demand-side response available to the electricity system today. However, in light of recent technological advances in metering, communication, and load control, utility load management programs must be carefully reviewed in order to determine appropriate investments to support this transition. This report investigates the feasibility of and options for modifying an existing utility load management system so that it might provide reliability services (i.e. ancillary services) in the competitive markets that have resulted from electricity industry restructuring. The report is a case study of Southern California Edison's (SCE) load management programs. SCE was chosen because it operates one of the largest load management programs in the country and it operates them within a competitive wholesale electricity market. The report describes a wide range of existing and soon-to-be-available communication, control, and metering technologies that could be used to facilitate the evolution of SCE's load management programs and systems to provision of reliability services. The fundamental finding of this report is that, with modifications, SCE's load management infrastructure could be transitioned to provide critical ancillary services in competitive electricity markets, employing currently or soon-to-be available load control technologies.

  14. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G


    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  15. Coupled Three-Dimensional Fracture Stimulation and Prediction Model for Enhanced Geothermal Systems (United States)

    Kumar, D.; Gutierrez, M.


    The paper presents development of a three-dimensional fracture stimulation and prediction model using the Boundary Element Method (BEM) for Enhanced Geothermal Systems (EGS). The BEM method results in a numerical procedure which eliminates discretization of complete reservoir domain; hence, only the fracture surface discretization is required. The Displacement Discontinuity Method which is an invariant of the BEM was used to model the fracture geometry (e.g., fracture width, length and elongation), fluid pressure and stress distribution around the fracture. The main feature of the model is that it is able to handle true three-dimensional fractures that can twist turn and not just planar or pseudo three-dimensional fracture geometries. The numerical aspects of various mechanisms involved in the hydraulic fracturing process in the EGS such as fracture deformation, fluid flow and heat flow, fracture initiation and propagation were addressed. The laminar fracture fluid flow and transient heat flow were modeled using the Finite Element Method. The non-Newtonian fluid flow behavior was assumed. Temperature-dependent fluid and rock physical properties were used. The fracture same mesh was used to model for the fracture deformation, fluid flow and heat flow processes. The fracture surface was discretized using 4-node rectangular elements. The important numerical issues of the BEM implementation for the fracture modeling such as near singular, hypersingular cases and crack tip singularity were taken into account. The processes involved in hydraulic fracturing are interdependent. The fracture aperture strongly influences the fluid flow rate inside the fracture, as the fluid velocity is proportional to its width. Thermal-induced stresses effects the fracture aperture. These fully coupled processes of fluid flow, heat flow, and fracture deformation were solved in a coupled manner using iterative method. One of the main challenges of this research was to couple the thermal

  16. Master's Program Module "Environmental Issues--Decision Making Experience" as Precondition for Implementation of Education for Sustainable Development for Professional Training of Teachers (United States)

    Vinokurova, Natalia Fedorovna; Martilova, Natalia Viktorovna; Krivdina, Irina Yurievna; Badin, Mikhail Mikhailovich; Efimova, Olga Evgenyevna


    The article discusses current issues related to the implementation of the UNESCO roadmap implementing Global action programme on education for sustainable development. In the context of increasing the professional level of pedagogical workers is a priority area in the implementation of education for sustainable development. Therefore, we believe…

  17. Analytical Estimation of Water-Oil Relative Permeabilities through Fractures

    Directory of Open Access Journals (Sweden)

    Saboorian-Jooybari Hadi


    Full Text Available Modeling multiphase flow through fractures is a key issue for understanding flow mechanism and performance prediction of fractured petroleum reservoirs, geothermal reservoirs, underground aquifers and carbon-dioxide sequestration. One of the most challenging subjects in modeling of fractured petroleum reservoirs is quantifying fluids competition for flow in fracture network (relative permeability curves. Unfortunately, there is no standard technique for experimental measurement of relative permeabilities through fractures and the existing methods are very expensive, time consuming and erroneous. Although, several formulations were presented to calculate fracture relative permeability curves in the form of linear and power functions of flowing fluids saturation, it is still unclear what form of relative permeability curves must be used for proper modeling of flow through fractures and consequently accurate reservoir simulation. Basically, the classic linear relative permeability (X-type curves are used in almost all of reservoir simulators. In this work, basic fluid flow equations are combined to develop a new simple analytical model for water-oil two phase flow in a single fracture. The model gives rise to simple analytic formulations for fracture relative permeabilities. The model explicitly proves that water-oil relative permeabilities in fracture network are functions of fluids saturation, viscosity ratio, fluids density, inclination of fracture plane from horizon, pressure gradient along fracture and rock matrix wettability, however they were considered to be only functions of saturations in the classic X-type and power (Corey [35] and Honarpour et al. [28, 29] models. Eventually, validity of the proposed formulations is checked against literature experimental data. The proposed fracture relative permeability functions have several advantages over the existing ones. Firstly, they are explicit functions of the parameters which are known for

  18. Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures. (United States)

    Reesink, Heidi L


    Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. DEM Particle Fracture Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Boning [Univ. of Colorado, Boulder, CO (United States); Herbold, Eric B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Homel, Michael A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Regueiro, Richard A. [Univ. of Colorado, Boulder, CO (United States)


    An adaptive particle fracture model in poly-ellipsoidal Discrete Element Method is developed. The poly-ellipsoidal particle will break into several sub-poly-ellipsoids by Hoek-Brown fracture criterion based on continuum stress and the maximum tensile stress in contacts. Also Weibull theory is introduced to consider the statistics and size effects on particle strength. Finally, high strain-rate split Hopkinson pressure bar experiment of silica sand is simulated using this newly developed model. Comparisons with experiments show that our particle fracture model can capture the mechanical behavior of this experiment very well, both in stress-strain response and particle size redistribution. The effects of density and packings o the samples are also studied in numerical examples.

  20. Geometrically Frustrated Fracture Mechanics (United States)

    Mitchell, Noah; Koning, Vinzenz; Vitelli, Vincenzo; Irvine, William T. M.


    When a flat elastic sheet is forced to conform to a surface with Gaussian curvature, stresses arise in the sheet. The mismatch between initial and final metrics gives rise to new fracture behavior which cannot be achieved by boundary loading alone. Using experiments of PDMS sheets frustrated on 3D-printed surfaces and a linearized analytical model, we demonstrate the ability of curvature to govern the sheets' fracture phenomenology. In this talk, we first show that curvature can both stimulate and suppress fracture initiation, depending on the position and orientation of the initial slit. Secondly, we show that curvature can steer the path of a crack as it propagates through the material. Lastly, the curvature can arrest cracks which would otherwise continue to propagate.

  1. open fractures - effect of infection on fracture fixation

    African Journals Online (AJOL)

    stability, soft tissue cover, union of the fracture and above all prevent infection. Therefore various methods ... Also soft tissue cover should be done as soon as possible following the fix and flap-protocal (7) for open fractures ... and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia.

  2. Optimizing fracture prevention: the fracture liaison service, an observational study

    NARCIS (Netherlands)

    Eekman, D.A.; van Helden, S.H.; Huisman, A.M.; Verhaar, H.J.J.; Bultink, I.E.M.; Geusens, P.P.; Lips, P.T.A.M.; Lems, W.F.


    Summary: The response rate to the invitation to the fracture liaison service and reasons for non-response were evaluated in 2,207 fragility fracture patients. Fifty-one percent responded; non-responders were most often not interested (38%) or were hip fracture patients. After 1 year of treatment,

  3. Orbital Roof Fractures as an Indicator for Concomitant Ocular Injury (United States)


    Indicator for Concomitant Ocular Injury Sb. GRANT NUMBER Sc. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Sd. PROJECT NUMBER Capt Santamaria, Joseph Se. TASK...NOTES Society of Military Ophthalmologists, New Orleans, LA, Nov 12th, 2017 14. ABSTRACT Title: Orbital Roof Fractures as an Indicator for...7.0 Title: Orbital Roof Fractures as an Indicator for Concomitant Ocular Injury Authors: Joseph Santamaria MD, Aditya Mehta MD, Donovan Reed MD

  4. The Impact of Behavioral Health Issues on Soldiers Returning from Deployment -- Assessing the Programs for Reintegration of South Carolina National Guard Soldiers (United States)


    home to begin a 30, 60, and 90-day cycle similar to the current system to ensure success in reintegration . Providing decompression immediately...and leads to a more successful transition into reintegration back into civilian life. A second recommendation is for the SCNG Family Programs to...RETURNING FROM DEPLOYMENT – ASSESSING THE PROGRAMS FOR REINTEGRATION OF SOUTH CAROLINA NATIONAL GUARD SOLDIERS BY COLONEL R. VAN MCCARTY United

  5. Odontoid fracture biomechanics. (United States)

    Ivancic, Paul C


    In vitro biomechanical study. To investigate mechanisms of odontoid fracture. Odontoid fractures in younger adults occur most often due to high-energy trauma including motor vehicle crashes and in older adults due to fall from standing height. Horizontally aligned head impacts into a padded barrier were simulated using a human upper cervical spine specimen (occiput through C3) mounted to a surrogate torso mass on a sled and carrying a surrogate head. We divided 13 specimens into 3 groups on the basis of head impact location: upper forehead in the midline, upper lateral side of the forehead, and upper lateral side of the head. Post-impact fluoroscopy and anatomical dissection documented the injuries. Time-history biomechanical responses were determined. Four of the 5 specimens subjected to impact to the upper forehead in the midline sustained type II or high type III odontoid fractures due to abrupt deceleration of the head and continued forward torso momentum. Average peak force reached 1787.1 N at the neck at 50.3 milliseconds. Subsequently, the motion peaks occurred for the head relative to C3 reaching 15.2° for extension, 2.1 cm for upward translation, and 5.3 cm for horizontal compression, between 62 and 68 milliseconds. We identified impact to the upper forehead in the midline as a mechanism that produced odontoid fracture and associated atlas and ligamentous injuries similar to those observed in real-life trauma. We were not able to create odontoid fractures during impacts to the upper lateral side of the forehead or upper lateral side of the head. Dynamic odontoid fracture was caused by rapid deceleration of the head, which transferred load inferiorly combined with continued torso momentum, which caused spinal compression and anterior shear force and forward displacement of the axis relative to the atlas.

  6. Bilateral Femoral Neck Fracture-Related Hyperparathyroidism


    Ezirmik, Naci; Yildiz, Kadri; Cadirci, Kenan


    Bilateral femoral neck fracture is not common as unilateral femoral fracture. Femoral neck fracture generally occurs by the high energized traumas. Traffic accidents and fallings are the most common reason for this fracture kind. But suddenly and minor traumatic fractures is not common. Especially, in the hormonal and pathogenic fractures is not common. In this case minor traumatic bilateral femoral fracture is presented. The fracture occurs in the background of critical medical condition by ...

  7. Mediating equity in shared water between community and industry: The effects of an after school program that addresses adolescents' knowledge, attitudes, and perceptions of water science and environmental issues (United States)

    Patton, Mary Chandler

    This critical ethnography deconstructs how one participant researcher came to understand young adults' changing knowledge about water science and environmental issues in an after school program in Colombia. The program intended to empower self-identified young community leaders by teaching participants to engage community members in discourse related to how environmental factors impact one's level of health and quality of life. The data presented in this study illustrate how student participants responded to long-term teacher engagement and to particular curricular components that included hands-on science teaching and social justice coaching. I assessed how student interest in and knowledge of local water ecology and sanitation infrastructure changed throughout the program. Students' responses to the use of technology and digital media were also included in the analysis. The data demonstrates a dramatic change in student's attitudes and perceptions related to their environment and how they feel about their ability to make positive changes in their community.

  8. JPRS Report, Proliferation Issues (United States)


    insisted that the missile’s "intelligent warhead" [cabeza inteligente ] Gonzalez added: "Concerning the salaries issue, I have was not sent to Spain-in fact...more than 152 mm and especially developed punches and matrices, and also a control system and especially developed software 1.6. Robots , devices, and...of radiation 1.6.3. especially developed control program software for robots indicated in point 1.6. Definitions: (1) " Robot " - manipulator which moves

  9. Fracture After Total Hip Replacement (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  10. [Fractures of the thumb ray]. (United States)

    Mehling, I M; Schillo, K; Arsalan-Werner, A; Seegmüller, J; Langheinrich, A C; Sauerbier, M


    Fractures of the first thumb ray are common and need accurate differential treatment to restore gripping hand functions. Displaced fractures of the distal and proximal phalanx of the thumb are often treated with screws or Kirschner wires. Stable fractures can also be treated non-operatively. Fractures of the base of the first metacarpal should be differentiated into extra-articular Winterstein fractures and intra-articular Bennett or Rolando fractures. Traction forces by the abductor pollicis longus tendon regularly lead to displacement of the shaft of the first metacarpal; therefore, these fractures usually require reduction and fixation. Good functional results can be achieved by operative treatment. Fractures of the trapezium are rare. If they are displaced, operative treatment is recommended to prevent osteoarthritis of the first carpometacarpal joint.

  11. Vertebroplasty for Spine Fracture Pain (United States)

    ... and break.How are spinal fractures treated?Most fractures of the spine are treated with bed rest until the pain goes away. Pain medicines, back braces and physical therapy may also be used. For some patients, doctors ...

  12. Dance Dynamics: Gender Issues in Dance Education. (United States)

    Meglin, Joellen A.; And Others


    Seven articles present gender issues from a variety of perspectives, discussing a gender fair dance education program in Australia, gender issues in dance history pedagogy, women and dance performance, encouraging male participation in dance, using West African dance to combat gender issues, and gender issues across the curriculum. (SM)

  13. Pediatric Orbital Fractures (United States)

    Oppenheimer, Adam J.; Monson, Laura A.; Buchman, Steven R.


    It is wise to recall the dictum “children are not small adults” when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillofacial surgeon must select an appropriate treatment strategy that considers both the nature of the injury and the child's stage of growth. The following review will discuss the management of pediatric orbital fractures, with an emphasis on clinically oriented anatomy and development. PMID:24436730

  14. Fractured Petroleum Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, Dr. Abbas


    In this report the results of experiments of water injection in fractured porous media comprising a number of water-wet matrix blocks are reported for the first time. The blocks experience an advancing fracture-water level (FWL). Immersion-type experiments are performed for comparison; the dominant recovery mechanism changed from co-current to counter-current imbibition when the boundary conditions changed from advancing FWL to immersion-type. Single block experiments of co-current and counter-current imbibition was performed and co-current imbibition leads to more efficient recovery was found.

  15. Understanding hydraulic fracturing: a multi-scale problem (United States)

    Hyman, J. D.; Jiménez-Martínez, J.; Viswanathan, H. S.; Carey, J. W.; Porter, M. L.; Rougier, E.; Karra, S.; Kang, Q.; Frash, L.; Chen, L.; Lei, Z.; O’Malley, D.; Makedonska, N.


    Despite the impact that hydraulic fracturing has had on the energy sector, the physical mechanisms that control its efficiency and environmental impacts remain poorly understood in part because the length scales involved range from nanometres to kilometres. We characterize flow and transport in shale formations across and between these scales using integrated computational, theoretical and experimental efforts/methods. At the field scale, we use discrete fracture network modelling to simulate production of a hydraulically fractured well from a fracture network that is based on the site characterization of a shale gas reservoir. At the core scale, we use triaxial fracture experiments and a finite-discrete element model to study dynamic fracture/crack propagation in low permeability shale. We use lattice Boltzmann pore-scale simulations and microfluidic experiments in both synthetic and shale rock micromodels to study pore-scale flow and transport phenomena, including multi-phase flow and fluids mixing. A mechanistic description and integration of these multiple scales is required for accurate predictions of production and the eventual optimization of hydrocarbon extraction from unconventional reservoirs. Finally, we discuss the potential of CO2 as an alternative working fluid, both in fracturing and re-stimulating activities, beyond its environmental advantages. This article is part of the themed issue ‘Energy and the subsurface’. PMID:27597789

  16. Quality of life after hip fracture in the elderly : A systematic literature review

    NARCIS (Netherlands)

    Peeters, C.M.M.; Visser, E.; van de Ree, C.L.P.; Gosens, T.; den Oudsten, B.L.; de Vries, J.


    Background With an increasing ageing population, hip fractures have become a major public health issue in the elderly. It is important to examine the health status (HS) and health-related quality of life (HRQOL) of the elderly faced with the epidemic of hip fractures. Objective To provide an

  17. Incorporating in vivo fall assessments in the simulation of femoral fractures with finite element models

    NARCIS (Netherlands)

    van der Zijden, A.M.; Janssen, D.; Verdonschot, Nicolaas Jacobus Joseph; Groen, B.E.; Nienhuis, B.; Weerdesteyn, V.; Tanck, E.


    Femoral fractures are a major health issue. Most experimental and finite element (FE) fracture studies use polymethylmethacrylate cups on the greater trochanter (GT) to simulate fall impact loads. However, in vivo fall studies showed that the femur is loaded distally from the GT. Our objective was

  18. Robotic Long Bone Fracture Reduction


    Graham, A. E.; Xie, S. Q.; Aw, K. C.; Xu, W.L.; Mukherjee, S.


    This research into a medical robot for realigning fractured bones aims to develop the interface, robot, and database technologies to improve the working situation for users and outcome for recipients. Compared with other approaches to fracture reduction, the system being developed here has a number of novel features. The geometric modeling has been effective in allowing a surgeon to visualize the fractured bone and has not been reported elsewhere for fracture reduction to the authors knowledg...


    African Journals Online (AJOL)


    Fracture of ilium, the most common fracture seen in the pelvis account for 46% of all pelvic fracture (Henry, 1985; De Camp, 2005). Whereas, acetabular fracture comprises 12 % of pelvic fractures in dogs (De Camp, 2005). In smaller dogs, most of the pelvic fractures recover without surgery. But immediate surgery is.

  20. Numerical Modeling of Fracture Propagation in Naturally Fractured Formations (United States)

    Wang, W.; Prodanovic, M.; Olson, J. E.; Schultz, R.


    Hydraulic fracturing consists of injecting fluid at high pressure and high flowrate to the wellbore for the purpose of enhancing production by generating a complex fracture network. Both tensile failure and shear failure occur during the hydraulic fracturing treatment. The shear event can be caused by slip on existing weak planes such as faults or natural fractures. From core observation, partially cemented and fully cemented opening mode natural fractures, often with considerable thickness are widely present. Hydraulic fractures can propagate either within the natural fracture (tensile failure) or along the interface between the natural fracture and the rock matrix (tensile/shear failure), depending on the relative strength of cement and rock matrix materials, the bonding strength of interface, as well as the presence of any heterogeneities. In this study, we evaluate the fracture propagation both experimentally and numerically. We embed one or multiple inclusions of different mechanical properties within synthetic hydrostone samples in order to mimic cemented natural fractures and rock. A semi-circular bending test is performed for each set of properties. A finite element model built with ABAQUS is used to mimic the semi-circular bending test and study the fracture propagation path, as well as the matrix-inclusion bonding interface status. Mechanical properties required for the numerical model are measured experimentally. The results indicate that the match between experiment and modeling fracture path are extremely sensitive to the chosen interface (bonding) model and related parameters. The semi-circular bending test is dry and easily conducted, providing a good platform for validating numerical approaches. A validated numerical model will enable us to add pressurized fluid within the crack and simulate hydraulic fracture-natural fracture interaction in the reservoir conditions, ultimately providing insights into the extent of the fracture network.

  1. Efficiency and accuracy of equivalent fracture models for predicting fractured geothermal reservoirs: the influence of fracture network patterns (United States)

    Chen, Tao; Clauser, Christoph; Marquart, Gabriele


    Frequently, flow and transport in fractured geothermal reservoirs are modeled using discrete and continuum fracture models. In discrete fracture models, each fracture is represented explicitly based on unstructured grids, which increases greatly the computational effort. In continuum models, e.g., equivalent fracture models, the hydraulic properties of fractures are averaged on coarse grids, which are often applied for the field-scale modeling. We use and compare both discrete and equivalent fracture models for predicting the field-scale temperature distribution in fractured geothermal reservoirs. We assess the efficiency and the accuracy of the equivalent fracture models regarding the influence of fracture network pattern: In one model fractures are parallel to the axes of the model, another one contains also non-parallel fractures. We use the OpenGeoSys and SHEMAT-Suite codes for discrete fracture modeling and for equivalent fracture modeling, respectively. For equivalent fracture modeling, both the classical finite volume scheme and the mimetic finite difference scheme are used for solving the flow equation. The Oda method is used for computing permeability for equivalent fracture models. For the non-parallel fracture network, the equivalent permeability tensor contains off-diagonal components. Our simulations show that the equivalent fracture models remain computationally efficient with changing fracture pattern. The temperature at the production well turns out to be less sensitive to fracture pattern variations compared to the discrete fracture model. And the equivalent fracture model yields efficient and accurate results in case of dominating parallel fractures.

  2. Calcaneal fractures • In children

    African Journals Online (AJOL)


    Jul 15, 1989 ... Eight patients with 9 calcaneal fractures were reviewed. Of the fractures 6 were intra-articular and 3 extra-articular but in children this distinction appears to have little relevan~e to treatment or prognosis. While these fractures are relatively uncommon in children, clinical suspicion is important in making the ...

  3. An Equivalent Fracture Modeling Method (United States)

    Li, Shaohua; Zhang, Shujuan; Yu, Gaoming; Xu, Aiyun


    3D fracture network model is built based on discrete fracture surfaces, which are simulated based on fracture length, dip, aperture, height and so on. The interesting area of Wumishan Formation of Renqiu buried hill reservoir is about 57 square kilometer and the thickness of target strata is more than 2000 meters. In addition with great fracture density, the fracture simulation and upscaling of discrete fracture network model of Wumishan Formation are very intense computing. In order to solve this problem, a method of equivalent fracture modeling is proposed. First of all, taking the fracture interpretation data obtained from imaging logging and conventional logging as the basic data, establish the reservoir level model, and then under the constraint of reservoir level model, take fault distance analysis model as the second variable, establish fracture density model by Sequential Gaussian Simulation method. Increasing the width, height and length of fracture, at the same time decreasing its density in order to keep the similar porosity and permeability after upscaling discrete fracture network model. In this way, the fracture model of whole interesting area can be built within an accepted time.

  4. Fracture Patterns Differ Between Osteogenesis Imperfecta and Routine Pediatric Fractures. (United States)

    Peddada, Kranti V; Sullivan, Brian T; Margalit, Adam; Sponseller, Paul D


    It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1). We reviewed records of 29,101 pediatric patients with fractures from 2003 through 2015. We included patients with closed fractures not resulting from motor vehicle accidents, gunshot wounds, nonaccidental trauma, or bone lesions. Patients with OI of any type were identified through International Classification of Diseases-9 code. We randomly sampled 500 pediatric patients in whom OI was not diagnosed to obtain a control (non-OI) group. We reviewed age at time of fracture, sex, fracture type, laterality, and bone and bone region fractured. Bisphosphonate use and OI type were documented for OI patients. Subanalysis of patients with type-1 OI was performed. The Fisher exact and χ tests were used to compare fracture rates between groups. P<0.05 was considered significant. Positive likelihood ratios for OI were calculated by fracture pattern. The non-OI group consisted of 500 patients with 652 fractures. The OI group consisted of 52 patients with 209 fractures. Non-OI patients were older at the time of fracture (mean, 9.0±5.0 y) than OI patients (mean, 5.5±4.4 y) (P<0.001). OI patients had more oblique, transverse, diaphyseal, and bilateral long-bone fractures than non-OI patients (all P<0.001). Non-OI patients had more buckle (P=0.013), metaphyseal (P<0.001), and physeal (P<0.001) fractures than OI patients. For patients with type-1 OI and long-bone fractures (n=18), rates of transverse and buckle fractures were similar compared with controls. Transverse humerus (15.2), olecranon (13.8), and diaphyseal humerus (13.0) fractures had the highest positive likelihood ratios for OI, and physeal (0.09) and supracondylar humerus (0.1) fractures had the lowest. Transverse and diaphyseal humerus and olecranon fractures were most likely to indicate OI. Physeal and supracondylar humerus fractures were least likely

  5. Fracture characterization and discrimination criteria for karst and tectonic fractures in the Ellenburger Group, West Texas: Implications for reservoir and exploration models

    Energy Technology Data Exchange (ETDEWEB)

    Hoak, T.E. [Science Applications International Corp., Germantown, MD (United States)]|[Kestrel Geoscience, Littleton, CO (United States); Sundberg, K.R. [Phillips Petroleum Co., Bartlesville, OK (United States); Deyhim, P. [Oklahoma State Univ., Stillwater, OK (United States); Ortoleva, P. [Indiana Univ., Bloomington, IN (United States). Lab. for Computational Geodynamics


    In the Ellenburger Group fractured dolomite reservoirs of West Texas, it is extremely difficult to distinguish between multiple phases of karst-related fracturing, modifications to the karst system during burial, and overprinting tectonic fractures. From the analyses of drill core, the authors developed criteria to distinguish between karst and tectonic fractures. In addition, they have applied these criteria within the context of a detailed diagenetic cement history that allows them to further refine the fracture genesis and chronology. In these analyses, the authors evaluated the relationships between fracture intensity, morphologic attributes, host lithology, fracture cement, and oil-staining. From this analysis, they have been able to characterize variations in Ellenburger tectonic fracture intensity by separating these fractures from karst-related features. In general, the majority of fracturing in the Ellenburger is caused by karst-related fracturing although a considerable percentage is caused by tectonism. These findings underscore the importance of considering the complete geologic evolution of a karst reservoir during exploration and field development programs. The authors have been able to more precisely define the spatial significance of the fracture data sets by use of oriented core from Andector Field. They have also demonstrated the importance of these results for exploration and reservoir development programs in West Texas, and the potential to extrapolate these results around the globe. Given the historic interest in the large hydrocarbon reserves in West Texas carbonate reservoirs, results of this study will have tremendous implications for exploration and production strategies targeting vuggy, fractured carbonate systems not only in West Texas, but throughout the globe.

  6. Program specialization

    CERN Document Server

    Marlet, Renaud


    This book presents the principles and techniques of program specialization - a general method to make programs faster (and possibly smaller) when some inputs can be known in advance. As an illustration, it describes the architecture of Tempo, an offline program specializer for C that can also specialize code at runtime, and provides figures for concrete applications in various domains. Technical details address issues related to program analysis precision, value reification, incomplete program specialization, strategies to exploit specialized program, incremental specialization, and data speci

  7. Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Kronborg, Lise; Bandholm, Thomas; Palm, Henrik


    IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...... of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive...... sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION: A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using...

  8. Fracture mechanics and parapsychology (United States)

    Cherepanov, G. P.


    The problem of postcritical deformation of materials beyond the ultimate strength is considered a division of fracture mechanics. A simple example is used to show the relationship between this problem and parapsychology, which studies phenomena and processes where the causality principle fails. It is shown that the concept of postcritical deformation leads to problems with no solution

  9. Inclusion Requires Fracturing (United States)

    Anila, Swarupa


    Inclusion strategies and approaches in interpretive planning processes for exhibitions are often resisted because they challenge precedents in museum practice. Maintaining traditional models may seem more comfortable for many museum professionals than to do the work of closely examining, fracturing, and transforming the practices that prioritize…

  10. Colles wrist fracture - aftercare (United States)

    The initial recovery from a wrist fracture can take 3 to 4 months or more. You may need physical therapy. You should start working with a physical therapist as soon as your provider recommends. The work may seem hard and at times ...

  11. Vertebral Compression Fractures (United States)

    ... should be avoided. Steps to take after the fracture has healed include: • Chair cushions to provide support to the lower spine • Getting up out of a desk chair at least a few minutes every hour • A gradual return to exercise such as walking and/or swimming 2007; reviewed ...

  12. Neglected hangman fracture

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava


    Full Text Available Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman′s fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

  13. AGE: An Issue to Manage. (United States)

    Thrust for Educational Leadership, 1987


    As California's youth culture yields to gray power, school administrators will be challenged to provide youth programs in an atmosphere of growing hostility and increased demands for services to the elderly. This article provides a sample action plan and issues brief to help educators involve older adults in school-based programs. (MLH)

  14. Pipkin Fractures: Fracture of the Head of Femur A Case Report ...

    African Journals Online (AJOL)

    Pipkin fracture is the fracture of the head of the femur. It can be associated with neck of femur fracture or / and posterior dislocation of the hip. This fracture is very rare fracture and has not been reported at our sub- region. We present this fracture in a 26 year old with a type I Pipkin fracture treated with closed reduction and ...

  15. Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint. (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A


    With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.

  16. Hydromechanical and Thermomechanical Behaviour of Elastic Fractures during Thermal Stimulation of Naturally Fractured Reservoirs (United States)

    Jalali, Mohammadreza; Valley, Benoît


    During the last two decades, incentives were put in place in order to feed our societies in energy with reduced CO2 emissions. Various policies have been considered to fulfill this strategy such as replacing coal by natural gas in power plants, producing electricity using CO2 free resources, and CO2 sequestration as a remediation for large point-source emitters (e.g. oil sands facilities, coal-fired power plants, and cement kilns). Naturally fractured reservoirs (NFRs) are among those geological structures which play a crucial role in the mentioned energy revolution. The behavior of fractured reservoirs during production processes is completely different than conventional reservoirs because of the dominant effects of fractures on fluid flux, with attendant issues of fracture fabric complexity and lithological heterogeneity. The level of complexity increases when thermal effects are taking place - as during the thermal stimulation of these stress-sensitive reservoirs in order to enhance the gas production in tight shales and/or increase the local conductivity of the fractures during the development of enhanced geothermal systems - where temperature is introduced as another degree of freedom in addition to pressure and displacement (or effective stress). Study of these stress-pressure-temperature effects requires a thermo-hydro-mechanical (THM) coupling approach, which considers the simultaneous variation of effective stress, pore pressure, and temperature and their interactions. In this study, thermal, hydraulic and mechanical behavior of partially open and elastic fractures in a homogeneous, isotropic and low permeable porous rock is studied. In order to compare the hydromechanical (HM) and thermomechanical (TM) characteristics of these fractures, three different injection scenarios, i.e. constant isothermal fluid injection rate, constant cooling without any fluid injection and constant cold fluid injection, are considered. Both thermomechanical and hydromechanical

  17. Anisotropy of strength and deformability of fractured rocks

    Directory of Open Access Journals (Sweden)

    Majid Noorian Bidgoli


    Full Text Available Anisotropy of the strength and deformation behaviors of fractured rock masses is a crucial issue for design and stability assessments of rock engineering structures, due mainly to the non-uniform and non-regular geometries of the fracture systems. However, no adequate efforts have been made to study this issue due to the current practical impossibility of laboratory tests with samples of large volumes containing many fractures, and the difficulty for controlling reliable initial and boundary conditions for large-scale in situ tests. Therefore, a reliable numerical predicting approach for evaluating anisotropy of fractured rock masses is needed. The objective of this study is to systematically investigate anisotropy of strength and deformability of fractured rocks, which has not been conducted in the past, using a numerical modeling method. A series of realistic two-dimensional (2D discrete fracture network (DFN models were established based on site investigation data, which were then loaded in different directions, using the code UDEC of discrete element method (DEM, with changing confining pressures. Numerical results show that strength envelopes and elastic deformability parameters of tested numerical models are significantly anisotropic, and vary with changing axial loading and confining pressures. The results indicate that for design and safety assessments of rock engineering projects, the directional variations of strength and deformability of the fractured rock mass concerned must be treated properly with respect to the directions of in situ stresses. Traditional practice for simply positioning axial orientation of tunnels in association with principal stress directions only may not be adequate for safety requirements. Outstanding issues of the present study and suggestions for future study are also presented.

  18. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans


    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  19. Characterization by notched and precracked Charpy tests of the in-service degradation of RPV steel fracture toughness

    Energy Technology Data Exchange (ETDEWEB)

    Fabry, A.


    The current engineering and regulatory practice to estimate fracture toughness safety margins for nuclear reactor pressure vessels (RPVs) relies heavily on the CVN impact test. Techniques to estimate in-service toughness degradation directly using a variety of precracked specimens are under development worldwide. Emphasis is on their miniaturization. In the nuclear context, it is essential to address many issues such as representativity of the surveillance programs with respect to the vessel in terms of materials and environment, transferability of test results to the structure (constraint and size effects), lower bound toughness certification, creadibility relative to trends of exising databases. An enhanced RPV surveillance strategy in under development in Belgium. It combines state-of-the-art micromechanical and damage modelling to the evaluation of CVN load-deflection signals, tensile stress-strain curves and slow-bend tests of reconstituted precracked Charpy specimens. A probabilistic micromechanical model has been established for static and dynamic transgranular cleavage initiation fracture toughness in the ductile-brittle transition temperature range. This model allows to project toughness bounds for any steel embrittlement condition from the corresponding CVN and static tensile properties, using a single scaling factor defined by imposing agreement with toughness tests in a single condition. The outstanding finding incorporated by this toughness transfer model is that the microcleavage fracture stress is affected by temperature in the ductile-brittle transition and that this influence is strongly correlated to the flow stress: this explains the shape of the K{sub Ic}n K{sub Id} temperature curves as well as the actual magnitude of the strain rate and irradiation effects. Furthermore, CVN crack arrest loads and fracture appearance are also taken advantage of in order to estimate K{sub Ia} degradation. Finally, the CVN-tensile load-temperature diagram


    Directory of Open Access Journals (Sweden)

    Đivo Ban


    Full Text Available Children and adolescents today, all before starting with regular sports activities and involvement in semi-professional and top professional sport, so it increases the num- ber of discovered stress fractures in this age. This type of injury can occur as a consequence of action one strong force, or the many repeated small force strength, to be exact, when the load (stress transcend ability reparations bones. Stress fractures are recorded and described up to the lower limbs. Research has been confirmed that the bones of lower leg are mostly made in injury, and with the el- derly and with the population of children and young adolescents. Occur in many sports, something to them is greater when the frequency of running and often are present in the female population. According to the results of numerous investigations, mistakes in the training are the most common cause of the emergence of stress fracture. In a direct comparison with complemented these injuries is the condition of muscles, so it is important that at the sa- me time carry out exercises strengthen muscles and stretching. Typical clinical signs of stress fractures are localized painful sensitivity to palpa- tion and runoff in a small number of cases. The basic diagnostic procedure is a medical check, it is the small, radiology and scintigraphyc diagnostics (most accurate and mag- netic resonance imaging. Treatment is usually without surgery and conservative, with rest and reducing stress, and its activity athlete breaks mainly between four and eight weeks. Only the very need surgical treatment The most important thing is that attention is focused on the proper prevention and to take all that it ever occurred to stress fractures that athletes ramble of the courts and the competition (better education of sports workers, separation of groups with increa- sed risk of the formation of an injury, adaptation activities age and abilities of athletes, adequate sports equipment, high-quality sports

  1. The Young, the Restless and the Jobless: The Case for a National Jobs Stimulus Program Targeted on America's Young Adults. Public Policy Issues Monograph. (United States)

    Sum, Andrew; Mangum, Garth; Taggart, Robert

    Although young people across the United States have suffered disproportionately in the recent recession, the economic and social effects of high levels of youth unemployment have received only scant media and political attention and few state or federal dollars. Analyses of successful youth and young adult programs identified seven core principles…

  2. Migration issues important -- Mongolia. (United States)


    Migration and urbanization are issues that require increasing attention in Mongolia. Mr. Sodov Sonin, Minister of Health and Social Welfare, stated at the Forum that fertility has declined, but mortality, in particular the mortality of children and mothers, is still too high. In addition, there is a significant gap between the knowledge of and behaviors concerning reproductive health, which is one of the causes of the country's high abortion rates. However, on the positive side, literacy is high among women--70% of the students in Mongolia's higher educational institutions are female and the State recognizes equal rights for women. Moreover, programs that promote health and education, including the National Program on Reproductive Health, are being implemented; but despite all these, Mongolia still lacks the human and financial resources to implement the ICPD Program of Action satisfactorily. The country also needs dramatic changes in mind-set and in terms of capacity building, given its ongoing socioeconomic transition.

  3. Surgical Management of Patellar Fractures. (United States)

    Kakazu, Rafael; Archdeacon, Michael T


    The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Fracture Phenomena in Amorphous Selenium

    DEFF Research Database (Denmark)

    Lindegaard-Andersen, Asger; Dahle, Birgit


    Fracture surfaces of amorphous selenium broken in flexure at room temperature have been studied. The fracture velocity was found to vary in different regions of the fracture surface. Peculiar features were observed in a transition zone between fast and slower fracture. In this zone cleavage steps...... with a nearly constant spacing of approximately 1 µ were found. Occasionally long cleavage whiskers—up to some millimeters long—were observed. Within certain regions the cleavage steps were crossed and interrupted by two line systems. The maximum fracture velocity has been measured to 350 m/sec. Further...

  5. Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010. (United States)

    Cirera, Eva; Pérez, Katherine; Santamariña-Rubio, Elena; Novoa, Ana M; Olabarria, Marta


    In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring

  6. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures. (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu


    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P femoral neck fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius

  7. Study on interaction between induced and natural fractures by extended finite element method (United States)

    Xu, DanDan; Liu, ZhanLi; Zhuang, Zhuo; Zeng, QingLei; Wang, Tao


    Fracking is one of the kernel technologies in the remarkable shale gas revolution. The extended finite element method is used in this paper to numerically investigate the interaction between hydraulic and natural fractures, which is an important issue of the enigmatic fracture network formation in fracking. The criteria which control the opening of natural fracture and crossing of hydraulic fracture are tentatively presented. Influence factors on the interaction process are systematically analyzed, which include the approach angle, anisotropy of in-situ stress and fluid pressure profile.

  8. Falls and fractures in participants and excluded non-participants of a fall prevention exercise program for elderly women with a history of falls: 1-year follow-up study. (United States)

    Kim, Hunkyung; Yoshida, Hideyo; Suzuki, Takao


    To evaluate the effectiveness of a strength and balance enhancing exercise intervention as a means of preventing falls in community-dwelling elderly Japanese women with a history of falls, while comparing functional fitness, fall and fracture rate in excluded subjects. A 1-year follow-up trial was carried out on 105 participants over the age of 70 years, who were randomly assigned to the exercise or education group, and also on 91 women excluded based on the exclusion criteria. The exercise group attended a 60-min exercise class twice a week for 3 months. Falls, injuries, fractures, and functional fitness assessments were measured at baseline, post-intervention and 1-year follow up. During the follow up, fall rates were 19.6% in the exercise group, 40.4% in the education group and 40.8% in excluded subjects (χ(2)  = 7.069, P = 0.029). Compared with the exercise group, the odds ratio (OR) for falls was greater in the education group (OR 2.78, 95% confidence interval (CI) 1.17-6.96) and excluded participants (OR 2.83, 95%CI 1.25-6.80). The OR for fractures was over fourfold greater in excluded participants (OR 4.30, 95% CI 1.02-9.70) than the exercise group. The exercise intervention for participants with fall history effectively decreased incidences of falls and fractures. However, fall and fracture rates in excluded people were high. Further research focusing on feasible countermeasures for falls in excluded people who are at high risk of fractures is required. © 2013 Japan Geriatrics Society.

  9. [Osteoporotic fractures of the pelvis]. (United States)

    Böhme, J; Höch, A; Josten, C


    The incidence of osteoporotic pelvic fractures is rapidly increasing. Following low energy trauma fractures are frequently classified as pelvic girdle fractures. Based on the pelvic expert group database of the German Trauma Society the estimated rate of osteoporotic pelvic ring fractures is about 51%. In cases of fractured pubic rami standard X-ray in anterior-posterior, inlet and outlet views should be carried out by computed tomography (CT) scanning to identify fractures of the sacrum. Only if pain persists and no fracture is evident with CT is magnetic resonance imaging (MRI) indicated. Therapy should be carried out under biomechanical instability aspects. Pubic rami fractures are stable and treated conservatively with sufficient pain medication, thromboembolic prophylaxis and physiotherapy. In cases of persisting pain or biomechanical instability operative treatment is indicated and stabilization methods should be chosen under biomechanical aspects. Therefore external fixator for pubic rami fractures and iliosacral screws, optionally with cement augmentation for posterior pelvic girdle fractures are the preferred techniques. Sacral fractures with severe osteolysis should be stabilized by lumbopelvic fixation techniques.

  10. This Issue

    Directory of Open Access Journals (Sweden)

    Editors / Herausgeber


    Full Text Available Whereas the last issue of DIEGESIS (4.1 was dedicated to “Narrative and Lies”, the current volume’s focus shifts to “Narrative and Truth”. Is there a correlation between a narrative’s truth claim and its form? Does the form of narrative allow for the possibility of certain types of truth-oriented discourses in the first place? Or does it, on the contrary, prove an impediment to authentic truthful speech?Johannes Stephan distinguishes two kinds of travelogues: those reproducing received knowledge and those attempting to present the traveller’s experiences. One example of the latter type is the Arabic ‘Travel Book’ (1764 by the Syrian author Ḥanna Dyāb, in which focalization is used not only to witness but also to visualise the experiences of the traveller.Evelyn Chew and Alex Mitchell discuss a similar problem with application to contemporary texts. They investigate the construction of truth claims in three interactive nonfiction life stories in different genres. In the three case studies, of an autobiography, a biographical docugame and a video-based web documentary respectively, subjective and objective legitimation strategies are investigated.Against a backdrop of philosophical discussions of the epistemic value of narration and with specific reference to Aristotle’s Poetics, Malte Dreyer distinguishes three forms of generating coherence in narrative texts: the causal, the teleological and the holistic. He goes on to apply these concepts to social contract theories and to discuss the validity claims of the different types of narrative explanation.In this issue’s “My Narratology” section, James Phelan responds to our questions about his personal ideas of narratology. He describes his own approach as “theorypractice” and argues in favour of conceptualising narrative as “rhetorical action”.We wish you an interesting read!

  11. Issue Management Risk Ranking Systems

    Energy Technology Data Exchange (ETDEWEB)

    Novack, Steven David; Marshall, Frances Mc Clellan; Stromberg, Howard Merion; Grant, Gary Michael


    Thousands of safety issues have been collected on-line at the Idaho National Engineering and Environmental Laboratory (INEEL) as part of the Issue Management Plan. However, there has been no established approach to prioritize collected and future issues. The authors developed a methodology, based on hazards assessment, to identify and risk rank over 5000 safety issues collected at INEEL. This approach required that it was easily applied and understandable for site adaptation and commensurate with the Integrated Safety Plan. High-risk issues were investigated and mitigative/preventive measures were suggested and ranked based on a cost-benefit scheme to provide risk-informed safety measures. This methodology was consistent with other integrated safety management goals and tasks providing a site-wide risk informed decision tool to reduce hazardous conditions and focus resources on high-risk safety issues. As part of the issue management plan, this methodology was incorporated at the issue collection level and training was provided to management to better familiarize decision-makers with concepts of safety and risk. This prioritization methodology and issue dissemination procedure will be discussed. Results of issue prioritization and training efforts will be summarized. Difficulties and advantages of the process will be reported. Development and incorporation of this process into INEELs lessons learned reporting and the site-wide integrated safety management program will be shown with an emphasis on establishing self reliance and ownership of safety issues.

  12. Pelvic fractures resulting from snowboarding. (United States)

    Ogawa, Hiroyasu; Sumi, Hiroshi; Sumi, Yasuhiko; Shimizu, Katsuji


    Information regarding pelvic fractures sustained during snowboarding is scant. To analyze the epidemiologic data, injury patterns, and types of pelvic fractures sustained during snowboarding. Case series; Level of evidence, 4. We analyzed the epidemiologic factors, injury patterns, and types of pelvic fractures in 145 patients with snowboarding-related pelvic fractures who were admitted to our institution from the 1998-1999 to the 2006-2007 ski season. The incidence of snowboarding-related pelvic fractures was 0.102 per 10 000 ski lift tickets, which amounted to 2% of all snowboarding-related fractures (fifth most common type of fracture among all snowboarding-related fractures). Of the pelvic fractures, 85.5% were stable (type A according to the Tile classification) and 14.5% were unstable (types B and C according to the Tile classification). Isolated sacral fractures had the second-highest incidence (24.1%) after pubic bone and/or ischium fractures (46.9%). A distinct female prevalence was seen (52.4%). Jumps and isolated falls were the main mechanisms of injury (80%), and the incidence of collision was significantly higher in the unstable group than in the stable group (P = .037). In all, 57.9% patients classified their skill level as "intermediate," and only 9.7% of patients had received professional snowboarding lessons. A total of 30 subjects (20.8%) had other injuries along with pelvic fractures; the patients with multiple injuries were significantly more frequent in the unstable group than in the stable group (P = .035). Pelvic fractures resulting from snowboarding accidents included a higher proportion with isolated sacral fractures in the stable group and a lower prevalence of associated injuries in the unstable group compared with those resulting from other causes.

  13. Multiphysics of Fractures across Scales (United States)

    Pyrak-Nolte, L. J.


    Remote monitoring of fluid flow in fractured rock faces challenges because fractures are topologically complex, span a range of length scales, and are routinely altered due to physical and chemical processes. A long-standing goal has been to find a link between fluid flow supported by a fracture and the seismic response of that fracture. This link requires a relationship between intrinsic fracture properties and macroscopic scattered wave fields. Furthermore, such a link among multiphysical properties of fracture should be retained as the scale of observation changes. Recently, Pyrak-Nolte and Nolte (Nature Comm., 2016) demonstrated, numerically, that a scaling relationship exists between fluid flow and fracture specific stiffness, linked through the topology of the fracture void geometry (i.e. fracture void space and contact area spatial distributions). This scaling relationship holds for fractures with either random or spatially correlated aperture distributions. To extend these results, a heuristic numerical study was performed to determine if fracture specific stiffness determined from seismic wave attenuation (defined through a displacement-discontinuity boundary condition) corresponds to static stiffness based on deformation measurements. In the long wavelength limit, static and dynamic stiffness are closely connected. As the scattering conditions of the fracture move out of the long-wavelength limit, a frequency-dependent stiffness is defined that captures low-order corrections, extending the regime of applicability of the displacement discontinuity model. The displacement discontinuity theory has a built-in scaling parameter that ensures some set of discontinuities will be optimal for detection as different wavelengths sample different subsets of fractures. Future studies will extend these concepts to fracture networks. Acknowledgments: The U.S. Department of Energy, Office of Science, Basic Energy Sciences, Chemical Sciences, Geosciences, and Biosciences

  14. Analysis of the pressure response of high angle multiple (HAM) fractures intersecting a welbore; Kokeisha multi fracture (HAM) kosei ni okeru atsuryoku oto kaiseki ni tsuite

    Energy Technology Data Exchange (ETDEWEB)

    Ujo, S.; Osato, K. [Geothermal Energy Research and Development Co. Ltd., Tokyo (Japan); Arihara, N. [Waseda University, Tokyo (Japan); Schroeder, R.


    This paper reports pressure response analysis on wells piercing a high angle multi (HAM) fracture model. In this model which is defined on a three-dimensional space, a plurality of slanted fractures intersect with wells at high angles (however, intersection of fractures with each other is not considered). With respect to the pressure response analysis method using this model, the paper presents a basic differential equation on pressure drawdown and boundary conditions in the wells taking flows in the fractures pseudo-linear, as well as external boundary conditions in calculation regions (a reservoir spreads to an infinite distance, and its top and bottom are closed by non-water permeating beds). The paper also indicates that results of calculating a single vertical fracture model and a slanted fracture model by using a numerical computation program (MULFRAC) based on the above equations agree well respectively with the existing calculation results (calculations performed by Erlougher and Cinco et al). 5 refs., 6 figs.

  15. Pisiform dislocation and distal radius ulna fracture | Kalande | East ...

    African Journals Online (AJOL)

    East and Central African Journal of Surgery. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 3 (2015) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Pisiform dislocation and distal radius ulna fracture. FM Kalande ...

  16. Geomechanical production optimization in faulted and fractured reservoirs

    NARCIS (Netherlands)

    Heege, J.H. ter; Pizzocolo, F.; Osinga, S.; Veer, E.F. van der


    Faults and fractures in hydrocarbon reservoirs are key to some major production issues including (1) varying productivity of different well sections due to intersection of preferential flow paths with the wellbore, (2) varying hydrocarbon column heights in different reservoir compartments due to

  17. Prevalent osteoporotic fractures in 622 obese and non- obese menopausal women. (United States)

    Poiana, C; Carsote, M; Radoi, V; Mihai, A; Capatina, C


    Hypothesis. The osteoporotic fractures represent a worldwide economical issue. In order to prevent them, we need to understand the risk factors constellation. Although obesity was traditionally considered as protective against osteoporosis, recent data exposed an increased risk of falling and thus a high risk of some fractures. Objective. We aimed to analyze the body mass index (BMI) in relationship with the bone mineral density (BMD) and the prevalent fractures. Methods and Results. Between 2008 and 2014, a cross-sectional observational study included Romanian menopausal Caucasian women without a previous diagnosis of bone maladies, or specific anti-osteoporotic therapy. Prevalent fragility fractures were both self-declared and incidental vertebral. All the subjects had lumbar BMD (GE Lunar Prodigy DXA machine). Out of 622 females (mean age of 58.65 years, mean BMI of 30.30 kg/ m2), 39.22% were obese (BMI ≥ 30kg/ m2). The fracture prevalence was 1.35% versus 1.67% in obese versus non-obese patients. The correlation coefficient between lumbar BMD and BMI was r=0.165, pObesity prevalence among females with fractures was 30.3% versus 40.73% in the non-fracture group. The most frequent sites were distal forearm (42.42%) and vertebral (21.21%). Discussions & Conclusions. Although the vertebral fractures might be underdiagnosed in our study and despite the fact that we enrolled a relatively young menopausal population, BMI positively correlated with BMD, regardless of the fractures' prevalence. In early menopause, the most frequent fracture is distal forearm. BMI is higher in patients with prevalent fractures vs. non-fractures (borderline significance). Obesity might not protect from any type of fracture but future evidence is necessary since one third of osteoporotic fractures are met in women with a BMI ≥ 30kg/ m2.

  18. Fracture density and spacing along Washita Valley fault, Arbuckle Mountains, Oklahoma

    Energy Technology Data Exchange (ETDEWEB)

    Ferebee, C.D.; Tapp, J.B. (Univ. of Tulsa, OK (USA))


    The authors document fracture density and spacing associated with the Washita Valley fault, a major strike-slip fault. The Washita Valley fault strikes northwest-southeast with up to 80 mi of exposure in southern Oklahoma and may be an early bounding fault of the Southern Oklahoma aulacogen (Ardmore/Marietta basins). Horizontal displacement on the fault has been estimated to be up to 40 mi, with vertical displacement on the order of 10,000 ft. Samples collected from traverses across the Washita Valley fault have been analyzed. The traverses cross the fault at different stratigraphic levels from Proterozoic igneous basement, through the Cambrian-Ordovician Arbuckle Group, Ordovician Simpson and Viola Groups, to the Silurian-Devonian Hunton Group. Several types of fracture systems are documented that reflect mechanical stratigraphy, burial depth during deformation, and episodic movement on the fault. The fractures in the study area include open fracture systems, calcite-filled fractures, tension gashes, and fractures related to pressure solution. The samples were cut parallel to the strike of the fault, vertical-normal to the fault, and horizontal-normal to the fault. These cuts allow examination of the total fracture strain, characterization of the fractures, and statistical analysis of fracture density. From these data, fracture density is shown to decrease exponentially moving away from the primary fault zone. The increased understanding of fracture patterns and characteristics will assist future exploration and development programs involving carbonate reservoirs associated with strike-slip systems.

  19. Simulation studies to evaluate the effect of fracture closure on the performance of naturally fractured reservoirs. Annual report

    Energy Technology Data Exchange (ETDEWEB)


    The first of a three-year research program to evaluate the effect of fracture closure on the recovery of oil and gas from naturally fractured reservoirs has been completed. The objectives of the study are to (1) evaluate the reservoir conditions where fracture closure is significant, and (2) evaluate innovative fluid injection techniques capable of maintaining pressure within the reservoir. Simulation studies were conducted with a dual porosity simulator capable of simulating the performance of vertical and horizontal wells. Each simulator was initialized using properties typical of the Austin Chalk reservoir in Pearsall Field, Texas. Simulations of both vertical and horizontal well performance were made assuming that fracture permeability was insensitive to pressure change. Sensitivity runs indicate that the simulator is predicting the effects of critical reservoir parameters in a logical and consistent manner. The results to-date confirm that horizontal wells can increase both oil recovery rate and total oil recovery from naturally fractured reservoirs. The year one simulation results will provide the baseline for the ongoing study which will evaluate the performance degradation caused by the sensitivity of fracture permeability to pressure change, and investigate fluid injection pressure maintenance as a means to improve oil recovery performance. The study is likely to conclude that fracture closure decreases oil recovery and that pressure support achieved through fluid injection could be beneficial in improving recovery.

  20. Presentation and outcome of traumatic spinal fractures

    Directory of Open Access Journals (Sweden)

    Ahmed El-Faramawy


    Full Text Available Background: Motor vehicle crashes and falls account for most of the spine fractures with subsequent serious disability. Aim: To define the incidence, causes, and outcome of spinal fractures. Materials and Methods: Data were collected retrospectively from trauma registry database of all traumatic spinal injuries admitted to the section of trauma surgery in Qatar from November 2007 to December 2009. Results: Among 3712 patients who were admitted to the section of trauma surgery, 442 (12% injured patients had spinal fractures with a mean age of 33.2 ± 12 years. The male to female ratio was 11.6:1. Motor vehicle crashes (36.5% and falls from height (19.3% were the leading causes of cervical injury (P = 0.001. The injury severity score ranged between 4 and 75. Nineteen percent of cases with cervical injury had thoracic injury as well (P = 0.04. Lumber injury was associated with thoracic injury in 27% of cases (P < 0.001. Combined thoracic and lumber injuries were associated with cervical injury in 33% of cases (P < 0.001. The total percent of injuries associated with neurological deficit was 5.4%. Fifty-three cases were managed surgically for spine fractures; 14 of them had associated neurological deficits. Overall mortalityrate was 5%. Conclusions: Spine fractures are not uncommon in Qatar. Cervical and thoracic spine injuries carry the highest incidence of associated neurological deficit and injuries at other spinal levels. Young males are the most exposed population that deserves more emphasis on injury prevention programs in the working sites and in enforcement of traffic laws.