A 3d-fem Simulation of Highest Stress Lines in Mandible Fractures by Elastic Impact

In this article, the more usual mandible fracture areas are located by identifying the highest stress lines using a three-dimensional (tetrahedral) finite element method. By taking into account the temporomandibular contact and the inertia effects, the mathematical model is considered to be a dynamic Signorini's problem, that is, a dynamic variational inequality which is discretized in time following Newmark's method. So, in each time step a stationary variational inequality is solved by a penalty-duality algorithm. Finally, some numerical results obtained by simulating the more usual fractures in the human mandible are presented and compared with clinical experimental information.     

Obesity and its socioeconomic determinants in Iran

ObjectiveTo investigate the socioeconomic inequality of obesity and its determinants in Iran.MethodsData was from Iran's surveillance system for risk factors of non-communicable diseases which was conducted on 89,400 individuals aged 15–64 years in 2005. Principal component analysis was used to create a new variable for defining socioeconomic status of participants. We assessed inequality by calculating a slop index of inequality and concentration index for obesity. Oaxaca-Blinder decomposition analysis was used to determine the determinants of inequality.ResultsThe slop index of inequality and concentration index for obesity was −13.1 (95% Confidence Intervals [CI]: −16.3 to −9.8) percentage points and −0.123, respectively. The level of inequality varied widely between different provinces in Iran and was more severe in women and urban population. Obesity persisted in 20.2% (95% CI: 19.4–20.9) of the low-socioeconomic group and 11.0% (95% CI: 10.5–11.6) of the high-socioeconomic group. More than 90% of this gap was due to differences of independent variables (mainly age, gender and marital status) in two socioeconomic status groups.ConclusionsA pro-rich inequality existed in the obesity in Iran. Older age, female gender and rural residency contributed most to the economic inequality of obesity.     

Raising grateful children one day at a time

ABSTRACT

We examined micro developmental processes related to the socialization of children's gratitude by testing whether parents who engage in more frequent daily socialization practices targeting children's gratitude reported more frequent gratitude displays by their children after controlling for potential confounds. 101 parent-child dyads completed a baseline lab visit followed by a seven-day diary study. Using multi-level modeling, we found that parents who engaged in more frequent gratitude socialization acts reported more frequent displays of gratitude by their children across the seven-days (between-dyad effect) and that on days when a parent engaged in more socialization acts than usual parents reported relative increases in gratitude displays by their children (within-dyad effect). These findings show that parent socialization acts are associated with children’s displayed gratitude and point to the need for future work to explore reactive and proactive parent-child interactions that may underlie these associations as well as associations between micro-developmental and macro-developmental processes.     

Stop ‘blaming the man’: perceptions of inequality and opportunities for success in the Obama era among middle-class African Americans

Abstract

This paper builds upon work that has shown that African Americans exhibit a dual consciousness when explaining persistent inequality. We draw upon 45 in-depth interviews with middle-class African Americans following the 2008 election to explore how they explain persistent disadvantage for African Americans, the destigmatization strategies they employ, and the impact they believe the election of Barack Obama will have on opportunities for African Americans. Consistent with dual consciousness theory, we find that respondents explain persistent disadvantage for African Americans by citing structural and motivational factors. We also extend previous work to show that for the majority of respondents the use of individualistic de-stigmatization strategies reinforces their dual consciousness. These respondents are optimistic about Obama's election because it supports their belief that African Americans should assume responsibility for improving their circumstances. A minority of respondents express more concern about the persistence of racial inequality, and consequentially are less optimistic about changes that Obama's election may bring about.     

密固达与地舒单抗治疗原发性骨质疏松的成本-效用分析

摘要 目的：评价密固达与地舒单抗治疗原发性骨质疏松的经济性。方法：基于我国卫生体系角度,采用Excel2010软件构建Markov评估模型,利用成本-效用分析的方法评估密固达与地舒单抗治疗原发性骨质疏松的经济性。成本、健康效用值及药物治疗源自已发表的文献。模型循环周期为1年,时效为终生。采用单因素敏感性分析和概率分析评估模型参数变化对结果的影响。结果：地舒单抗用药方案比密固达方案给患者带来0.76质量调整生命年（QALYs）但同时用药成本也高于密固达方案2101.31元,其ICER为2764.88元/QALY。单因素敏感性分析发现药物成本对结果影响较大。概率敏感性分析结果显示,当采用3倍我国2022年人均国内生产总值（GDP）作为意愿支付阈值时,地舒单抗方案更具有经济性。结论：低于3倍我国2022年GDP阈值条件下,地舒单抗治疗原发性骨质疏松更具有经济性。     

Hommel's procedure in linear time

Hommel's and Hochberg's procedures for familywise error control are both derived as shortcuts in a closed testing procedure with the Simes local test. Hommel's shortcut is exact but takes quadratic time in the number of hypotheses. Hochberg's shortcut takes only linear time after the P‐values are sorted, but is conservative. In this paper, we present an exact shortcut in linear time on sorted P‐values, combining the strengths of both procedures. The novel shortcut also applies to a robust variant of Hommel's procedure that does not require the assumption of the Simes inequality.     

Disparities in disability life expectancy in us birth cohorts: The influence of sex and race

Abstract

Racial and sex disparities in chronic diseases and mortality are sources of health inequality and have been observed from infancy to adulthood. Disparities in health and mortality contribute to corresponding disparities in healthy life. I address two previously unanswered questions in the aging literature. First, does the racial and sex gap in healthy life narrow, persist, or expand over age and time, particularly considering severity of ill health, among the oldest old? Second, do some race‐sex groups of birth cohorts live not just longer lives, but longer healthier lives, while others spend additional years in illness? To estimate the quantities, I employ a refined definition of physical disability and apply a new extension of Sullivan's method to true birth cohorts. The results suggest among the oldest old, few racial or sex disparities exist over age and time in mild disability. Yet, racial and sex disparities persist over age and time in severe disability.     

Gender and performance in athletics

Abstract

A comparison of women's and men's performance in swimming, running, and skating is made based on available world record data. The ratio of women's to men's record times is analyzed as a time series, and the asymptotic value of this ratio is discussed in the context of a model. “Rate of improvement curves” are defined over time and by event in a given sport and are compared across gender. The relationship of record time to event distance is estimated and also analyzed across event and gender boundaries. We make three conclusions: 1. The rate of improvement for women has been extraordinary and is larger for longer distance vents. 2. Law‐like relations emerge for record times and event lengths. These relations have interesting physical interpretations when examined for various sports. 3. The male physiology is more suited to anaerobic strength events while, given increased access and participation, women can be expected to be more on a par with men in some long‐distance aerobic events.     

Why Are There Social Gradients in Preventative Health Behavior? A Perspective from Behavioral Ecology

Background

Within affluent populations, there are marked socioeconomic gradients in health behavior, with people of lower socioeconomic position smoking more, exercising less, having poorer diets, complying less well with therapy, using medical services less, ignoring health and safety advice more, and being less health-conscious overall, than their more affluent peers. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not.

Methodology/Principal Findings

This paper presents a theoretical model of why socioeconomic gradients in health behavior might be found. I conjecture that lower socioeconomic position is associated with greater exposure to extrinsic mortality risks (that is, risks that cannot be mitigated through behavior), and that health behavior competes for people''s time and energy against other activities which contribute to their fitness. Under these two assumptions, the model shows that the optimal amount of health behavior to perform is indeed less for people of lower socioeconomic position.

Conclusions/Significance

The model predicts an exacerbatory dynamic of poverty, whereby the greater exposure of poor people to unavoidable harms engenders a disinvestment in health behavior, resulting in a final inequality in health outcomes which is greater than the initial inequality in material conditions. I discuss the assumptions of the model, and its implications for strategies for the reduction of health inequalities.     

Tratamiento con equinocandinas en un paciente crítico sometido a técnica continua de reemplazo renal

BackgroundCritically ill patients with invasive candidiasis (IC) often suffer renal failure, which sometimes requires continuous renal replacement techniques (CRRT). Echinocandins are the first line treatment for IC in critically ill patients with mild or severe illness. Their elimination during CRRT should be negligible due to their pharmacokinetic and pharmacodynamic (PK/PD) profile, and dose adjustment are not needed, as suggested by the few reported clinical studies.Clinical caseThis is the case of a 66 year old male who underwent surgery due to peritonitis secondary to intestinal suture dehiscence. The patient was admitted to ICU with septic shock symptoms and multiple organ dysfunction syndrome (MODS), and CRRT was started. Anidulafungin was prescribed at the usual dosage due to the IC risk factors present, and the observation of yeasts in the peritoneal fluid. Anidulafungin was selected due to the hepatic failure suffered by the patient. An isolate of Candida albicans susceptible to fluconazole was cultured from peritoneal fluid and rectal exudates. However, anidulafungin was maintained due to the MODS and observing the clearance of fluconazole during CRRT. The patient's condition improved favourably, being moved to the surgical ward 20 days after the surgery.ConclusionsEchinocandins, due to their PK/PD profile, could be safely given at usual doses to critically ill patients undergoing CRRT. However, new studies are required to strengthen this recommendation. Its extrahepatic metabolism makes anidulafungin a more attractive option among echinocandins and other antifungals when used in patients with different degrees of hepatic failure     

Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care

ObjectiveTo determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia.DesignRandomised controlled trial.Setting31 UK primary care centres.Participants478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration.InterventionsNear patient testing for H pylori and open access endoscopy for patients with positive results. Control patients received acid suppressing drugs or specialist referral at general practitioner''s discretion.Results40% of the study group tested positive for H pylori. 45% of study patients had endoscopy compared with 25% of controls. More peptic ulcers were diagnosed in the study group (7.4% v 2.1%, P=0.011). Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups. No significant differences were observed in rates of prescribing, consultation, or referral. Costs were higher in the study group (£367.85 v £253.16 per patient).ConclusionsThe test and endoscopy strategy increases endoscopy rates over usual practice in primary care. The additional cost is not offset by benefits in symptom relief or quality of life.

What is already known on this topic

Patients younger than 50 without H pylori infection are unlikely to have treatable disease detected at endoscopySuch patients can be managed by acid suppression and reassurance aloneTest and endoscopy (referral of patients testing positive for H pylori in primary care) has been recommended as a way to reduce endoscopic workload

What this paper adds

Applying a test and endoscopy strategy increased the endoscopy referral rate from 25% to 40%The strategy produced no significant differences in symptoms or quality of life compared with usual managementThe increased costs of this strategy cannot be justified     

Other people’s children: inclusive parenting in a diversified neighbourhood in Norway

ABSTRACT

This article explores how parents include other people’s children in intensive parenting practices. Increased diversification of Norwegian society calls attention to opportunities for social mobility and the risk of greater inequality. However, insufficient research has been carried out into how parents pursue parenting in such a context. How are parenting practices informed by increased diversity? Why and how do parents become engaged with other people’s children? This study explores the concept of intensive parenting, which researchers view as commonplace among Western middle-class parents, and which leads to individualizing parenting. It argues that for some, intensive parenting also incorporates inclusive parenting – a responsibility not only towards their own child, but a concern for and time investment in other people’s children. This parenting style is linked to a desire to create a more egalitarian society, and a belief that a child’s upbringing and future depends upon the wellbeing of other people’s children.     

Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes

ObjectiveTo determine patients'' preferences for a shared or directed style of consultation in the decision making part of the general practice consultation.DesignStructured interview, with video vignettes of acted consultations.Setting5 practices in Lothian, Scotland.Participants410 patients (adults and adults accompanying children) attending surgery appointments.ResultsPatients varied in their preference for involvement in decision making in the consultation. Under multiple regression analysis, patients'' preference was found to be independently predicted by the problem viewed (patients presented with physical problems preferred a directed approach), patients'' age (patients aged 61 or older were more likely to prefer the directed approach), social class (social classes I and II were more likely to prefer the shared approach), and smoking status (smokers more likely to prefer the shared approach). Those patients who were able to answer (or who thought their doctor''s style similar to those in the vignettes) were more likely to describe their own doctor''s style as similar to their preferred style. No major association in preference was found with sex, frequency of attendance, or perceived chronic ill health.ConclusionPatients may vary in their desire for involvement in decision making in consultations. Although this variation seems to depend on the presenting problem, age, social class, and smoking status, these associations are not absolute, with large minorities in each group. Doctors need the skills, knowledge of their patients, and the time to determine on which occasions, with which illnesses, and at which level their patients wish to be involved in decision making.     

Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey

ObjectivesTo analyse the relation between geographical inequalities in income and the prevalence of common chronic medical conditions and mental health disorders, and to compare it with the relation between family income and these health problems.Design Nationally representative household telephone survey conducted in 1997-8.Setting 60 metropolitan areas or economic areas of the United States.Participants 9585 adults who participated in the community tracking study.Results A strong continuous association was seen between health and education or family income. No relation was found between income inequality and the prevalence of chronic medical problems or depressive disorders and anxiety disorders, either across the whole population or among poorer people. Only self reported overall health, the measure used in previous studies, was significantly correlated with inequality at the population level, but this correlation disappeared after adjustment for individual characteristics.Conclusions This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health.

What is already known on this topic

Several studies have found a relation between income inequality and self reported health or mortality

What this study adds

There is a strong social gradient in health, as measured by the prevalence of chronic medical conditions and specific mental health disorders, by income or educationNo such association is seen between income inequality and health     

Migrant African women: tales of agency and belonging

Abstract

This paper explores issues of belonging and agency among asylum seekers and refugee women of African origin in the UK. It discusses the ways these women engendered resistance in their everyday life to destitution, lack of cultural recognition, and gender inequality through the foundation of their own non-governmental organization, African Women's Empowerment Forum, AWEF, a collective ‘home’ space.

The focus of this account is on migrant women's agency and self-determination for the exercise of choice to be active actors in society. It points to what might be an important phenomenon on how local grassroots movements are challenging the invisibility of asylum seekers’ and refugees’ lives and expanding the notion of politics to embrace a wider notion of community politics with solidarity.

AWEF is the embodiment of a social space that resonates the ‘in-between’ experience of migrant life providing stability to the women members regarding political and community identification.     

Male Corncrakes Crex crex extend their home ranges by visiting the territories of neighbouring males

Capsule Radiotracked male Corncrake often intruded on the territories of neighbouring males.

Aims To test that intruders' visits are goal-directed, not just a by-product of extended spatial activity during daylight hours.

Methods Using radiotelemetry, we sampled a total of 20 three-day home ranges from 11 tagged males. We recorded daily vocal activity and used a permutation test to see if the movements of tracked males were independent of the position of neighbouring males.

Results The majority of males who had a neighbouring male, up to approximately 600 m from their night calling site, undertook goal-directed visits to the neighbour's territory. Males undertook these visits every day, or every other day, when the neighbours were close. Males undertook visits approximately once every three days when they were more distant. The time spent in the neighbour's territory was longest where the distance between night calling sites was about 200 m. Males tended to be silent in neighbour's territory, apparently to prevent confrontation. Otherwise the distance of neighbouring males did not significantly affect daytime vocal activity. Visiting males tended to sing more often in their home territories.

Conclusions Daily movement of the majority of males was towards the neighbouring male's calling site. We suggest that the purpose of these visits was to seek females. These males may try to drive a female into their territory or gain extra-pair copulation.     

Muscle mitochondrial energetics predicts mobility decline in well‐functioning older adults: The baltimore longitudinal study of aging

BackgroundMuscle mitochondrial dysfunction is associated with poor mobility in aging. Whether mitochondrial dysfunction predicts subsequent mobility decline is unknown.MethodsWe examined 380 cognitively normal participants aged 60 and older (53%women, 22%Black) who were well‐functioning (gait speed ≥ 1.0 m/s) and free of Parkinson''s disease and stroke at baseline and had data on baseline skeletal muscle oxidative capacity and one or more mobility assessments during an average 2.5 years. Muscle oxidative capacity was measured by phosphorus magnetic resonance spectroscopy as the post‐exercise recovery rate of phosphocreatine (k_PCr). Mobility was measured by four walking tests. Associations of baseline k_PCr with mobility changes were examined using linear mixed‐effects models, adjusted for covariates. In a subset, we examined whether changes in muscle strength and mass affected these associations by adjusting for longitudinal muscle strength, lean mass, and fat mass.ResultsLower baseline k_PCr was associated with greater decline in all four mobility measures (β, p‐value: (0.036, 0.020) 6‐m usual gait speed; (0.029, 0.038) 2.5‐min usual gait speed; (0.034, 0.011) 6‐m rapid gait speed; (−0.042, <0.001) 400‐m time). In the subset, further adjustment for longitudinal muscle strength, lean mass, and fat mass attenuated longitudinal associations with changes in mobility (Δβ reduced 26–63%).ConclusionAmong initially well‐functioning older adults, worse muscle mitochondrial function predicts mobility decline, and part of this longitudinal association is explained by decline in muscle strength and mass. Our findings suggest that worse mitochondrial function contributes to mobility decline with aging. These findings need to be verified in studies correlating longitudinal changes in mitochondrial function, muscle, and mobility performance.