Situational risk factors for fall-related vertebral fractures in older men and women.

Situational factors might help explain why most vertebral fractures occur in older people without a previous osteoporosis diagnosis. After adjusting for predisposing risk factors, the activity before the fall, type of fall, and falling direction remained as strong determinants of fall-related vertebral fractures in older men and women. INTRODUCTION: A matched case-control study was conducted to investigate the effects of situational factors, in addition to predisposing factors, on clinical vertebral fractures in older men and women in Taiwan. METHODS: Cases were community-dwelling individuals aged ≥ 65 years who visited emergency departments (EDs) of two university-affiliated hospitals due to a fall and had a primary diagnosis of a vertebral fracture during a 1-year period in 2017. Five control patients per case, matched by the time of falling, gender, and age, who sought care in the same ED due to a fall resulting in a soft tissue injury were selected. A total of 64 men (age range: 65 ~ 99 years) and 194 women (age range: 65 ~ 100 years), diagnosed with a vertebral fracture, participated in the study. RESULTS: Multivariable logistic models were conducted separately for men and women. Results suggested that the following factors were significantly associated with an increased risk of vertebral fractures in men: a low educational level (adjusted odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.02 ~ 3.71), asthma (OR = 2.96; 95% CI, 1.35 ~ 6.92), depression (OR = 4.31; 95% CI, 1.03 ~ 17.5), toileting (OR = 2.30; 95% CI, 1.04 ~ 4.94), slipping (OR = 5.27; 95% CI, 1.80 ~ 15.4), stepping down (OR = 3.99; 95% CI, 1.40 ~ 11.4), sudden leg weakness (OR = 3.73; 95% CI, 1.13 ~ 12.4), and falling backwards (OR = 3.78; 95% CI, 1.83 ~ 7.80); and in women: a fracture history (OR = 2.00; 95% CI, 1.07 ~ 3.76), osteoporosis (OR = 1.94; 95% CI, 1.15 ~ 3.49), getting in/out of the bed/chair (OR = 1.90; 95% CI, 1.07 ~ 3.39), stepping down (OR = 2.10; 95% CI, 1.17 ~ 3.77), and falling backwards (OR = 4.00; 95% CI, 2.39 ~ 6.68) and sideways (OR = 2.61; 95% CI, 1.38 ~ 4.96). CONCLUSIONS: The combination of predisposing and situational risk factors may display a more comprehensive risk profile for the occurrence of VFs, and thus, interventions that add both types of risk factors may result in greater risk reduction of VFs, although those specifically targeted at situational risk factors during falls are limited and their effectiveness and efficiency remained to be explored.

Clinical and molecular features of adenovirus type 2, 3, and 7 infections in children in an outbreak in Taiwan, 2011.

OBJECTIVES: We studied paediatric patients with human adenovirus (HAdV) infection during the 2011 outbreak in northern Taiwan to define the clinical features of different HAdV genotypes in children. METHODS: Between January and December 2011, 637 patients <19 years of age exhibited culture-confirmed adenoviral infection in Chang Gung Memorial Hospital, and provided specimens available for genotyping by multiplex real-time PCR. Clinical data were collected retrospectively. RESULTS: Excluding five cases with multiple genotypes, 632 cases were included for analysis. Three genotypes were identified, including HAdV-3 (429/632; 67.6%), HAdV-7 (144/632; 22.6%) and HAdV-2 (59/632; 9.8%). Median age was 4.58 years (range 2 months to 18 years), with children infected with HAdV-3 significantly older (82.9% >3 years; p <0.001). Of the 621 inpatients, 98.2% had fevers and all exhibited respiratory symptoms, 75 patients (12.1%) had lower respiratory tract infections, 20 (3.2%) required intensive care (HAdV-2: 1; HAdV-3: 8; and HAdV-7: 11), and three died (all HAdV-7-infected). HAdV-3-infected patients were significantly more likely to have upper respiratory symptoms and a high serum C-reactive protein level >100 mg/L, whereas leucocytosis (white blood cell count >15 000/mm3) was more common in HAdV-2-infected patients (p 0.007). HAdV-7 infections were significantly associated with a longer duration of fever, leucopenia (white blood cell count <5000/mm3), thrombocytopenia (platelet count <150 000/mm3), lower respiratory tract infections, a longer length of hospital stay, and requiring intensive care (all p <0.001). CONCLUSION: Childhood HAdV-2, HAdV-3 and HAdV-7 infections may exhibit different clinical manifestations. Although HAdV-3 was the most prevalent genotype observed during the 2011 Taiwan outbreak, HAdV-7 caused more severe disease characteristics and outcomes.

Relations of osteoporosis and follow-up duration to recurrent falls in older men and women.

SUMMARY: There were differences in risk factors between men and women and between two follow-up time lengths. Osteoporosis was significantly associated with recurrent falls for women but not for men. The relationship of osteoporosis with falls in the past year decreased during follow-up, while those of sedatives and hypnotics remained. INTRODUCTION: A prospective study to investigate relationships between osteoporosis and recurrent falls at two follow-up lengths of 6 and 12 months in older men and women. METHODS: In total, 204 men and 447 women who visited an emergency department due to a fall were recruited. RESULTS: For men, the risk of falling was not significantly associated with osteoporosis at 6 or 12 months. Men with a fall history were 127 and 100 %, respectively, more likely to have a fall at 6 and 12 months than those without. Men who did not use walking aids were 97 % more likely to have a fall at 12 months than those who did. Women with osteoporosis were 246 and 104 %, respectively, more likely to have a fall at 6 and 12 months than those without. Women with a fall history were 129 and 66 %, respectively, more likely to have a fall at 6 and 12 months than those without. Women taking sedatives and hypnotics were 75 and 102 %, respectively, more likely to have a fall at 6 and 12 months than their counterparts. Women with depression were 138 % more likely to have a fall at 6 months and those using walking aids were 59 % more likely to have a fall at 12 months, compared to their counterparts. CONCLUSIONS: Osteoporosis is association with falls for older women but not for older men. Identifying risk factors for recurrent falls in older people may be affected by the follow-up length, as their associations are reduced over time.

Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan.

UNLABELLED: Three modifiable factors of fall direction, poor bone strength, and depression were associated with an increased risk of hip fractures for elderly men and women; fall direction was a much stronger predictor than the other two. When a fall occurs, changing fall direction may be most effective to prevent hip fractures. INTRODUCTION: A matched case-control study was conducted to identify risk factors for hip fractures in elderly men and women in Taiwan. METHODS: Cases were defined as persons who visited the emergency room due to a fall and were diagnosed with a first hip fracture. For each case, a control was matched by gender and time of falling, selected from persons who sought care at the same emergency room due to a fall resulting in injury other than a hip fracture. In total, 85 paired men and 221 paired women were included. RESULTS: For men, backward, straight-down, and sideways falls were associated with 10.8-, 13.6-, and 15.2-fold increased risks of hip fractures, respectively, compared with forward falls. Poor bone strength and depression were associated with 2.27- and 2.85-fold increased risks of hip fractures, respectively, while dependence in ≥3 activities of daily living was associated with a fivefold lower risk. For women, compared with forward falls, backward, straight-down, and sideways falls were associated with 10.2-, 9.86-, and 12.8-fold increased risks of hip fractures, respectively. Living in a rented house, poor bone strength, depression, and use of antidiabetics were associated with 1.65-, 2.78-, 1.89-, and 1.92-fold increased risks of hip fractures, respectively. Hormone replacement therapy was associated with a fivefold lower risk of hip fractures. CONCLUSIONS: While bone strength and depression can be risk factors for hip fractures in elderly people, the direction of the fall was the strongest predictor. Some risk factors differed between elderly men and women.

Removal of acetone and methylacetate mixtures from waste gases by a trickle-bed air biofilter.

The biofilter process is a relatively new technology that has been proven more cost-effective than traditional technologies for treating low-strength and some high-strength volatile organic compounds (VOCs) from waste gases. Acetone (AT) and methylacetate (MA) mixtures are commonly encountered from the manufacture of artificial rubber or polyurethane resin. This research attempts to employ a trickle-bed air biofilter (TBAB) for treating AT and MA mixtures under different influent carbon loadings. In the pseudo-steady-states, the elimination capacities of AT and MA increased but the removal efficiencies decreased with increased influent carbon loading. The removal efficiencies of MA were higher than those of AT showing that MA is a preferred substrate in the ATMA waste gas and the differences were enhanced at a high carbon loading. Greater than 95% AT removal and nearly complete MA removal were achieved with influent carbon loadings of AT and MA below 20 and 27 g m(-1) h(-1), respectively. The TBAB appears very efficient for treating ATMA emission with low to medium carbon loadings.

Removal of acrylonitrile and styrene mixtures from waste gases by a trickle-bed air biofilter.

The trickle-bed air biofilter (TBAB) performance for treating acrylonitrile (AN) and styrene (SR) mixtures was evaluated under different influent carbon loadings. In the pseudo steady state conditions, the elimination capacities of AN and SR increased but the removal efficiencies decreased with increased influent carbon loading. The removal efficiencies of AN were higher than those of SR, indicating that AN is a preferred substrate in the ANSR waste gas. More than 80% removal efficiencies were achieved with influent carbon loadings of AN and SR below 28 and 22 g/m(3)/h, respectively. The TBAB appears to be efficient for controlling ANSR emission with low to medium carbon loadings, and the effectiveness could be maintained over 175 days of laboratory operation. The elimination capacities of AN and SR for a pure volatile organic compound (VOC) feed were higher than those for a mixed VOC feed and the differences increased with increased influent VOC loading.

Treatment of methylacetate waste gas using a trickle-bed air biofilter.

The trickle-bed air biofilter (TBAB) performance for methylacetate (MA) removal from waste gases was evaluated under different gas flow rates and influent concentrations. In the pseudo-steady-state conditions, the elimination capacity increased but the removal efficiency decreased with the increase of MA loading. More than 95 and 90% removal efficiencies were achieved for influent MA loadings below 390 and 727 g/m3/h, respectively. The TBAB appears to be a very effective treatment process for controlling MA emission under low to high loading conditions, and the effectiveness could be maintained over 190 days of laboratory operation.

Treatment of N,N-dimethylacetamide waste gas by a trickle-bed air biofilter.

The system performance of a trickle-bed air biofilter (TBAB) for treating N,N-dimethylacetamide (DMAC) waste gas was investigated under different gas flow rates and influent concentrations. In the pseudo-steady-state conditions, the DMAC elimination capacity increased but the removal efficiency decreased as the influent loading increased. More than 90% and 80% DMAC removal efficiencies are achieved for influent loadings below 20.2 and 34.5 g DMAC/m3/h, respectively. The TBAB appears to be an effective treatment process for controlling DMAC emission with low-to-medium loadings and the effectiveness could be maintained over a long-period operation.

Coordination trends in alkali metal crown ether uranyl halide complexes: the series [A(crown)]2[UO(2)X(4)] where A=Li, Na, K and X=Cl, Br.

UO(2)(C(2)H(3)O(2))(2).2H(2)O reacts with AX or A(C(2)H(3)O(2) or ClO(4)) (where A = Li, Na, K; X = Cl, Br) and crown ethers in HCl or HBr aqueous solutions to give the sandwich-type compounds [K(18-crown-6)](2)[UO(2)Cl(4)] (1), [K(18-crown-6)](2)[UO(2)Br(4)] (2), [Na(15-crown-5)](2)[UO(2)Cl(4)] (3), [Na(15-crown-5)](2)[UO(2)Br(4)] (4), [Li(12-crown-4)](2)[UO(2)Cl(4)] (5), and [Li(12-crown-4)](2)[UO(2)Br(4)] (6). The compounds have been characterized by single-crystal X-ray diffraction, powder diffraction, elemental analysis, IR, and Raman spectroscopy. The [UO(2)X(4)](2-) ions coordinate to two [A(crown)](+) cations through the four halides only (2), through two halides only (3), through the two uranyl oxygens and two halides (3, 4), or through the two uranyl oxygen atoms only (5, 6). Raman spectra reveal nu(U-O) values that correlate with expected trends. The structural trends are discussed within the context of classical principles of hard-soft acid-base theory.

Crash severity, injury patterns, and helmet use in adolescent motorcycle riders.

BACKGROUND: This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders. METHODS: Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage. RESULTS: The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders. CONCLUSION: Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.

Removal of styrene vapor from waste gases by a trickle-bed air biofilter.

The trickle-bed air biofilter (TBAB) performance for the removal of high-strength styrene was evaluated under different gas flow rates and influent concentrations. Under pseudo-steady-state conditions, the elimination capacity increased but the removal efficiency decreased with the increase of styrene loading. More than 90 and 80% removal efficiencies were achieved for influent styrene loadings below 32 and 55g/m(3)/h, respectively. The TBAB appears to be an effective treatment process for controlling high-strength styrene emission under low-to-medium loading conditions, and the effectiveness could be maintained over 140 days of laboratory operation.

Removal of ethylacetate vapor from waste gases by a trickle-bed air biofilter.

Biofilter system is a relatively new process that has been proven to be more cost-effective than traditional technologies such as carbon adsorption, liquid scrubbing, condensation, thermal incineration, and catalytic incineration for removing low-strength volatile organic compounds from waste gases. The trickle-bed air biofilter (TBAB) performance for ethylacetate (EA) removal was evaluated under different influent loadings. In the pseudo-steady states, the elimination capacity increased, but the removal efficiency decreased with increased influent loading. More than 95 and 90% removal efficiencies could be achieved for EA loadings below 490 and 810 g m(-3) h(-1), respectively. The TBAB appears to be very effective for controlling EA emission under low to high loading conditions, and the effectiveness could be maintained over 190 days of laboratory operation.

Removal of BTEX vapor from waste gases by a trickle bed biofilter.

The system performance of a trickle bed biofilter for treating single and mixed benzene, toluene, ethylbenzene, and o-xylene (BTEX) vapors from waste gases was investigated under different gas flow rates and influent BTEX concentrations. When a single substrate was fed, removal efficiencies of greater than 90% could be achieved for the loads below 64 g benzene/m3/hr, 110 g toluene/m3/hr, 53 g ethylbenzene/m3/hr, and 55 g o-xylene/m3/hr. When a mixed substrate was fed, removal efficiencies of each compound could be above 90% at BTEX loads below 96 g/m3/hr. The trickle bed biofilter appears to be an effective treatment process for removing both single and mixed BTEX vapors with low to high loads. Under similar substrate loads, BTEX vapors were preferentially biodegraded in the order of toluene, benzene, o-xylene, and ethylbenzene. The volumetric removal rates (elimination capacities) of BTEX vapors for a single-substrate feed were higher than those for a mixed-substrate feed under similar substrate loads; these differences were enhanced at higher substrate loads and less significant for a preferred substrate.

Malfunction of an active fixation J-shaped screw-in atrial electrode lead: a case report.

Active fixation leads, using active grasping devices, ensure good postoperative lead fixation, long-term performance, and make possible later lead removal on demand. However, these delicate designs have not been without practical difficulties. We present two cases of fixation stylet fracture during helix extension and retraction maneuver respectively with resultant lead inoperability and abandonment. The fixed leads could be removed by torquing the entire lead counterclockwise.

Transvenous permanent left ventricular pacing. A case report.

This case report presents a patient who inadvertently received transvenous permanent left ventricular pacing through an unexpected atrial septal defect. This lead malpositioning was proved by two-dimensional and transesophageal echocardiography. The abnormal pattern of electric activation was demonstrated by radionuclide phase image analysis. He has been followed up for a total of forty-three months with antiplatelet therapy and has been free from systemic embolic phenomena. A simple and readily available method that could lead to early recognition of lead malpositioning is reiterated and the various causes, methods of detection, and prognosis of left ventricular pacing are discussed.

Cost and determinants of morbidity from work related disabling injuries in Taiwan.

OBJECTIVES: To estimate the cost and determinants of morbidity from work related disabilities. METHODS: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work. RESULTS: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990. CONCLUSION: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments.

Prevalence of antibody to hepatitis E virus among healthy individuals in southern Taiwan.

The seroprevalence of hepatitis E virus (HEV) among 997 healthy individuals aged 6 to 84 years, collected between July 1993 and June 1994 at Kaohsiung-Pingtung area in Southern Taiwan was studied. Of the study populations of vegetable farmers, elementary school children, volunteer blood donors and college students, the prevalence of IgG anti-HEV ranged from 6.4% to 8.8%. In suburban elemantary school children of Mang-Chou Village at Pingtung-Hsien, the seroprevalence rate (9.6%) was significantly higher than the positive rate (1.5%) found in rural aboriginal elementary school of San-Min Village at Kaohsiung-Hsien. IgG anti-HEV antibodies were widely distributed among all age groups, with a significantly higher percentage (13.1%) in the age group of 46-55 years old.

Vaporizer for volatile anesthetics during high-frequency jet ventilation.

At present, the potent inhalation anesthetics cannot be used during high-frequency jet ventilation (HFJV) because a suitable vaporizer is not available. A vaporizer for enflurane during HFJV was designed, built, and tested, based on the principle of airblast atomization in which liquid enflurane is delivered to the vaporizer by an infusion pump. Eight dogs were kept anesthetized with enflurane for 2 h using this device. Vital signs and arterial blood gases were within normal limits during anesthesia. The concentration of vaporized enflurane, measured by mass spectrometry, could be reliably and accurately controlled within the clinical range at any minute volume by adjusting the infusion rate. Measurements of blood enflurane indicated that enflurane uptake could be adequately achieved.

Detrimental cerebrometabolic effects of hyperoxia in newborn rats.

To investigate the pathogenesis of oxygen toxicity in the newborn brain, we exposed one-day-old Sprague-Dawley albino rats to 100% O(2) and measured whole-brain high-energy phosphates, glucose, lactate, and free fatty acids (FFA) after 0, 15, 30, 60 and 120 min. Whole-brain adenosine triphosphate and creatine phosphate fell significantly from about 4.5 to 2.5 ?mol-mg(?1) protein. Brain lactate remained at about 0.3 ?mol.mg(?1) protein in hyperoxic rats, but increased in normoxic rats, from 0.3 to 1.3 ?mol.mg(?1) protein at 120 min. Total FFA decreased from 30 to 15 nmol.mg(?1) protein during normoxia, but increased to 40 nmol.mg(?1) protein during hyperoxia. Undetectable in normoxic rats, arachidonic acid increased to between 4 and 6 nmol.mg(?1) protein during hyperoxia while oleic acid increased by two to threefold. In normoxia, palmitate decreased by 70% from 12 to 4 nmol.mg(?1) protein whereas in hyperoxia it remained at 10 nmol.mg(?1) protein. Normobaric 100% O(2) has detrimental metabolic effects on the neonatal brain which cannot be attributed to cerebral vasospasm or seizure-induced cerebral anoxia because lactic acidosis was not observed. FFA changes suggest that a likely explanation is membrane lipid peroxidation from O(2)-induced free radicals.