Screening for women with increased risk of fragility fractures in a general female population using digital X-ray radiogrammetry (DXR).

OBJECTIVE: To evaluate the predictive ability of digital X-ray radiogrammetry (DXR) for fracture in women attending general mammography screening. STUDY DESIGN: In a nested case-control study, women aged between 40 and 75 years, who attended the regional mammography screening program, had their bone mass assessed with DXR and provided information regarding clinical risk factors for osteoporosis. Follow-up was done through cross-referencing with National Patient Registers. Associations between DXR, clinical risk factors and fracture risk were examined. Receiver operating characteristics curves for DXR T-score and different fracture types were plotted, and their respective AUC calculated. MAIN OUTCOME MEASURES: Fractures (hip, major osteoporotic and any clinical facture). Fracture diagnoses were retrieved from National Patient Registers. RESULTS: 14,841 women had their bone mass examined in conjunction with mammography. Of these women, 10,967 returned fully completed questionnaires regarding clinical risk factors. In total 605 fractures (including 355 major osteoporotic fractures and 18 hip fractures) occurred during the follow-up period (median follow-up time was 3.3 years). Women with fractures were older and had lower DXR T-score compared with those without. DXR T-score correlated with fracture risk. HR/SD T-score decrease was 2.15 (CI 1.55-3.00) for hip, 1.47 (CI 1.36-1.59) for major osteoporotic and 1.33 (CI 1.26-1.42) for any clinical fracture. The AUCs for the different fracture types were 0.79 (hip), 0.69 (major osteoporotic) and 0.65 (any clinical). CONCLUSIONS: DXR T-score is negatively correlated with risk of fracture in a general female population. This indicates a potential use of DXR in population-based screening for osteoporosis.

Nonuniversal power-law spectra in turbulent systems.

Turbulence is generally associated with universal power-law spectra in scale ranges without significant drive or damping. Although many examples of turbulent systems do not exhibit such an inertial range, power-law spectra may still be observed. As a simple model for such situations, a modified version of the Kuramoto-Sivashinsky equation is studied. By means of semianalytical and numerical studies, one finds power laws with nonuniversal exponents in the spectral range for which the ratio of nonlinear and linear time scales is (roughly) scale independent.

Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk--a study in 5,420 women and 2,837 men.

OBJECTIVES: To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. METHODS: A total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age ≥ 40 years, no prior hip fracture and observation time > 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. RESULTS: 8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. CONCLUSIONS: DXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. KEY POINTS: • Digital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. • Digital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. • Osteoporosis can potentially be identified in patients with suspected wrist fractures. • DXR can potentially be used for selective osteoporosis screening.

Dissipation layers in Rayleigh-Bénard convection: a unifying view.

Boundary layers play an important role in controlling convective heat transfer. Their nature varies considerably between different application areas characterized by different boundary conditions, which hampers a uniform treatment. Here, we argue that, independent of boundary conditions, systematic dissipation measurements in Rayleigh-Bénard convection capture the relevant near-wall structures. By means of direct numerical simulations with varying Prandtl numbers, we demonstrate that such dissipation layers share central characteristics with classical boundary layers, but, in contrast to the latter, can be extended naturally to arbitrary boundary conditions. We validate our approach by explaining differences in scaling behavior observed for no-slip and stress-free boundaries, thus paving the way to an extension of scaling theories developed for laboratory convection to a broad class of natural systems.

Wave-number-frequency spectrum for turbulence from a random sweeping hypothesis with mean flow.

We derive the energy spectrum in wave-number-frequency space for turbulent flows based on Kraichnan's idealized random sweeping hypothesis with additional mean flow, which yields the instantaneous energy spectrum multiplied by a Gaussian frequency distribution. The model spectrum has two adjustable parameters, the mean flow velocity and the sweeping velocity, and has the property that the power-law index of the wave-number spectrum translates to the frequency spectrum, invariant for arbitrary choices of the mean velocity and sweeping velocity. The model spectrum incorporates both Taylor's frozen-in flow approximation and the random sweeping approximation in a natural way and can be used to distinguish between these two effects when applied to real time-resolved multipoint turbulence data. Evaluated in real space, its properties with respect to space-time velocity correlations are discussed, and a comparison to the recently introduced elliptic model is drawn.

Statistical analysis of global wind dynamics in vigorous Rayleigh-Bénard convection.

Experimental and numerical studies of thermal convection have shown that sufficiently vigorous convective flows exhibit a large-scale thermal wind component sweeping along small-scale thermal boundary layer instabilities. A characteristic feature of these flows is an intermittent behavior in the form of irregular reversals in the orientation of the large-scale circulation. There have been several attempts toward a better understanding and description of the phenomenon of flow reversals, but so far most of these models are based on a statistical analysis of few-point measurements or on simplified theoretical assumptions. The analysis of long-term data sets (>5×10(5) turnover times τ(t)=d/u(rms)) obtained by numerical simulations of turbulent two-dimensional Rayleigh-Bénard convection allows us to get a more comprehensive view of the spatio-temporal flow behavior. By means of a global statistical analysis of the characteristic spatial modes of the flow we extract information about the stability of dominant large-scale modes as well as the reversal paths in state subspace. We examine probability density functions and drift vector fields of two-dimensional state subspaces spanned by different large-scale spatial modes. This also provides information about the coexistence of dominant modes.

Lagrangian particle statistics in turbulent flows from a simple vortex model.

The statistics of Lagrangian particles in turbulent flows is considered in the framework of a simple vortex model. Here, the turbulent velocity field is represented by a temporal sequence of Burgers vortices of different circulation, strain, and orientation. Based on suitable assumptions about the vortices' statistical properties, the statistics of the velocity increments is derived. In particular, the origin and nature of small-scale intermittency in this model is investigated both numerically and analytically. We critically compare our results to experimental studies.

Paramecium--a model system for studying cellular graviperception.

Experiments under varied gravitational accelerations as well as in density-adjusted media showed that sensation of gravity in protists may be linked to the known principles of mechanosensation. Paramecium, a ciliate with clear graviresponses (gravitaxis and gravikinesis) is an ideal model system to prove this hypothesis since the ciliary activity and thus the swimming behaviour is controlled by the membrane potential. It has also been assumed that the cytoplasmic mass causes a distinct stimulation of the bipolarly distributed mechano-sensitive K+ and Ca2+ ion channels in the plasma membrane in dependence of the spatial orientation of the cell. In order to prove this hypothesis, different channel blockers are currently under investigation. Gadolinium did not inhibit gravitaxis in Paramecium, showing that it does not specifically block gravireceptors. Further studies concentrated on the question of whether second messengers are involved in the gravity signal transduction chain. Exposure to 5 g for up to 10 min led to a significant increase in cAMP.

Lassa fever encephalopathy: Lassa virus in cerebrospinal fluid but not in serum.

The pathogenesis of neurologic complications of Lassa fever is poorly understood. A Nigerian patient had fever, disorientation, seizures, and blood-brain barrier dysfunction, and Lassa virus was found in cerebrospinal fluid (CSF) but not in serum. The concentration of Lassa virus RNA in CSF corresponded to 1 x 10(3) pfu/mL, as determined by a quantitative real-time polymerase chain reaction assay. To characterize the Lassa virus in CSF, the 3.5-kb S RNA was sequenced. In the S RNA coding sequences, the CSF strain differed between 20% and 24.6% from all known prototype strains. These data suggest that Lassa virus or specific Lassa virus strains can persist in the central nervous system and thus contribute to neuropathogenesis. Lassa virus infection should be considered in West African patients or in travelers returning from this area who present only with fever and neurologic signs.