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Background The incidence and causes of facial fractures differ between patients, but patterns arise within populations. These patterns vary by gender, age, and between countries. This study aims to determine variables to identify patients at risk for facial fractures in a United States trauma population.Methods This is a single-center study of Trauma Registry data, inclusive of years July 1, 2016, to January 31, 2022. Inclusion criteria were based upon all trauma patients. Confirmation of a non-isolated facial fracture (dependent variable) was verified using ICD10 diagnosis codes. A logistic regression was performed in SPSS to ascertain the effects of predictor variables on the likelihood that a trauma patient will experience a facial fracture.Results 20377 patients were included in the analysis based upon the requirements specified in the methods section; 1575 (7%) had a positive facial fracture. The logistic regression model was statistically significant (N = 18507, P< .01). Significant risk factors for facial fracture identified included helicopter transport (OR = 1.35, P< .01) and increasing injury severity scores (OR = 1.07, P< .01). Modes of injury most likely to predict facial fracture included assault (OR = 6.62, P< .01), moped (OR = 2.02, P< .01), and motorcycle trauma (OR = 1.55, P< .01). The discharge disposition most likely among facial fracture patients included short-term general hospital (OR = 1.71, P< .01) and intermediate care facility (OR = 4.47, P< .01).Conclusions Patients with traumatic injuries from assault, moped, and motorcycle accidents were more likely to present with facial fractures. These patients had more severe injuries, seen as increased ISS scores, higher likelihood of transport by helicopter, and the need for additional care after discharge.

The nation was never more united in a common cause. During World War II, more than 16 million Americans upended their lives to join the fight against the Axis powers. [...]

Background: Insulin sensitivity (Si) is improved by weight loss and exercise, but the effects of the replacement of saturated fatty acids (SFAs) with monounsaturated fatty acids (MUFAs) or carbohydrates of high glycemic index (HGI) or low glycemic index (LGI) are uncertain. Objective: We conducted a dietary intervention trial to study these effects in participants at risk of developing metabolic syndrome. Design: We conducted a 5-center, parallel design, randomized controlled trial [RISCK (Reading, Imperial, Surrey, Cambridge, and Kings)]. The primary and secondary outcomes were changes in Si (measured by using an intravenous glucose tolerance test) and cardiovascular risk factors. Measurements were made after 4 wk of a high-SFA and HGI (HS/HGI) diet and after a 24-wk intervention with HS/HGI (reference), high-MUFA and HGI (HM/HGI), HM and LGI (HMFLGI), low-fat and HGI (LF/HGI), and LF and LGI (LF/LGI) diets. Results: We analyzed data for 548 of 720 participants who were randomly assigned to treatment. The median Si was 2.7 x [10.sup.-4] mL x [micro][U.sup.-1] x [min.sup.-1] (interquartile range: 2.0, 4.2 x [10.sup.-4] mL x [micro][U.sup.-1] x [min.sup.-1]), and unadjusted mean percentage changes (95% CIs) after 24 wk treatment (P = 0.13) were as follows: for the HS/HGI group, -4% (-12.7%, 5.3%); for the HM/HGI group, 2.1% (-5.8%, 10.7%); for the HM/LGI group, -3.5% (-10.6%, 4.3%); for the LF/HGI group, -8.6% (-15.4%, -1.1%); and for the LF/LGI group, 9.9% (2.4%, 18.0%). Total cholesterol (TC), LDL cholesterol, and apolipoprotein B concentrations decreased with SFA reduction. Decreases in TC and LDL-cholesterol concentrations were greater with LGI. Fat reduction lowered HDL cholesterol and apolipoprotein A1 and B concentrations. Conclusions: This study did not support the hypothesis that isoenergetic replacement of SFAs with MUFAs or carbohydrates has a favorable effect on Si. Lowering GI enhanced reductions in TC and LDL-cholesterol concentrations in subjects, with tentative evidence of improvements in Si in the LF-treatment group. This trial was registered at clinicaltrials.gov as ISRCTN29111298. Am J Clin Nutr 2010;92:748-58. doi: 10.3945/ajcn.2009.29096.

Among the elements of the first Troubled Asset Relief Program (TARP) bill voted into law on October 3, 2008, was the temporary suspension of the progressive phasing-in process of Statement [...]

Background: The process of randomization is used commercially to harden fats as an alternative to partial hydrogenation, but its effects on cardiovascular disease risk factors are uncertain. Objective: The objective was to compare the chronic and acute effects of randomization of a fat rich in 1,3-distearyl, 2-oleyl glycerol on fasting and postprandial lipids, glucose, insulin, and activated clotting factor VII (FVIIa) concentrations. Design: A crossover design study in 16 men compared fasting and postprandial lipid, glucose, insulin, and FVIIa concentrations at baseline and after a 3-wk diet providing 30 g unrandomized or randomized shea butter and sunflower oil blends (SSOBs), both of which contained [approximately equal to] 50% stearic acid. Fecal fat excretion was measured during each dietary period. Postprandial changes were assessed after the consumption of meals providing 50 g test fat. A subsequent study compared postprandial changes after the consumption of an oleic acid--rich sunflower oil meal and an unrandomized SSOB meal. Results: Both SSOBs were well digested and absorbed. Randomization did not affect fasting or postprandial lipid, glucose, insulin, or FVIIa concentrations. Compared with the oleic acid--rich meal, the unrandomized SSOB resulted in 53% lower postprandial lipemia, 23% higher hepatic lipase activity, and a 25% lower postprandial increase in FVIIa concentration. The solid fat contents at 37 [degrees]C were 22%, 41%, and 0% with the unrandomized SSOB, randomized SSOB, and oleic acid--rich meals, respectively. Conclusions: Stearic acid--rich triacylglycerol in both unrandomized and randomized forms does not adversely affect lipid risk factors for cardiovascular disease. The high proportion of solid fat at 37 [degrees]C may explain the decreased postprandial lipemic response. KEY WORDS Stearic acid, postprandial lipemia, factor VII, triacylglycerol structure, fat digestion, physical properties of fats, randomization

Background: Insulin resistance is associated with elevated plasma triacylglycerol, low HDL concentrations, elevated postprandial lipemia, and a predominance of small, dense LDLs (sdLDLs). It has been hypothesized that the dietary ratio of n-6 to n-3 (n-6:n-3) polyunsaturated fatty acids (PUFAs) may have favorable effects on these risk factors by increasing insulin sensitivity. Objective: The objective was to measure changes in insulin sensitivity, lipoprotein size, and postprandial lipemia after a 6-mo alteration in n-6:n-3. Design: In a randomized, parallel design in 258 subjects aged 45-70 y, we compared 4 diets providing 6% of energy as PUFAs with an n-6:n-3 between 5:1 and 3:1 with a control diet that had an n-6: n-3 of 10:1. The diets were enriched in [alpha]-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or both. Insulin sensitivity was assessed with the homeostatic model assessment of insulin resistance and the revised quantitative insulin sensitivity test. Results: Dietary intervention did not influence insulin sensitivity or postprandial lipase activities. Fasting and postprandial triacylglycerol concentrations were lower, and the proportion of sdLDLs decreased (by 12.7%; 95% CI: -22.9%, 2.4%), with an n-6:n-3 of [approximately equal to] 3:1, which was achieved by the addition of long-chain n-3 PUFAs (EPA and DHA). Conclusions: Decreasing the n-6:n-3 does not influence insulin sensitivity or lipase activities in older subjects. The reduction in plasma triacylglycerol after an increased intake of n-3 long-chain PUFAs results in favorable changes in LDL size. KEY WORDS Blood lipids, n-3 fatty acids, n-6 fatty acids, insulin sensitivity, lipoprotein lipase, LDL, HDL, long-chain polyunsaturated fatty acids

Background: Elevated fibrinogen, activated factor XII (FXIIa), and factor VII coagulant activity (FVIIc) are associated with higher risk of fatal ischemic heart disease. This study tested the hypothesis that lowering the dietary ratio of n-6 to n-3 polyunsaturated fatty acids (n-6:n-3) would modify these risk factors in older men and women. Objective: The objective of the study was to measure fasting hemostatic risk factors and postprandial changes in activated FVII (FVIIa) concentrations after a 6-mo alteration in dietary n-6:n-3. Design: In a randomized, parallel design in 258 subjects aged 45-70 y, we compared 4 diets providing 6% of energy as polyunsaturated fatty acids at an n-6:n-3 between 5:1 and 3:1 with a control diet that had an n-6:n-3 of 10:1. The diets were enriched in [alpha]-linolenic acid, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid, or both. Results: Fasting and 3-h plasma triacylglycerol concentrations were 11.1% and 7.2% lower with the diet that had an n-6:n-3 of [approximately equal to] 3:1 and that was enriched with EPA and DHA than with the other diets. Fasting fibrinogen, FXIIa, FVIIc, FVIIa, and FVII antigen and post-prandial FVIIa were not influenced by the diets. Avoiding foods high in fat the day before measurement decreased FVIIc and FVIIa by 8% and 19.2%, respectively. A test meal containing 50 g fat resulted in a mean 47% (95% CI: 42%, 52%) increase in FVIIa 6 h later, but the response did not differ by n-6:n-3. Conclusion: Decreasing the n-6:n-3 to [approximately equal to] 3:1 by increasing the intake of EPA and DHA lowers fasting and postprandial plasma triacylglycerol concentrations in older persons but does not influence hemostatic risk factors. KEY WORDS Factor VII, factor XII, n-3 fatty acids, ratio of n-6 to n-3 fatty acids, triacylglycerol, nonesterified fatty acids, fibrinogen

Traditionally, demand deposits have been used as a primary source to fund bank balance sheets. Such core deposits are more stable than short-term borrowing or other volatile liabilities. As commercial [...]

Background: Plasma concentrations of long-chain n-3 polyunsaturated fatty acids are lower in vegetarians and in vegans than in omnivores. No data are available on whether these concentrations differ between long- and short-term vegetarians and vegans. Objectives: We compared plasma fatty acid composition in meat-eaters, vegetarians, and vegans and examined whether the proportions of eicosapentaenoic acid (20:5n-3; EPA), docosapentaenoic acid (22:5n-3; DPA), and docosahexaenoic acid (22:6n-3; DHA) were related to the subjects' duration of adherence to their diets or to the proportions of plasma linoleic acid (18:2n-6; LA) and [alpha]-linolenic acid (18:3n-3; ALA). Design: The present cross-sectional study included 196 meat-eating, 231 vegetarian, and 232 vegan men in the United Kingdom. Information on anthropometry, diet, and smoking habits was obtained through a questionnaire. Total fatty acid composition in plasma was measured. Results: The proportions of plasma EPA and DHA were lower in the vegetarians and in the vegans than in the meat-eaters, whereas only small differences were seen for DPA. Plasma EPA, DPA, and DHA proportions were not significantly associated with the duration of time since the subjects became vegetarian or vegan, which ranged from < 1 y to >20 y. In the vegetarians and the vegans, plasma DHA was inversely correlated with plasma LA. Conclusions: The proportions of plasma long-chain n- 3 fatty acids were not significantly affected by the duration of adherence to a vegetarian or vegan diet. This finding suggests that when animal foods are wholly excluded from the diet, the endogenous production of EPA and DHA results in low but stable plasma concentrations of these fatty acids. KEY WORDS n-3 Fatty acids, vegetarians, vegans, cross-sectional study

Background: Decreased fibrinolytic activity is associated with an increased risk of ischemic heart disease and elevated plasma triacylglycerol concentrations. Objective: The goal was to determine whether plasminogen activator inhibitor 1 (PAI-1) and fibrinolytic activities are influenced by 1) dietary fat intake from a test meal and 2) the PAI-1 4G allele. Design: A parallel randomized controlled trial was used to compare the effect on fibrinolytic activity, measured as dilute clot lysis time, of high-oleate or high-palmitate test meals (both containing 50 g fat; both n = 18) with that of a low-fat test meal (15 g fat; n = 15) in men aged > 52 y. In a second study, postprandial changes in PAI-1 activity were measured in 32 men in response to a high-oleate meal containing 50 g fat. The results from both studies were analyzed according to PAI-1 4G-675/5G genotype. Results: Fasting dilute clot lysis time was positively associated with body mass index (r = 0.326, P = 0.02) and was shortened postprandially (P < 0.00001) independent of the fat content of the meal. Fasting PAI- 1 activity was higher in those carrying the 4G allele and was correlated with fasting plasma triacylglycerol concentrations (r = 0.48, P = 0.008) and factor VII coagulant activity (r = 0.46, P = 0.012) after adjustments for age, body mass index, and genotype. Plasma PAI-1 activity decreased significantly after a meal but was not associated with postprandial changes in plasma triacylglycerols after a high-fat meal. The postprandial increase in plasma triacylglycerols was higher in subjects carrying the 4G allele. Conclusion: Fibrinolytic activity is not lower after meals rich in palmitate or oleate than after a low-fat meal. KEY WORDS Plasminogen activator inhibitor 1, PAI-1, monounsaturated fatty acids, saturated fatty acids, PAI 4G-675/5G, fibrinolysis

Background: Long-chain n-3 polyunsaturated fatty acids have variable effects on LDL cholesterol, and the effects of docosahexaenoic acid (DHA) are uncertain. Objective: The objective of the study was to determine the effect on blood lipids of a daily intake of 0.7 g DHA as triacylglycerol in middle-aged men and women. Design: Men and women aged 40-65 y (n = 38) underwent a double-blind, randomized, placebo-controlled, crossover trial of treatment with 0.7 g DHA/d for 3 mo. Results: DHA supplementation increased the DHA concentration in plasma by 76% (P < 0.0001) and the proportion in erythrocyte lipids by 58% (P < 0.0001). Values for serum total cholesterol, LDL cholesterol, and plasma apolipoprotein B concentrations were 4.2% (0.22 retool/L; P = 0.04), 7.1% (0.23 mmol/L; P = 0.004), and 3.4% (P = 0.03) higher, respectively, with DHA treatment than with placebo. In addition, the LDL cholesterol:apolipoprotein B ratio was 3.1% higher with DHA treatment than with placebo (P = 0.04), which suggested an increase in LDL size. Plasma lathosterol and plant sterol concentrations were unaffected by treatment. Conclusion: A daily intake of [approximately equal to] 0.7 g DHA increases LDL cholesterol by 7% in middle-aged men and women. It is suggested that DHA down-regulates the expression of the LDL receptor. KEY WORDS Lipids, docosahexaenoic acid, LDL

Background: The consumption of a synthetic, randomized, stearic acid-rich triacylglycerol results in decreased postprandial lipemia and activated factor VII (FVII:a) compared with cocoa butter (a nonrandomized, symmetrical, stearic acid-rich triacylglycerol). It was hypothesized that this difference is a consequence of the differences in structure between the 2 triacylglycerols. Objective: The objective was to test whether the consumption of randomized cocoa butter decreases postprandial lipemia and FVII:a. Design: A randomized crossover trial with 17 male subjects compared the effects of meals containing 50 g fat provided as a symmetrical (cocoa butter) or an asymmetrical (randomized cocoa butter) triacylglycerol on postprandial changes in lipids, chylomicron composition, and FVII:a. Results: After randomization, the postprandial area under the curve for plasma triacylglycerol decreased by 41% (P < 0.01). At 3 h the plasma concentrations of triacylglycerol, palmitic acid, stearic acid, and oleic acid were 26%, 18%, 34%, and 19% lower, respectively. The proportion of oleic acid in the sn-2 position of the chylomicron triacylglycerol was reduced from 67.4 mol% to 35.9 mol% and resulted in an increase in the proportion of stearic acid in the sn-2 position from 9.2 mol% to 25.4 mol%. FVII:a did not increase 6 h after consumption of the randomized cocoa butter ([bar][chi]: 1.2; 95% CI: -2.7, 4.6 U/L) but increased significantly ([bar][chi]: 7.7; 95% CI: 2.5,12.9 U/L) 6 h after consumption of the unrandomized cocoa butter. Conclusions: Symmetrical stearic acid-rich triacylglycerol with oleic acid in the sn-2 position appears to be absorbed more rapidly than is asymmetrical triacylglycerols with long-chain saturated fatty acids in the sn-2 position, which leads to activation of FVII. KEY WORDS Factor VII, stearic acid, postprandial lipemia, saturated fatty acids, triacylglycerols, digestion

Background: Soybeans contain estrogenic isoflavones that may influence plasma concentrations of transforming growth factor [[beta].sub.1] (TGF-[[beta].sub.1]) and plasma lipid and hemostatic risk factors for coronary heart disease. Objective: We compared the effects of moderate intakes of soy protein containing intact phytoestrogens (high-isoflavone diet) and soy protein from which most of the phytoestrogens had been extracted (low-isoflavone diet) on active TGF-[[beta].sub.1] concentrations and plasma lipid and hemostatic risk factors for coronary heart disease. Design: A randomized crossover trial was conducted in 22 young, healthy, normolipidemic subjects (5 men and 17 women) who consumed diets providing 56 or 2 mg isoflavones/d for 17 d each with a 25-d washout period between treatments. Fasting blood samples were obtained on days 13 and 14 of each treatment to measure plasma isoflavone, lipid, fibrinogen, and active TGF-[[beta].sub.1] concentrations and factor VII coagulant and plasminogen activator inhibitor type 1 activities. Results: Plasma isoflavone concentrations were 100-999 times greater after the high-isoflavone diet than after the low-isoflavone diet (P < 0.05). Plasma HDL-cholesterol and apolipoprotein A-I concentrations were 4% (95% CI: 1%, 8%) and 6% (95% CI: 3%, 10%) higher, respectively, after the high-isoflavone diet than after the low-isoflavone diet (P < 0.01 for both). Conclusion: Compared with soy protein from which most of the phytoestrogens have been extracted, soy protein with intact phytoestrogens increases HDL-cholesterol and apolipoprotein A-I concentrations but does not influence LDL-cholesterol, TGF-[[beta].sub.1] or fibrinogen concentrations; factor VII coagulant activity; or plasminogen activator inhibitor type 1 activity in normolipidemic, healthy subjects. KEY WORDS Isoflavones, phytoestrogens, genistein, transforming growth factor [beta] 1, plasma lipids, lipoproteins, factor VII coagulant, fibrinogen, plasminogen activator inhibitor, soy, coronary heart disease, coronary artery disease

Index futures price biases are investigated and analyzed. Future volatility is better forecast using option-implied volatility.

In monotectic systems, there are thermodynamic restrictions on compositions and temperatures below the monotectic where the equilibrium solid cannot form directly from the undercooled homogeneous liquid. In this region, the solid can form only after liquid – liquid phase separation has occurred. As suggested by earlier research, the thermodynamic restrictions on the solidification process may be useful to control the microstructure of rapidly solidified materials. Thus, it could be commercially important to understand the thermodynamic limitations on the formation of the solid in monotectic systems. The liquid miscibility gaps, metastable liquidi, and spinodal curves in the binary Zn– Bi, Zn–Pb, and Zn–Tl systems were assessed by using a subregular solution model to describe the Gibbs energies of the liquid phases. The present results were compared and discussed with other experimental and assessed data available in the literature.

A new measure of tourism spending expenditures, using sales tax data, might be more complete than other methods found in the literature. The authors assert that benefits of tourism spending can be measured only in terms of profits in the form of actual taxes the jurisdiction collect and by returns to tourism proprietors, net of expenses. In contrast, other studies that focus only on gross spending overestimate the benefits of tourism.

A matched-control study of plasma retinol, [alpha]-tocopherol, carotenoid, and cholesterol concentrations and the polyunsaturated fatty acid content of plasma and erythrocyte phospholipids was undertaken in 65 elderly patients with age-related maculopathy and 65 control subjects matched for age and sex. Despite the high statistical power of the study and large variations between subjects in the variables under consideration, no significant differences were noted between patients and control subjects. However, several statistically significant differences were noted between male and female subjects independent of their classification with maculopathy or as controls and age: plasma cholesterol, total phospholipids, [alpha]-tocopherol, and [beta]-cryptoxanthin concentrations were higher in females than in males. The mean plasma cholesterol concentration for the upper tertile of the whole sample was 7.6 mmol/L. Plasma concentrations of total carotenoids, [alpha]-carotene, and [beta]-carotene, but not [alpha]-tocopherol, were significantly lower in smokers than in nonsmokers. The results of this study do not provide any evidence in favor of changing the dietary intake of polyunsaturated fatty acids or fat-soluble vitamins to protect against age-related maculopathy. Am J Clin Nutr 1993;57:428-33

Background: Jones fractures of the proximal fifth metatarsal are predisposed to delayed union and nonunion due to a tenuous blood supply. Solid intramedullary (IM) screw fixation is recommended to improve healing, traditionally followed by delayed weightbearing (DWB). However, early weightbearing (EWB) postoperatively may facilitate functional recovery. The purpose of this study was to compare union rates and time to union after solid IM screw fixation of Jones fractures in patients treated with an EWB protocol to those treated with a DWB protocol, as well as to identify any factors that may be predictive of delayed or nonunion.Methods: True Jones (zone 2 fifth metatarsal base) fractures treated from April 2012 through January 2018 with IM screw fixation and 6 months follow-up were identified (41 fractures in 40 patients; mean ± SD age, 45.3 ± 17.9 years). Patients were divided into EWB and DWB cohorts (within or beyond 2 weeks, respectively). Delayed union (12.5 weeks) was statistically derived from established literature. Union times were compared between cohorts. Regression analyses were conducted to investigate possible confounders contributing to delayed union. There were 20 fractures in the EWB cohort and 21 fractures in the DWB cohort.Results: There was no significant difference in healing times (EWB: 25% by 6th week, 55% by the 12th week, 20% delayed; DWB: 33% by 6th week, 43% by 12th week, 24% delayed; P= .819) or delayed unions (EWB, 20% vs DWB, 24%; P> .999). There were no nonunions. No significant confounding risk factors were identified.Conclusion: Postoperative protocols using early weightbearing following solid IM screw fixation of Jones fractures appear to be safe and do not delay fracture healing or increase the risk of delayed union. Older age may be a risk for delayed union, but larger studies are needed to evaluate this with appropriate power in light of possible confounders. EWB protocols may allow better functional recovery without compromising outcomes by increasing the risk of delayed union.Level of Evidence: Therapeutic level III, retrospective comparative study.

Objective Osteochondritis dissecans (OCD) is a knee disorder of predominately pediatric populations. Because of low incidence, it has traditionally been difficult to study OCD. The purpose of this study was to report long-term outcomes of skeletally immature OCD lesions and determine risk factors for persistent knee pain at final follow-up.Design A geographic database of more than 500,000 patients was reviewed to identify patients with knee OCD. Clinical course including operative management, persistent knee pain, and total knee arthroplasty (TKA) were analyzed through review of radiographs, magnetic resonance images, and physician notes.Results A total of 95 skeletally immature patients (70 male, 25 female, mean age 12.5 ± 2.0 years) were followed for a mean of 14 years (range, 2-40 years). Fifty-three patients were treated operatively and 42 were treated nonoperatively. At final follow-up, 13 patients noted persistent knee pain, 8 treated operatively versus 5 treated nonoperatively. Risk factors for knee pain were female gender, patellar lesions, and unstable lesions. Four patients (8%) treated operatively and 2 patients (5%) treated nonoperatively developed symptomatic osteoarthritis at a mean of 28.6 years following diagnosis. Three patients underwent TKA at a mean age of 52 years, significantly younger than that observed for primary TKA at our institution (P= 0.004).Conclusions Skeletally immature OCD patients have promising histories, with an estimated 14% risk of persistent knee pain, 6% symptomatic osteoarthritis, and 3% conversion to TKA at 14 years’ mean follow-up. Females, patellar lesions, and unstable lesions demonstrated increased persistent knee pain risk. Patients with OCD undergo TKA at a significantly younger age than the general population.

A technique used by the Trinity River Authority of Texas to replace a sewer tunnel under surface obstacles is presented. Replacement of an aging 20-mgd sewage lift station, force main and downstream interceptor sewer was recommended as part of improvements on the Jefferson Avenue Relief Tunnel, which provides wastewater transportation and treatment services for 20 cities and the Fort Worth International Airport. Trenchless technology was used to minimize disturbance to surface structures such as residential areas, roads and highways a school and a defense plant installation. The project cost $6.4 million., Rehabilitating or replacing underground infrastructure is a challenge for many utilities. Surface development may prevent using conventional engineering and construction methods or make them cost-prohibitive. These constraints can also present [...]

PART I: A STUDY IN THE MELTING EFFECTIVENESS OF SOLID CHEMICAL DEICERS Cities around the United States use thousands of tons of road deicer to help keep roads safe during [...]

Several reconstructive techniques exist to treat posterior cruciate ligament (PCL) deficiency. The purpose of this study is to report knee function and clinical stability after PCL reconstruction (PCLR) using an all-inside technique. Thirty-two patients with isolated or combined PCL injuries treated with all-inside PCLR using soft tissue allograft were included. Documented physical examination findings including ligamentous stability examination were recorded. All-inside, single-bundle PCLR demonstrated satisfactory clinical and functional outcomes comparable with previous other PCLR techniques. The advantages of this technique include bone preservation, minimizing risk of tunnel convergence, and allowing for sequential graft tensioning.

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis.Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years).Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 (P< .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place.Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates.Level of Evidence: Level IV, case series.

The long-awaited U.S. Supreme Court decision on required Bible reading and recitation of the Lord's Prayer in public schools is a significant affirmation of minority rights in a religiously pluralistic society. In declaring unconstitutional state laws that prescribed these religious practices, the court has responded to the realities of American society in the mid-twentieth century, though its discussion of establishment of religion bears only remotely on the concept set forth in the First Amendment. The original First Amendment barred from establishing a religion, solely in the sense of giving special privileges to a single denomination. The Supreme Court has rendered many more church-state decisions since 1940 than it did in the previous century and a half, nearly all involving the First Amendment as applied to state arid local statutes by the Fourteenth Amendment.

The article discusses the implications of greater interference in and control of industry by governments and governmental agencies in the United States. The efforts of the Interstate Commerce Commission and state government commissions to regulate public utilities under a uniform accounting and reporting system are described, as well as the National Recovery Administration's efforts to establish similar standards for manufacturing and merchandising industries. The various stages of accounting work that would be affected by public regulation are presented, including companies' internal records, external reports, and accounting and cost schedules. Details related to the regulations' effectiveness in preventing price cutting are also discussed.

The article mentions accounting interpretation in the United States and the steel industry's wage policy. The stance of the United Steelworkers of America has been that corporate profits are substantial enough to support higher wages and still allow a fair return on capital. The issue is whether profit figures in accounting reports are accurate or companies are understating their profits with charges against their income accounts such as depreciation. The union presented the contention that--in a single year--steel companies have concealed as much as $210 million in profits. Topics include five reasons for basing depreciation on first cost, the distinction between accounting income and economic or real income, and consideration of the costs of replacing inventory or equipment as profits.

The article discusses the impact of military expenditures and sustained military readiness on the United States economy, in light of a North Korean attack on South Korea on June 25, 1950 and the potential for Russian aggression in Europe. America needs industrial mobilization, sustained productive capacity, and a supply of superior weapons to protect itself and contribute to European rearmament. At the same time, the U.S. needs to protect its civilian economy from inflationary pressures. Topics include data from the military budget, estimate of the potential labor force and the rate of productivity that affect output, the tax burden of mobilization, price and wage controls, and rationing.

The article refers to government policy on accounting practices in the United States. Controversies have arisen in accounting because it is applied to business problems and government policy on trade regulation, taxes, and profits. Examples include confusion over the original cost rule in financial accounting and base points in pricing related to cost accounting and budgeting. Policy perspectives of the Federal Trade Commission, Interstate Commerce Commission, Civil Aeronautics Board, and Federal Power Commission are mentioned. Topics include the views of Lord MacMillan on two types of thinking, amortization for utilities transferring property within the industry, three explanations for "write-ups," fair commercial value negotiated at arm's length, and tax formulation in California.

The most important financial accounting discussions of recent times relate to the problems arising from the higher price levels; the disparity between original cost of plant and the replacement costs which will some day have to be met; and the resulting accounting difficulties, especially in the determination of annual income. It is the purpose of this article to put these problems in perspective and to try to strike some sort of over-all balance among the many thinkers and writers who have taken positions on various aspects of the issue involved. [ABSTRACT FROM AUTHOR]

The article focuses on the annual report, which provides stockholders with a portrait of the company's operations and financial performance. Annual reports contain financial statements and define the corporate image for shareholders, employees, customers, and the general public. The company report might include a statement from the corporate president, which refers to the company's future development. The United States Securities and Exchange Commission requires that company accounts be reviewed by an independent accountant whose findings are included in the annual report. Topics include a shift in business communication style, the issue of making financial statements more readable which could also make them misleading, and the purpose of income statements.

The article discusses the accounting practices and attitudes which have developed in Great Britain and the resulting public understanding of company affairs and accountants' credibility. The article discusses the calculation of depreciation, disclosure of secret or "inner" reserves, valuation of inventories, audit of accounts receivable, publishing of consolidated statements, changes in accounting practice, and accountants' insurance against liability for malpractice. The article questions why critics of accountants fail to call for legislation to address their criticisms. Special attention is given to the attitudes about accountants from those involved in the investment industry, government, and academia. Discussion of accountants' societies and their education and training is presented.

The article examines Great Britain's regulation of company accounts and finance. The author relates the response of over 60 individuals within the financial, legal, and academic communities about their thoughts on specific British legal requirements for financial information. The author asks how these requirements were developed and what are the essential safeguards of the integrity of British securities offered to the public. The article relates the thoughts of respondents to the Act of 1929 which consolidated previous company acts. The article reports a general reluctance on the part of the respondents for further government regulation. Responses to the author's query about essential protection of investors and necessary information is related.

Background: An elevated postprandial lipid concentration is believed to be atherogenic and to increase the risk of thrombosis. Objective: The objective was to test whether the consumption of a stearic acid-rich structured triacylglycerol has adverse effects on postprandial fibrinolytic activity and lipemia, factor VII coagulant (FVII:c) activity, and activated FVII (FVIIa) concentrations. Design: A randomized crossover design was used to compare the effects on middle-aged healthy men (n = 17) and women (n = 18) of meals enriched with cocoa butter, high-oleate sunflower oil (oleate), or a structured triacylglycerol containing stearic acid. Results: The mean increases from fasting in plasma triacylglycerol 3 h after the oleate, cocoa butter, and structured triacylglycerol meals were 1.36 (95% CI: 1.17, 1.56), 1.39 (1.17,1.63), and 0.65 (0.50, 0.82) mmol/L, respectively. Tissue plasminogen activator activity increased and plasminogen activator type 1 activity decreased after all 3 meals. Plasma FVII:c increased after the oleate and cocoa butter meals but not after the structured triacylglycerol meal. The values 6 h after the oleate and cocoa butter meals were 11.3% (7.0%, 15.6%) and 9.9% (4.7%, 15.2%), respectively, and were significantly different (P [is less than] 0.0001 and P = 0.001, respectively) from the value after the triacylglycerol meal [2.1% (-1.1%, 5.3%)]. Plasma FVIIa increased after all 3 meals, more so after the oleate and cocoa butter meals than after the structured triacylglycerol meal. Conclusion: The consumption of stearic acid in the form of a structured triacylglycerol leads to less of an increase in plasma triacylglycerol and in FVII:c than does a meal enriched in cocoa butter or oleate. Am J Clin Nutr 2001;73:715-21. KEY WORDS Factor VII, oleic acid, postprandial lipemia, saturated fatty acids, stearic acid, thrombosis, triacylglycerol, plasminogen activator

Background: Oxidative damage to lipids may be involved in the etiology of atherosclerosis, cardiovascular disease in general, and cancer. The soy isoflavone phytoestrogens, genistein and daidzein, and equol (a daidzein metabolite produced by intestinal microflora) are antioxidants in vitro; equol is a particularly good inhibitor of LDL oxidation and membrane lipid peroxidation. Objective: We sought to investigate the effects of a diet enriched with soy containing isoflavones on in vivo biomarkers of lipid peroxidation and resistance of LDL to oxidation, compared with a diet enriched with soy from which the isoflavones had been extracted. Design: A randomized, crossover design was used to compare diets enriched with soy that was low or high in isoflavones in 24 subjects. Plasma concentrations of an [F.sub.2]-isoprostane, 8-epi-prostaglandin [F.sub.2[Alpha]] (8-epi-[PGF.sub.2[Alpha]]), a biomarker of in vivo lipid peroxidation, and resistance of LDL to copper-ion-induced oxidation were determined. Results: Plasma concentrations of 8-epi-[PGF.sub.2[Alpha]] were significantly lower after the high-isoflavone dietary treatment than after the low-isoflavone dietary treatment (326 + 32 and 405 [+ or -] 50 ng/L, respectively; P = 0.028) and the lag time for copper-ion-induced LDL oxidation was longer (48 [+ or -] 2.4 and 44 [+ or -] 1.9 min, respectively; P = 0.017). Lag time for oxidation of unfractionated plasma and plasma concentrations of malondialdehyde, LDL [Alpha]-tocopherol, polyunsaturated fatty acids, and isoflavonoids did not differ significantly between dietary treatments. Conclusions: Consumption of soy containing naturally occurring amounts of isoflavone phytoestrogens reduced lipid peroxidation in vivo and increased the resistance of LDL to oxidation. This antioxidant action may be significant with regard to risk of atherosclerosis, cardiovascular disease in general, and cancer. Am J Clin Nutr 2000;72:395-400. KEY WORDS Isoflavone, phytoestrogen, soy, antioxidant, lipid peroxidation, low-density lipoprotein, LDL oxidation, [F.sub.2]-isoprostanes, cancer prevention, cancer, cardiovascular disease, heart disease, coronary artery disease, atherosclerosis, arteriosclerosis

The success of the World Trade Organization (WTO) will not equal that of its predecessor, the General Agreement on Tariffs and Trade (GATT). Instead, the WTO will be increasingly ignored [...]

Intakes of partially hydrogenated fish oil and animal fats have declined and those of palm, soybean, sunflower, and rapeseed oils have increased in northern Europe in the past 30 y. Soybean and rapeseed oils are currently the most plentiful liquid vegetable oils and both have desirable ratios of n-6 to n-3 fatty acids. However, soybean and rapeseed oils are commonly partially hydrogenated for use in commercial frying to decrease susceptibility to oxidative degradation. This process leads to selective losses of [Alpha]-linolenic acid (18:3n-3). Intake of linoleic acid (18:2n-6) has risen in many northern European countries. In the United Kingdom, intakes have increased from [approximately equals] 10 g/d in the late 1970s to [approximately equals] 15 g/d in the 1990s. The intake of [Alpha]-linolenic acid is estimated to be [approximately equals] 1-2 g/d but varies with the type of culinary oil used. There are few reliable estimates of the intake of long-chain n-3 fatty acids, but those are generally [approximately equals]0.1-0.5 g/d. The increased use of intensive, cereal-based livestock production systems has resulted in a lower proportion of n-3 fatty acids in meat compared with traditional extensive production systems. Overall, there has been a shift in the balance between n-6 and n-3 fatty acids over the past 30 y. This shift is reflected in the declining concentrations of docosahexaenoic acid and rising concentrations of linoleic acid in breast milk. Am J Clin Nutr 2000;71(suppl): 176S-8S. KEY WORDS Essential fatty acids, linoleic acid, [Alpha]-linolenic acid, docosahexaenoic acid, Europe, food chain, breast milk

Long-chain polyunsaturated fatty acids (LCPUFAs) derived from linoleic (18:2n-6) and [Alpha]-linolenic (18:3n-3) acids are required for the normal development of the retina and central nervous system, but the extent to which they can be synthesized from the parent fatty acids is debated. Consuming LCPUFAs markedly increases their proportions in tissue lipids compared with their parent fatty acids. Thus, it has been argued that LCPUFAs must be supplied in the diet. LCPUFAs are generally absent from plant foods, thus it is important find out how essential fatty acid requirements are met by vegetarians. A developing fetus obtains LCPUFAs via selective uptake from its mother's plasma and LCPUFAs are present in the breast milk of vegetarians. There is no evidence that the capacity to synthesize LCPUFAs is limited in vegetarians. However, there are greater proportions of n-6 LCPUFAs and lower proportions of n-3 LCPUFAs in vegetarians compared with omnivores. This difference is probably a consequence of the selection of foods by vegetarians with high amounts of linoleic acid. Although lower concentrations of docosahexaenoic acid (22:6n-3; DHA) have been observed in blood and artery phospholipids of infants of vegetarians, it is uncertain whether their brain lipids contain lower proportions of DHA than do those of infants of omnivores. On the basis of experiments in primates that showed altered visual function with a high ratio of linoleic acid to [Alpha]-linolenic acid, it would be prudent to recommend diets with a ratio between 4:1 and 10:1 in vegetarians and that excessive intakes of linoleic acid be avoided. Am J Clin Nutr 1999;70(suppl):555S-9S. KEY WORDS Docosahexaenoic acid, vegetarians, lipids, pregnancy, lactation, essential fatty acids, retinal development, central nervous system development

The hydrolysis products of hexachlorodisilane (HCDS) show common heat sensitivity and can become shock sensitive under certain conditions. Study of the shock sensitivity has been difficult due to the unpredictable nature of this phenomenon. We have identified the parameters affecting the shock sensitivity of the materials and developed synthetic methods to consistently prepare the hydrolysis products with a high shock sensitivity. We characterized the composition of the hydrolysis products to be [SiOx(OH)4–2x]m[Si2Oy(OH)6–2y]n(H2O)owhere xis 0–2, yis 0–3, mis less than n, and ovaries. The hydrogen atoms in the silanol groups or absorbed water are the oxidant and the silicon atoms in the Si–Si bonds are the reductant. When the materials are disturbed by a thermal or mechanical impact, fast redox reactions happen to form molecular hydrogen. A sequence of free radical reactions was proposed to explain the shock sensitivity and shock-induced chemical transformation.

Background: First-time lateral patellar dislocation is a common orthopaedic injury. The purposes of this study were to (1) evaluate the incidence of first-time lateral patellar dislocation in a geographically-determined population, (2) report trends over time in the incidence of dislocation, and (3) describe the rate of surgical treatment.Hypothesis: The rate of patellar dislocation is highest among adolescent patients.Study Design: Cohort study.Level of Evidence: Level 3.Methods: The study population included 609 individuals identified through a multidisciplinary geographic cohort county database who were diagnosed with first-episode lateral patellar dislocation between 1990 and 2010. The complete medical records were reviewed to confirm the diagnosis and to evaluate details of injury and treatment. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Poisson regression analyses were performed to examine incidence trends by age, sex, and calendar period.Results: The overall age- and sex-adjusted annual incidence of patellar dislocation was 23.2 (95% CI, 21.2-24.9) per 100,000 person-years. The annual incidence was similar between male and female patients and highest among adolescents aged 14 to 18 years (147.7/100,000 person-years). The mean age at dislocation was 21.4 ± 9.9 years, and 331 patients (54.4%) were female. During the study period, there was a significant decline in the incidence of patellar dislocation among men aged 19 to 25 years (P= 0.002) and girls aged 14 to 18 years (P= 0.025). Eighty patients received surgical treatment during the study period, including 66 patients (10.8%) for recurrent instability and 14 patients (2.3%) for acute osteochondral injury.Conclusion: With an annual incidence of 23.2 per 100,000 person-years, lateral patellar dislocation is a frequently encountered orthopaedic injury. The incidence of dislocation among adolescent patients in this cohort is higher than previously reported. Despite a decrease in the annual incidence of dislocation in adolescent girls, the overall incidence of patellar dislocation remained relatively constant over a 21-year observation period.Clinical Relevance: This study demonstrates that the incidence of patellar dislocation in adolescents is greater than previously reported.

To compare the effectiveness of ultrasound‐guided injections to blind injections in the treatment of carpal tunnel syndrome (CTS) in a large community‐based cohort. This study evaluated residents of Olmsted County, Minnesota, treated with a corticosteroid injection for CTS between 2001 and 2010. The proportion of patients receiving retreatment and the duration of retreatment‐free survival between blind and ultrasound‐guided injections were compared. Propensity score matching was used to control for confounding by indication. In the matched data set consisting of 234 (of 600) hands treated with a blind injection and 87 (of 89) ultrasound‐guided injection cases, ultrasound guidance was associated with a reduced hazard of retreatment (hazard ratio 0.59 [95% confidence interval (95% CI) 0.37–0.93]). In addition, ultrasound guidance was associated with 55% reduced odds of retreatment within 1 year compared to blind injections (adjusted odds ratio 0.45 [95% CI 0.24–0.83]). This study indicates that ultrasound‐guided injections are more effective in comparison to blind injections in the treatment of CTS.

Qualitative study.

Background: Tennis elbow is commonly encountered by physicians, yet little is known about the cost of treating this condition.Hypothesis: The largest cost associated with treating tennis elbow is procedural intervention.Study Design: Descriptive epidemiology study.Level of Evidence: Level 4.Methods: This retrospective population-based study reviewed patients who were treated for new-onset tennis elbow between January 1, 2003 and December 31, 2012. All patients were followed up through their medical and administrative records to identify health care encounters and interventions for tennis elbow. Unit costs for each health service/procedure were adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars.Results: In a cohort of 931 patients who had 2 or more clinical encounters for new-onset lateral epicondylosis during a 12-month period after initial diagnosis, 62% received a median of 3 physical therapy sessions (cost, $100/session) and 40% received a median of 1 steroid injection (cost, $82/injection). Only 4% of patients received surgical intervention with mean costs of $4000. The mean (median) total direct medical cost of services related to lateral epicondylosis for the entire cohort was $660 ($402) per patient over the 1-year period after diagnosis. Patients who continued to be treated conservatively between 6 and 12 months after diagnosis incurred relatively low median costs of $168 per patient.Conclusion: In this cohort, a second encounter with a physician for tennis elbow was a strong predictor of increased treatment cost due to a higher likelihood of specialist referral, use of physical therapy, or treatment with steroid injection.Clinical Relevance: The majority of direct medical spending on tennis elbow occurs within the first 6 months of treatment, and relatively little expense occurs between 6 and 12 months after diagnosis unless a patient undergoes surgical intervention.

A variety of modified fats that provide different functionalities are used in processed foods to optimize product characteristics and nutrient composition. Partial hydrogenation results in the formation of transFAs (TFAs) and was one of the most widely used modification processes of fats and oils. However, the negative effects of commercially produced TFAs on serum lipoproteins and risk for cardiovascular disease resulted in the Institute of Medicine and the 2010 US Dietary Guidelines for Americans both recommending that TFA intake be as low as possible. After its tentative 2013 determination that use of partially hydrogenated oils is not generally regarded as safe, the FDA released its final determination of the same in 2015. Many food technologists have turned to interesterified fat as a replacement. Interesterification rearranges FAs within and between a triglyceride molecule by use of either a chemical catalyst or an enzyme. Although there is clear utility of interesterified fats for retaining functional properties of food, the nutrition and health implications of long-term interesterified fat consumption are less well understood. The Technical Committee on Dietary Lipids of the North American Branch of the International Life Sciences Institute sponsored a workshop to discuss the health effects of interesterified fats, identify research needs, and outline considerations for the design of future studies. The consensus was that although interesterified fat production is a feasible and economically viable solution for replacing dietary TFAs, outstanding questions must be answered regarding the effects of interesterification on modifying certain aspects of lipid and glucose metabolism, inflammatory responses, hemostatic parameters, and satiety.

To determine if participation in a weight loss program impacted upon a composite end point of all-cause mortality and cardiovascular morbidity in obese patients with chronic kidney disease (CKD).

Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants.

Name changes are usually more dramatic than the addition of a single letter. We've seen NYNEX morph into Bell Atlantic and more recently become Verizon, while Arthur Anderson was reborn [...]