We connect the Mimetic Finite Difference method (MFD) with the finite-volume two-point flux scheme (TPFA) for Voronoi meshes. The main effect is reducing the saddle-point system to a much smaller symmetric-positive definite matrix. In addition, the generalization allows MFD to seamlessly integrate with existing porous media modeling technology. The generalization also imparts the monotonicity property of the TPFA method on MFD. The connection is achieved by altering the consistency condition of the velocity bilinear operator. First-order convergence theory is presented as well as numerical results that support the claims. We demonstrate a methodology for using MFD in modeling fluid flow in fractures coupled with a reservoir. The method can be used for nonplanar fractures. We use the method to demonstrate the effects of fracture curvature on single-phase and multi-phase flows. Standard benchmarks are used to demonstrate the accuracy of the method. The approach is coupled with existing reservoir simulation technology. / text

No description available.

The purpose of this paper is the development of a model to investigate possible causal relationships among some of the commonly reported risk factors for the development of osteoporosis and consequential hip fracture. Comparison of hip fracture incidence between women of primarily European descent, referred to in the literature as Caucasians, and Japanese women is made. Studies report the incidence of hip fractures among Japanese women is lower than among Caucasian women. Numerous factors related to the development of osteoporosis are significantly different between Japan and the United States. The model helps explain the interrelationships among the variables involved in this observed geographical variation in hip fracture incidence. / Department of Anthropology

A quantidade de trabalhos específicos sobre os traumatismos alvéolo-dentários de maior extensão encontrados na literatura é pequena. Este estudo mostra o resultado de 127 casos de traumatismos alvéolo-dentários diagnosticados no Hospital Municipal Arthur Ribeiro de Saboya, em São Paulo, entre junho de 2001 e dezembro de 2002. A análise dos dados permitiu identificar o grupo etário de 0 a 10 anos e o sexo masculino como os mais atingidos, a queda como o fator etiológico mais comum e a fratura alveolar como o principal tipo de lesão encontrada. A maioria dos pacientes apresentou lesões extra e intra orais e 73,2% tardaram até 05 horas para procurar atendimento após o acontecimento do trauma. / There are few specific reports in the literature bearing information on dento-alveolar injuries. A survey was done considering 127 patients recorded from June 2001 to December 2002 showing dento-alveolar injuries treated at the Arthur Ribeiro Saboya Municipal Hospital, Sao Paulo, Brazil. The analysis of data revealed that male patients and the age group 0–10 yr were most prevalently involved in this kind of trauma, the main cause was accidental fall and alveolar fractures were the most frequent type of injury. The majority of the patients suffered some kind of soft tissues injuries and 73,2% of the patients received the first dental assistance during the first 5 hours following the incident.

As fraturas benignas osteoporóticas e malignas da coluna vertebral representam um desafio diagnóstico para os médicos especialistas. As fraturas benignas osteoporóticas ocorrem em virtude da fragilidade óssea da osteoporose e as fraturas malignas são secundárias a infiltração neoplásica. Estes dois grupos tem em comum o fato de acometerem predominantemente a população idosa. Alguns sinais radiológicos favorecem o diagnóstico de fraturas benignas osteoporóticas enquanto outros sinais de imagem favorecem o diagnóstico de fraturas malignas, no entanto nenhum sinal identificado nas imagens é específico. O propósito de realizar esse estudo foi identificar se o nível de formação médica dos radiologistas e ortopedistas (cirurgiões da coluna vertebral) exerce influência para o diagnóstico etiológico dessas fraturas nos exames de RM da coluna lombar, assim como avaliar o grau de concordância intra e interobservador para o diagnóstico de fraturas benignas por osteoporose e fraturas malignas. Foram incluídos no estudo de forma retrospectiva os exames de 63 pacientes consecutivos da rotina clínica do HCRP, realizados previamente por indicação clínica e com diagnóstico de fratura não traumática de corpo vertebral. Para avaliar a influência do nível de formação médica, quatro radiologistas e dois cirurgiões da coluna vertebral com diferentes níveis de formação realizaram avaliações de forma independente e as cegas em relação as demais leituras e em relação às informações do prontuário clínico. As imagens de RM anonimizadas e no formato DICOM foram avaliadas em workstation OsiriX. Os médicos observadores fizeram as leituras classificando cada vértebra da região lombar da seguinte forma: sem fratura, com fratura de características benignas ou com fratura de características malignas. Cada observador realizou duas leituras, com intervalo de 15 dias entre as leituras. O padrão de referência foi obtido a partir da avaliação pormenorizada do prontuário eletrônico de cada paciente realizada por médico radiologista sênior, a partir do Sistema de Informações do Hospital (HIS) e do Sistema Informatizado da radiologia (RIS), incluindo a biópsia com confirmação histopatológica nos casos de neoplasia e o seguimento clinico e laboratorial por pelo menos dois anos nos casos em que não houve indicação clínica de biópsia. Utilizando este padrão de referência foram calculadas para cada leitura, a sensibilidade, a especificidade, acurácia, valor preditivo positivo e negativo com intervalo de confiança (IC) 95%. Os resultados demonstram uma excelente concordância intraobservador e uma boa concordância interobservador, porém sem relevância estatística. Além disso, de uma forma geral a sensibilidade dos observadores para a detecção de fraturas malignas foi boa. A especificidade, acurácia e valor preditivo negativo foram elevados para todos os observadores. O valor preditivo positivo variou de moderado a substancial. Portanto, não houve influência do nível de formação médica para o desempenho diagnóstico na detecção de fraturas benignas osteoporóticas e fraturas malignas nas imagens de ressonância magnética. / Benign osteoporotic and malignant spinal fractures represent a diagnostic challenge for medical specialists. Osteoporotic benign fractures occur because of the bone fragility of osteoporosis and malignant fractures are secondary to neoplastic infiltration. These two groups have in common the fact that they affect predominantly the elderly population. Some radiological signs favor the diagnosis of benign osteoporotic fractures while other imaging signs favor the diagnosis of malignant fractures, however no signs identified in the images are specific. The purpose of this study was to identify whether the level of medical training of radiologists and orthopedists (spine surgeons) influences the etiological diagnosis of these fractures in lumbar spinal MRI (magnetic resonance imaging), as well as to evaluate the degree of intra and interobserver agreement for the diagnosis of benign fractures due to osteoporosis and malignant fractures. We retrospectively included the exams of 63 consecutive patients from the clinical routine of the HCRP, performed previously by clinical indication and with diagnosis of non-traumatic vertebral body fracture. To evaluate the influence of the level of medical training, four radiologists and two spine surgeons with different levels of training performed evaluations independently, without knowing the other readings and without the information in the medical record. The anonymized MRI in the DICOM format were evaluated in OsiriX workstation. Observer doctors did the readings by classifying each vertebra in the lumbar region as follows: no fracture, with fracture of benign features or with fracture of malignant characteristics. Each observer performed two readings, with a 15-day interval between readings. The reference standard was obtained from the detailed evaluation of each patient\'s electronic medical record by a senior radiologist, with the Hospital Information System (HIS) and the Computerized Radiology System, including biopsy with histopathological confirmation in cases of neoplasia and clinical and laboratory follow-up for at least two years in cases in which there was no clinical indication of biopsy. Using this reference standard, sensitivity, specificity, accuracy, positive and negative predictive value with 95% confidence interval (CI) were calculated for each reading. The results demonstrate excellent intraobserver agreement and good interobserver agreement, but without statistical relevance. In addition, the sensitivity of the observers for the detection of malignant fractures was generally good. The specificity, accuracy and negative predictive value were high for all observers. The positive predictive value ranged from moderate to substantial. Therefore, there was no influence of the level of medical training for diagnostic performance in the detection of benign osteoporotic fractures and malignant fractures in magnetic resonance imaging.

Os anti-hipertensivos bloqueadores de canais de cálcio, por interferirem no transporte de cálcio através das membranas celulares, podem afetar muitos processos metabólicos, incluindo o metabolismo ósseo. O objetivo deste estudo foi avaliar, de forma radiográfica, histológica e bioquímica, os efeitos do bloqueador de canais de cálcio amlodipina no processo de reparo de um defeito ósseo, simulando fratura, no ramo mandibular de ratos. Foram utilizados 50 ratos machos Wistar, que foram submetidos ao mesmo procedimento cirúrgico unilateral simulando fratura mandibular, e distribuídos em dois grupos de 25 animais: grupo experimental, que receberam amlodipina, via oral, na dosagem de 0,04 mg / rato / dia, iniciando 12 dias antes do procedimento e continuando até o sacrifício; grupo controle, que permaneceu não tratado. Os animais foram sacrificados nos períodos de 1, 7, 14, 30 e 90 dias pós-operatórios. Foram realizados testes bioquímicos de fosfatase alcalina e cálcio séricos. Exame radiográfico foi obtido para mensuração da área radiolúcida do defeito ósseo. O estudo histológico compreendeu a análise descritiva do processo de reparo ósseo e a avaliação histomorfométrica da quantidade de osso neoformado. Os valores numéricos foram submetidos a análises estatísticas. A análise radiográfica demonstrou maior área radiolúcida no interior do defeito ósseo para o grupo experimental, nos períodos de 14 (p=0,016), 30 (p=0,009) e 90 (p=0,028) dias. Na análise histológica não se observaram atrasos no processo de reparo ósseo para ambos os grupos. Porém, na análise histomorfométrica, o grupo da amlodipina apresentou redução significante do volume de osso neoformado nos períodos de 7 e 14 dias (p=0,049), não havendo diferenças significativas no período de 30 dias. Houve redução significante nos níveis de fosfatase alcalina para o grupo da amlodipina nos períodos iniciais (p=0,049). Não houve alterações para os níveis de cálcio sérico. Concluiu-se que o uso crônico da amlodipina prejudicou a neoformação óssea no processo de reparo do defeito cirúrgico no ramo mandibular de ratos, porém não impediu a consolidação da fratura. / Antihypertensive, calcium channel blockers, which interfere on calcium transport across the cell membrane, may affect many metabolic processes, including bone metabolism. The aim of this study was to evaluate by radiographic, histologic and biochemical analyses the effects of calcium channel blocker amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. Fifty male Wistar rats were used, and submitted to the same unilateral surgical procedure simulating a mandibular fracture, distributed into two groups of 25 animals: experimental group, which received oral doses of 0.04 mg / rat / day starting 12 days before of procedure and continuing until sacrifice; control group, which remained untreated. Animals were sacrificed at 1, 7, 14, 30 and 90 days postoperatively. Blood biochemical tests of alkaline phosphatase and serum calcium were made. Radiographic examination was obtained in order to mensurate the radiolucent area of bone defect. Histological study comprised descriptive analysis of bone healing and histomorphometric analysis of the amount of newly formed bone. Numerical values were submitted to statistical analyses. Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p=0.016), 30 (p=0.009) and 90 (p=0.028) days. In the histological analysis there was no delay in the bone repair stages in both groups. However, in the histomorphometric analysis, the experimental group presented significative lowering of newly formed bone volume at 7 and 14 days periods (p=0.049), with no significant differences at 30 days period. There was significative decrease of alkaline phosphatase levels in experimental group in the initial periods (p=0.049). There was no change in the serum calcium levels. It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.

Il est bien connu que les particules inertielles dans un écoulement périodique ont tendance à se focaliser sur des trajectoires privilégiées. Le but de ce travail de thèse est d'étudier l'influence de cette focalisation sur le transport et la sédimentation de particules dans une fracture plane à rugosité périodique. Tout d'abord, un écoulement monophasique dans une fracture est analysé asymptotiquement dans le cas de faible rugosité. Les résultats classiques de la théorie de la lubrification inertielle sont généralisés au cas de fractures avec des parois asymétriques. Les corrections non linéaires à la loi de Darcy sont calculées explicitement en fonction des facteurs géométriques de la fracture. Le transport de particules dans une fracture horizontal est étudié asymptotiquement dans le cas de particules de faible inertie. Les particules se focalisent sur une trajectoire attractrice, si le débit d'écoulement est assez fort par rapport à la gravité. Un diagramme complet de focalisation a été obtenu, qui prédit l'existence de l'attracteur en fonction du nombre de Froude et des facteurs géométriques de la fracture. Les paramètres quantitatifs du transport ont été calculés également. L'influence de la force de portance sur la migration de particules a été étudiée également. Dans un canal vertical, la portance (provoquée par la gravité) modifie le nombre d'attracteurs et leurs positions. En absence de gravité, la portance peut provoquer une dynamique chaotique des particules. En outre, le captage des particules par une paire de tourbillons a été étudié. Le diagramme d'accumulation obtenu démontre que toute paire de tourbillons peut être un piège à particules / It is well-known that inertial particles tend to focus on preferential trajectories in periodic flows. The goal of this thesis was to study the joint effect of particle focusing and sedimentation on their transport through a model 2D fracture with a periodic corrugation. First, single-phase flow though the fracture has been considered: the classical results of the inertial lubrication theory are revisited in order to include asymmetric fracture geometries. Cubic corrections to Darcy's law have been found analytically and expressed in terms of two geometric factors, describing channel geometry. For weakly-inertial particles in a horizontal channel it has been shown that, when inertia is strong enough to balance out the gravity forces, particles focus to some attracting trajectory inside the channel. The full trapping diagram is obtained, that predicts the existence of such attracting trajectory regime depending on the Froude number and on geometric factors. Numerical simulations confirm the asymptotic results for particles with small response times. The influence of the lift force on particle migration has also been studied. In a vertical channel the lift is induced by gravity and leads to complex trapping diagrams. In the absence of gravity the lift is caused by inertial lead/lag of particles and can lead to chaotic particle dynamics. Finally, for dust particles in a vortex pair it has been shown that particles can be trapped into one or two equilibrium points in a reference frame rotating with the vortices. A full trapping diagram has been obtained, showing that any pair of vortices can trap particles, independently of their strength ratio and the direction of rotation

Objectif: La prématurité a lieu pendant une période critique de la minéralisation osseuse. Nous avons évalué si la naissance prématurée se traduit par un risque plus élevé de fracture orthopédique chez les enfants. Méthodes: Nous avons mené une étude de cohorte rétrospective sur 788 903 enfants nés entre 2006 et 2016 au Québec, Canada, avec 5 436 400 personnes-années de suivi. Nous avons distingué les enfants nés prématurés (<37 semaines) et nés à terme (≥ 37 semaines). Nous avons identifié les hospitalisations futures pour fractures osseuses nécessitant un traitement chirurgical avant 2018. Nous avons calculé les taux d'incidence et les hazard ratios estimés (HR) avec des intervalles de confiance (IC) à 95% pour mesurer l'association entre la prématurité et les fractures à l'aide de modèles de régression de Cox ajustés pour les caractéristiques de l’enfant et maternelles. Nous avons déterminé si le risque de fracture variait en fonction de l'âge de l'enfant. Résultats: Il y avait 51 212 nouveau-nés prématurés dans cette étude (6,5%). L'incidence de fracture était de 17,9 par 10 000 personnes-années chez les enfants prématurés et de 15,3 par 10 000 personnes-années pour les enfants nés à terme. Comparativement aux enfants nés à terme, les enfants prématurés présentaient un risque de fracture 1,08 fois plus élevé lors du suivi (IC 95% 0,99-1,18). Les associations étaient plus fortes pour le fémur (HR 1,27, IC 95% 1,01-1,60) et les fractures liées à une agression (HR 2,27, IC 95% 1,37-3,76). Les associations variaient également avec l'âge, les enfants prématurés ayant deux fois le risque de fracture du fémur entre 6 et 17 mois (HR 2,20, IC 95% 1,45-3,35), mais aucune association par la suite. Conclusion: La prématurité est associée à un risque accru de certaines fractures osseuses et de fractures liées à des agressions avant l'âge de 18 mois. Les familles d'enfants prématurés pourraient bénéficier de conseils et de soutien pour la prévention des fractures au cours de la petite enfance. / Objective: Preterm birth occurs during a critical period of bone mineralization. We assessed whether preterm birth translates into a higher risk of orthopedic fracture in childhood. Methods: We conducted a retrospective cohort study of 788,903 infants born between 2006 and 2016 in Quebec, Canada, including 5,436,400 person-years of follow-up. We distinguished preterm (<37 weeks) and term (≥37 weeks) infants and identified future hospitalizations for bone fractures that required operative treatment before 2018. We calculated incidence rates and estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of prematurity with fractures using Cox regression models adjusted for maternal and infant characteristics. We determined if the risk of fracture varied by the child’s age. Results: There were 51,212 preterm infants in this study (6.5%). The incidence of fracture was 17.9 per 10,000 person-years in preterm children and 15.3 per 10,000 person-years in term children. Compared with term, preterm children had 1.08 times the risk of fracture during follow-up (95% CI 0.99-1.18). Associations were stronger for femur (HR 1.27, 95% CI 1.01-1.60) and assault-related fractures (HR 2.27, 95% CI 1.37-3.76). Associations also varied with age, with preterm children having 2 times the risk of femur fracture between 6 and 17 months of age (HR 2.20, 95% CI 1.45-3.35), but no association thereafter. Conclusion: Preterm birth is associated with an increased risk of certain bone fractures and assault-related fractures before 18 months of age. Families of preterm children may benefit from counselling and support for fracture prevention during early childhood.

Introduktion: Barnmisshandel är ett problem som ökat senaste tiden och kan visa sig påolika sätt. Den fysiska barnmisshandeln innefattar ofta frakturer. För att kunna härleda frakturer till barnmisshandel behöver röntgensjuksköterskan ha kunskap om frakturernas utseende och dess placering. Syfte: Studiens syfte var att kartlägga frakturer och dess lokalisation som indikerar på fysisk barnmisshandel. Metod: Denna studie är en allmän litteraturöversikt. Utifrån syftet har tio artiklar analyserats och kategoriserats. Resultat: Studien kunde påvisa olika typer av frakturer som ofta var förekommande vid barnmisshandel. Dessa kategoriserades in i thorax, extremiteter, huvud och multipla frakturer. Det konstaterades bland annat att vänstersidiga frakturer, särskilt vid förekomst av revbensfrakturer, var överrepresenterade vid misshandel av barn under 18 månader. Små barn har dessutom högre risk att drabbas av skallfrakturer i samband med misshandel än äldre barn samt att de oftare har fler än en fraktur. Slutsats: Det finns frakturer som kan sättas mer i samband med barnmisshandel än andra. Genom ökad kunskap om dessa frakturer kan röntgensjuksköterskan lära sig att uppmärksamma dessa i tid och förhoppningsvis förhindra ytterligare misshandel av barnet. Om konventionell röntgen är rätt metod kan ifrågasättas då en datortomografi lättare kan upptäcka frakturerna. Det behöver dock vidare forskning av områden där det är svårt att avgöra om det rör sig om en fraktur eller inte. / Introduction: Child abuse is a problem that has increased recently and can manifest itself in different ways. Physical child abuse often involves fractures. To trace fractures related to child abuse, the radiographer needs to have knowledge of the appearance of the fractures and their location. Aim: The aim of the study was to map fractures and their location that indicates physical child abuse. Method: This study is a general literature review. Based on the purpose, ten articles have been analyzed and categorized. Results: The study was able to identify different types of fractures that were common in child abuse. These were categorized into thorax, extremities, head, and multiple fractures. It was found, among other things, that left-sided fractures, especially in the presence of rib fractures, were overrepresented in the abuse of children under 18 months. In addition, young children are at higher risk of suffering from skull fractures in connection with abuse than older children and that they more often have more than one fracture. Conclusion: There are fractures that can be associated more with child abuse than others. Through increased knowledge of these fractures, the radiographer can learn to pay attention to these in time and hopefully prevent further abuse of the child. Whether conventional X-ray is the right method can be questioned as a computed tomography scan can more easily detect the fractures. However, it needs further research of areas where it is difficult to determine whether it is a fracture or not.

Le soulagement de la douleur est un enjeu majeur lorsqu'un traitement non chirurgical et palliatif est prodigué aux aînés ayant subi une fracture de la hanche. Considérant que le quart d'entre eux souffrent de troubles neurocognitifs (TNC), il importe d'assurer une évaluation avec un outil d'évaluation de la douleur adapté afin de leur administrer les traitements appropriés. Les objectifs de cette étude étaient de décrire le soulagement de la douleur à la suite d'une fracture de la hanche chez les patients non opérés, atteints d'un TNC, et recevant des soins palliatifs; et d'identifier les stratégies de soulagement de la douleur utilisées. Une étude observationnelle en deux volets a été menée et l'évaluation de la douleur lors des cinq premiers jours suivant l'admission a été effectuée à l'aide de l'échelle comportementale ALGOPLUS. Les résultats ont démontré que la douleur était plus importante à la mobilisation qu'au repos. Les doses d'analgésie opioïdes étaient ajustées à la hausse et la coanalgésie était fortement utilisée. Toutefois, très peu de stratégies non pharmacologiques étaient utilisées de façon systématique. La douleur demeure un problème important chez les patients avec un TNC ayant subi une fracture de la hanche, malgré une offre de soins palliatifs et de fin de vie. Les résultats de cette étude proposent certaines pistes de solutions pour optimiser le soulagement de la douleur auprès de cette population afin de lui offrir une fin de vie confortable. / Pain relief is a major issue when non-surgical, palliative treatment is provided to older adults who sustained a hip fracture. Considering that a quarter of them suffer from neurocognitive disorders (NCD), it is important to ensure assessment with an adequate pain assessment tool in order to provide appropriate treatments. The aims of this study were to describe pain relief following hip fracture in non-operated patients with NCD receiving palliative care; and to identify pain relief strategies used. A two-part observational study was conducted and pain assessment during the first five days after admission was performed using the ALGOPLUS behavioral scale. Results showed that pain was greater during mobilization than at rest. Opioid analgesia doses were adjusted upwards, and coanalgesia was used extensively. However, very few non-pharmacological strategies were systematically used. Pain remains a significant problem in hip fracture patients with NCD, regardless palliative care. The results of this study suggest possible solutions to optimize pain relief in this population, in order to offer them a comfortable end-of-life.