F ractures are a major clinical concern in older women and men. The most commonly considered sites of fracture are the hip, spine, and wrist.1-4 About 40% of white women aged 50 years and older will experience at least 1 clinically recognized fracture at one of these skeletal sites and be subjected to increased risks of morbidity and mortality. 5,6 However, other less recognized fractures, such as those of the pelvis, ribs, shoulder, distal femur, and proximal tibia, may also lead to reductions in quality of life. 7-10OBJECTIVE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women who report previous fractures, and to provide perspective by comparing these findings with those in other chronic conditions (diabetes, arthritis, lung disease). PATIENTS AND METHODS:Fractures are a major cause of morbidity among older women. Few studies have examined HRQL in women who have had prior fractures and the effect of prior fracture location on HRQL. In this observational study of 57,141 postmenopausal women aged 55 years and older (enrollment from December 2007 to March 2009) from 17 study sites in 10 countries, HRQL was measured using the European Quality of Life 5 Dimensions Index (EQ-5D) and the health status, physical function, and vitality questions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS:Reductions in EQ-5D health-utility scores and SF-36-measured health status, physical function, and vitality were seen in association with 9 of 10 fracture locations. Spine, hip, and upper leg fractures resulted in the greatest reductions in quality of life (EQ-5D scores, 0.62, 0.64, and 0.61, respectively, vs 0.79 without prior fracture). Women with fractures at any of these 3 locations, as well as women with a history of multiple fractures (EQ-5D scores, 0.74 for 1 prior fracture, 0.68 for 2, and 0.58 for ≥3), had reductions in HRQL that were similar to or worse than those in women with other chronic diseases (0.67 for diabetes, 0.69 for arthritis, and 0.71 for lung disease).CONCLUSION: Previous fractures at a variety of bone locations, particularly spine, hip, and upper leg, or involving more than 1 location are associated with significant reductions in quality of life. If their full health impact is to be appreciated, fractures at a range of sites need to be examined to determine their effects on health-related quality of life (HRQL). Mayo Clin

Purpose To determine if important geographic differences exist in treatment rates for osteoporosis and whether this variation can be explained by regional variation in risk factors. Methods The Global Longitudinal Study of Osteoporosis in Women is an observational study of women ≥55 years sampled from primary care practices in 10 countries. Self-administered questionnaires were used to collect data on patient characteristics, risk factors for fracture, previous fractures, anti-osteoporosis medication, and health status. Results Among 58,009 women, current anti-osteoporosis medication use was lowest in Northern Europe (16%) and highest in USA and Australia (32%). Between 48% (USA, Southern Europe) and 68% (Northern Europe) of women aged ≥65 years with a history of spine or hip fracture since age 45 were untreated. Among women with osteoporosis, the percentage of treated cases was lowest in Europe (45– 52% versus 62–65% elsewhere). Women with osteopenia and no other risk factors were treated with anti-osteoporosis medication most frequently in USA (31%) and Canada (31%), and least frequently in Southern Europe (12%), Northern Europe (13%), and Australia (16%). After adjusting for risk factors, US women were threefold as likely to be treated with anti-osteoporosis medication as Northern European women (odds ratio 2.8; 95% confidence interval 2.5–3.1) and 1.5 times as likely to be treated as Southern European women (1.5, 1.4–1.6). Up to half of women reporting previous hip or spine fracture did not receive treatment. Conclusions The likelihood of being treated for osteoporosis differed between regions, and cannot be explained by variation in risk factors. Many women at risk of fracture do not receive prophylaxis.

This work is concerned with the analysis of a drift-diffusion model for the electrothermal behavior of organic semiconductor devices. A “generalized Van Roosbroeck” system coupled to the heat equation is employed, where the former consists of continuity equations for electrons and holes and a Poisson equation for the electrostatic potential, and the latter features source terms containing Joule heat contributions and recombination heat. Special features of organic semiconductors like Gauss–Fermi statistics and mobility functions depending on the electric field strength are taken into account. We prove the existence of solutions for the stationary problem by an iteration scheme and Schauder’s fixed point theorem. The underlying solution concept is related to weak solutions of the Van Roosbroeck system and entropy solutions of the heat equation. Additionally, for data compatible with thermodynamic equilibrium, the uniqueness of the solution is verified. It was recently shown that self-heating significantly influences the electronic properties of organic semiconductor devices. Therefore, modeling the coupled electric and thermal responses of organic semiconductors is essential for predicting the effects of temperature on the overall behavior of the device. This work puts the electrothermal drift-diffusion model for organic semiconductors on a sound analytical basis.

No abstract

This work is concerned with the micro-architecture of multi-layer material that globally exhibits desired mechanical properties, for instance a negative apparent Poisson ratio. We use inverse homogenization, the level set method, and the shape derivative in the sense of Hadamard to identify material regions and track boundary changes within the context of the smoothed interface. The level set method and the shape derivative obtained in the smoothed interface context allows to capture, within the unit cell, the optimal microgeometry. We test the algorithm by computing several multi-layer auxetic micro-structures. The multi-layer approach has the added benefit that contact during movement of adjacent "branches" of the micro-structure can be avoided in order to increase its capacity to withstand larger stresses.Date: 2018/04/10.