Background Upper extremity fractures are increasing in frequency and have profound socioeconomic implications. The purpose of this study was to assess trends in ambulatory upper extremity fracture fixation in the USA from 1996 to 2006 using data from the National Survey of Ambulatory Surgery (NSAS). Methods The NSAS was used to identify cases of closed forearm, carpal, metacarpal, and phalanx fractures treated with open or closed reduction with internal fixation in 1996 and 2006. Data were analyzed for trends in fracture location, age, gender, facility type, payor status, and anesthesia type. US census data were used to obtain national population estimates. Results Over the 10-year study period, there was a 54.4 % increase in the population-adjusted rate of upper extremity fractures treated with internal fixation (34.6 to 53.4 per 100,000 capita). There was a 173 % increase in the ageadjusted rate of patients over 55 years treated with internal fixation. There was a 505 % increase in the number of cases performed at freestanding surgical centers compared to hospital-based facilities. Though the majority of cases involved general anesthesia, regional anesthesia (16.6 versus 20.6 %) and monitored anesthesia care (7.1 versus 11.8 %) increased in frequency. Private insurance groups funded the majority of surgeries in both study years. Conclusion The volume of ambulatory surgery for upper extremity fractures has increased dramatically from 1996 to 2006. Operative treatment of upper extremity fractures has increased markedly. Our analysis provides valuable information for providers and policy-makers for allocating the appropriate resources to help sustain this volume.

Monohydrate and anhydrate crystalline forms of the DNA nucleobase cytosine interconvert via a topotactic solid-state mechanism where water functions as a molecular switch. The solid-state dehydration mechanism and kinetics were elucidated using complementary time-resolved synchrotron powder X-ray diffraction and thermogravimetric methods. Results indicate the reaction initiates from the crystal surface, involves no other crystalline intermediates, and proceeds at rates that depend on the monohydrate processing. A molecular-level model, based on least-motion arguments and consistent with the totality of the experimental data, is proposed to account for the high degree of structure transfer associated with the transformation. Water loss on the monohydrate crystal surface activates the rotation of one-dimensional cytosine ribbons, which in turn alters the local environment of the neighboring unit cell, facilitating the release of additional water molecules and ribbon rotation. As the dehydration front progresses into the solid, this cooperative mechanism effectively converts two-dimensional layers of antiparallel π-offset stacked ribbons into orthogonal two-dimensional layers of parallel π-face–face stacked ribbons. Moisture sorption experiments performed under high-humidity conditions confirm the anhydrate product can be reversibly rehydrated back to the monohydrate and that repeated dehydration–rehydration cycles proceed at consistent rates. The ability to track both the structural and compositional changes in the sample throughout the course of the reaction makes this a powerful combination of techniques for characterizing cooperative rotational motions triggered by water loss and/or uptake from crystalline materials.

Natural disasters are often described as having antagonistic qualities (e.g., wildfires ravage). The information deficit model presumes that when people assess the risk of weather hazards, they ignore irrelevant metaphoric descriptors. However, metaphoric frames affect reasoning. The current research assessed whether antagonist metaphors for natural disasters affect perceptions of the risk they pose. Three studies ( N = 1,936) demonstrated that participants forecasted an antagonist-framed natural hazard as being more severe, and intended to evacuate more often, than a literal-framed natural hazard. Thus, the metaphorical language used to discuss natural disasters deserves consideration in the development of effective risk communication.

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