We report on the design, construction, and operation of a horizontal field, 30 T magnet system with a conical bore optimized for synchrotron x-ray powder diffraction. The magnet offers ±31° optical access downstream of the sample, which allows to measure a sufficiently large number of Debye rings for an accurate crystal structure analysis. Combined with a 290 kJ generator, magnetic field pulses of 60 ms length were generated in the magnet, with a rise time of 4.1 ms and a repetition rate of 6 pulses/h at 30 T. The coil is mounted inside a liquid nitrogen bath. A liquid helium flow cryostat reaches into the coil and allows sample temperature between 5 and 250 K. The setup was used on the European Synchrotron Radiation Facility beamlines ID20 and ID06.

Shift work disorder is a type of sleep disorder that occurs when an individual is unable to successfully synchronize his or her internal clock with a work schedule that requires staying awake and working when it is dark and sleeping when it is light. Approximately 10% of shift workers suffer from this disorder, which seriously impairs their ability to function. Shift work disorder is associated with increased risk of gastrointestinal problems, cancer, depression, heart disease, excessive sleepiness and accidents, and decreased productivity. This report describes the prevalence, diagnostic criteria, differential diagnosis, and clinical consequences of shift work disorder to help clinicians recognize this impairing condition.

Many animals use long-range signals to compete over mates and resources. Optimal transmission can be achieved by choosing efficient signals, or by choosing adequate signalling perches and song posts. High signalling perches benefit sound transmission and reception, but may be more risky due to exposure to airborne predators. Perch height could thus reflect male quality, with individuals signalling at higher perches appearing as more threatening to rivals. Using playbacks on nightingales (Luscinia megarhynchos), we simulated rivals singing at the same height as residents, or singing three metres higher. Surprisingly, residents increased song output stronger, and, varying with future pairing success, overlapped more songs of the playback when rivals were singing at the same height than when they were singing higher. Other than expected, rivals singing at the same height may thus be experienced as more threatening than rivals singing at higher perches. Our study provides new evidence that territorial animals integrate information on signalling height and thus on vertical cues in their assessment of rivals.

Introduction : The imidazopyridine derivative zolpidem , which acts as a benzodiazepine (BZ) receptor agonist, is the most widely prescribed hypnotic drug in the US. Areas covered : This review addresses the neuroreceptor properties of zolpidem; clinical pharmacokinetics, pharmacodynamics and drug interactions; efficacy as a hypnotic; adverse effects; tolerance, dependence and withdrawal; relation to motor vehicle accidents and complex sleep behaviors; and new dosage forms. Expert opinion : Approved doses of zolpidem (10 mg for adults, 5 mg for the elderly) are consistently effective in reducing sleep latency and consequently increasing sleep duration in patients with insomnia. However, favorable effects on sleep maintenance are observed less consistently. Residual daytime effects are unlikely with recommended doses, and provided that at least 8 h elapse prior to arising. Hypnotic efficacy is maintained with repeated nightly use, and the risk of rebound insomnia is low. Dependence and abuse of zolpidem are no more likely to occur than with typical benzodiazepines. Newly available novel dosage forms of zolpidem have increased therapeutic options for patients with insomnia variants such as sleep maintenance insomnia and middle-of-the-night awakening.

BACKGROUND: Fragility fractures are a major health care problem worldwide. Due to the ageing population an increase of distal femoral fractures is to be expected. We studied the long-term functional outcome and their influencing factors in geriatric patients with LISS-plated distal femoral fractures. PATIENTS AND METHODS: A cohort study with functional long-term follow up examination was carried out in a level one trauma centre on distal femoral fracture patients 65 years and older. Of 53 consecutive patients who were treated in our hospital, 43 patients with a mean age of 80 years met our inclusion criteria. 48.8% died within the study period of 5.3 years. On the remaining patients the residential status, the Barthel index and the Parker score were assessed. RESULTS: The mean Barthel index was 47.7 and the mean Parker score was 3.5. 23% were found to be totally housebound and 26% were not able to perform any social activity. Only 18% were able to walk unaided. Patients with any medical complication had significantly higher mortality rates. Patients with extraarticular fractures had better mobility scores. Nursing home residents showed higher mortality rates but compared to patients coming from their own home the difference regarding Barthel and Parker scores remained non-significant. CONCLUSION: This study documents the poor functional long-term outcome of geriatric patients with distal femoral fractures. In comparison to other fragility fracture patients it seems that this population is at higher risk to die in-hospital during their perioperative course. Medical complications have to be avoided as they were found to be associated with worse functional outcome and higher mortality rates. An osteoporosis therapy may be associated with reduced mortality rates also in these patients.

A series of chiral mono-, di-, and trinuclear gold(I) complexes have been prepared and used as precatalysts in the asymmetric cyclohydroamination of N-protected γ-allenyl sulfonamides. The stereodirecting ligands were mono-, di-, and tridentate 2,5-diphenylphospholanes, which possessed C(1), C(2), and C(3) symmetry, respectively, thereby rendering the catalytic sites in the di- and trinuclear complexes symmetry equivalent. The C(3)-symmetric trinuclear complex displayed the highest activity and enantioselectivity (up to 95 % ee), whilst its mono- and dinuclear counterparts exhibited considerably lower enantioselectivities and activities. A similar trend was observed in a series of mono-, di-, and trinuclear 2,5-dimethylphospholane gold(I) complexes. Aurophilic interactions were established from the solid-state structures of the trinuclear gold(I) complexes, thereby raising the question as to whether these secondary forces were responsible for the different catalytic behavior observed.

Introduction: The population is rapidly aging and remaining more active over the age of 65. An increasing number of sports related injuries in individuals 65 and older are thus anticipated. The aim of this study is to analyze the epidemiology of sports injuries in the age group aged 65 and older. Methods: Data from the medical records of adults aged 65 years and older who were treated for sports-related injuries at a level one trauma center between December 1994 and February 2008 was collected and statistically analyzed. Results: A total of 2,635 patients met our inclusion criteria. There were 1,647 men (62.5%) and 988 women (37.5%) with a mean age of 70.9 years. The yearly number of injuries doubled during the study period (1996-2007). The most common mechanism of injury was a simple fall from standing height (69%). Nearly 75% of all injuries occurred during alpine skiing, cycling or mountain climbing. The median Injury Severity Score was 4. Minor injuries and wounds (40%) were recorded most commonly followed by fractures (27%), sprains, ligament injuries (19%) and injuries of muscles and tendons (6%). The most frequent diagnoses were minor injuries to the head and ligament injuries around the knee joint. Injuries to the upper extremities occurred in 33.7%, injuries to the lower extremities in 29.4% and injuries to the head occurred in 20% of the patients. Women sustained substantially more fractures than men. Conclusion: Adults aged 65 and older are remaining active in sports, which results in higher numbers of sports related injuries in this age group. Identification of type, mechanism and distribution of the injuries can help with the recognition of risk factors for injury. This may enable us to develop appropriate preventative measures to reduce the incidence, and morbidity of such injuries.

BACKGROUND Shift work disorder (SWD) is characterized by symptoms of excessive sleepiness during work hours or insomnia during allotted daytime sleep hours, as well as by a disruption of the circadian rhythm. Many shift workers with SWD experience significant social, behavioral, and health problems as a result of this disorder. SWD is associated with a higher risk of occupational and motor vehicle accidents, and thus poses a public health risk. METHODS Currently there are both pharmacologic and non-pharmacologic treatments for this disorder that can be used to normalize the disruption of the circadian cycle or alleviate the symptoms of excessive sleepiness or insomnia. The American Academy of Sleep Medicine and the British Society of Psychopharmacology have developed guidelines for the diagnosis and treatment of patients with SWD. RESULTS Recommended therapies for altering the circadian cycle include chronobiotics such as melatonin or melatonin agonists and non-pharmacologic interventions such as timed light exposure. Other therapies, such as sedative hypnotics, target daytime insomnia, while pharmacologic agents such as modafinil, armodafinil, and caffeine and non-pharmacologic approaches such as napping promote nighttime alertness. CONCLUSIONS While no therapies (pharmacological or nonpharmacological) can restore altered circadian cycles to baseline levels, proper identification and management of SWD will likely reduce its co-morbidities and improve the quality of life for individuals with this disorder.

INTRODUCTION AND OBJECTIVES The on-the-road driving test in normal traffic is applied to examine the impact of drugs on driving performance. Although participants are accompanied by a licensed driving instructor, under Dutch law, the driver is primarily responsible for safe driving and is not permitted to continue driving when it is judged that the drug compromises safety. This review examined the prevalence and nature of stopped driving tests, and the relationship with Standard Deviation of Lateral Position (SDLP), i.e. the "weaving of the car". MATERIALS AND METHODS A literature search was conducted to gather all publications on clinical trials that applied the on-the-road driving test, examining the effects of Central Nervous System (CNS)-drugs such as anxiolytics, antidepressants, antihistamines, analgesics, and hypnotics. RESULTS 47 papers reported on 50 Dutch clinical trials in which 1059 subjects participated (903 healthy volunteers and 156 patients). A total of 7232 driving tests were performed; 5050 after drug treatment and 2042 after placebo. 3.1% of all driving tests were terminated before completion: 4.1% after drug treatment, and 0.7% after placebo. The decision to stop a driving test was 3-4 times more often made by the driving instructor than the subject. The most common reasons for stopping were the driver feeling tired or sleepy, or the driving instructor noticing signs of drowsiness and performance impairment. Although SDLP values of stopped driving tests are sometimes high, there is no clear relationship between SDLP (changes from placebo) and the decision to stop a driving test. Based on 8 studies that reported exact data, 39.6% of stopped drivers had a lower and 60.4% had a higher SDLP than 35 cm, i.e. the cut-off point of safe driving. This confirms that perception of the driver as well as judgment by the instructor of driving to be 'unsafe' differs between individuals. CONCLUSION Driving tests are sometimes stopped after drug treatment or placebo. The decision to stop driving is not a good correlate of objective performance.

OBJECTIVE: To assess the effect of pregabalin on polysomnographic (PSG) measures of sleep, and patient-rated sleep, tiredness, and pain in fibromyalgia patients. METHODS: Randomized, double-blind, placebo-controlled, 2-period crossover PSG study. Patients ≥18y with fibromyalgia satisfied subjective and objective sleep disturbance criteria prior to randomization. Eligible patients were randomized (1:1) to pregabalin (300-450mg/day) or placebo for crossover Period 1; and vice versa for Period 2. Each crossover period comprised a dose-adjustment and dose-maintenance phase, with a 2-week taper/washout between periods. In-laboratory PSGs were recorded during 2 consecutive nights at screening and the end of each crossover period. The primary endpoint was difference in sleep maintenance defined by PSG-recorded wake-after-sleep-onset (WASO; minutes) between 4-weeks' treatment with pregabalin and with placebo. Other PSG measures, patient-rated sleep, tiredness, and pain, and tolerability were assessed. RESULTS: Of 119 patients randomized (103[86.6%] female; 48.4y), 102(85.7%) completed both periods. Treatment with pregabalin showed a reduction in PSG-determined WASO versus treatment with placebo (Week 4 difference [95% confidence interval]:-19.2[-26.7 to -11.6]mins;P<0.0001). Pain score improved (reduced) with pregabalin versus placebo treatment at all 4 weeks (Week 4 difference:-0.52[-0.90 to -0.14];P=0.008). Modest (rho<0.3) but significant correlations were found between PSG sleep assessments and ratings of pain and sleep quality. Frequently reported adverse events (pregabalin vs. placebo) were: dizziness (30.4% vs. 9.9%), somnolence (20.5% vs. 4.5%), and headache (8.9% vs. 8.1%). CONCLUSION: Patients with fibromyalgia treated with pregabalin had statistically-significant and meaningful improvements in sleep, as assessed by PSG. Patients with fibromyalgia also reported reduced daily pain. Pregabalin was well tolerated. © 2012 by the American College of Rheumatology.