bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of antenatal care in 13 sub-Saharan African countries in the SDG era: evidence from Demographic and Health Surveys
Authors: Ameyaw Edward Kwabena , Baatiema Linus , Naawa Ambrose , Odame Frederick , Koramah Doris , Arthur-Holmes Francis , Frimpong Shadrack Osei , Hategeka Celestin
Published: April 2024

Background

Maternal and neonatal mortality remains high in sub-Saharan Africa (SSA) with women having 1 in 36 lifetime risk. The WHO launched the new comprehensive recommendations/guidelines on antenatal care (ANC) in 2016, which stresses the essence of quality antenatal care. Consequently, the objective of this cross-sectional study is to investigate the quality of ANC in 13 SSA countries.

Methods

This is a cross-sectional study that is premised on pre-existing secondary data, spanning 2015 to 2021. Data for the study was obtained from the Measure DHS Programme and included a total of 79,725 women aged 15–49 were included. The outcome variable was quality ANC and it was derived as a composite variable from four main ANC services: blood pressure taken, urine taken, receipt of iron supplementation and blood sample taken. Thirteen independent variables were included and broadly categorised into individual and community-level characteristics. Descriptive statistics were used to present the proportion of women who had quality ANC across the respective countries. A two-level multilevel regression analysis was conducted to ascertain the direction of association between quality ANC and the independent variables.

Results

The overall average of women who had quality ANC was 53.8% [CI = 51.2,57.5] spanning from 82.3% [CI = 80.6,85.3] in Cameroon to 11% [CI = 10.0, 11.4] in Burundi. Women with secondary/higher education had higher odds of obtaining quality ANC compared with those without formal education [aOR = 1.23, Credible Interval [Crl] = 1.10,1.37]. Poorest women were more likely to have quality ANC relative to the richest women [aOR = 1.21, Crl = 1.14,1.27]. Married women were more likely to receive quality ANC relative to those cohabiting [aOR = 2.04, Crl = 1.94,3.05]. Women who had four or more ANC visits had higher odds of quality ANC [aOR = 2.21, Crl = 2.04,2.38]. Variation existed in receipt of quality ANC at the community-level [σ2 = 0.29, Crl = 0.24,0.33]. The findings also indicated that a 36.2% variation in quality ANC is attributable to community-level factors.

Conclusion

To achieve significant improvement in the coverage of quality ANC, the focus of maternal health interventions ought to prioritise uneducated women, those cohabiting, and those who are unable to have at least four ANCs. Further, ample recognition should be accorded to the existing and potential facilitators and barriers to quality ANC across and within countries.
Relationship between lymphocytes and idiopathic macular hole
Authors: Gao Ying , Tang Yun , Yu Ting , Ding Ying , Chen Yilu , Ye Wei , Zhao Changlin , Lu Rongxin
Published: April 2024

Background

An idiopathic macular hole (IMH) is a full-thickness anatomic defect extending from the internal limiting membrane to the photoreceptor layer of the macula without any known cause. Recently, clinical laboratory markers of systemic inflammatory status derived from complete blood counts have been evaluated in ocular diseases. This study aimed to explore whether they could predict the development and progression of IMHs.

Methods

A retrospective review of 36 patients with IMH and 36 sex-and-age-matched patients with cataracts was conducted. We collected complete blood counts of all participating individuals and calculated systemic immunoinflammatory indicators. The maximum base diameter of the IMH (BD), minimum diameter of the IMH (MIN), height of the IMH (H), area of the intraretinal cyst (IRC), and curve lengths of the detached photoreceptor arms were measured on optical coherence tomography (OCT) images. We used these values to calculate the macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI), hole form factor (HFF), and macular hole closure index (MHCI). We performed a receiver operating characteristic (ROC) curve analysis of 30 patients with IMH who were followed up 1 month after surgery.

Results

Lymphocyte counts were significantly higher in the IMH group. No other significant differences were observed between the IMH and control groups. Lymphocyte counts in the IMH group were significantly negatively correlated with MIN and BD and were significantly positively correlated with MHI, THI, and MHCI. However, lymphocyte counts were not significantly correlated with H, IRC, DHI, and HFF. In the ROC analysis, BD, MIN, MHI, THI, and MHCI were significant predictors of anatomical outcomes. According to the cut-off points of the ROC analysis, lymphocyte counts were compared between the above-cut-off and below-cut-off groups. Lymphocyte counts were significantly higher in the MIN ≤ 499.61 μm, MHI ≥ 0.47, THI ≥ 1.2, and MHCI ≥ 0.81 groups. There were no significant differences between the above-cut-off and below-cut-off BD groups.

Conclusions

Although inflammation may not be an initiating factor, it may be involved in IMH formation. Lymphocytes may play a relatively important role in tissue repair during the developmental and postoperative recovery phases of IMH.
Developing a prediction model to identify people with severe mental illness without regular contact to their GP - a study based on data from the Danish national registers
Authors: Naesager Astrid Helene Deleuran , Damgaard Sofie Norgil , Rozing Maarten Pieter , Siersma Volkert , Møller Anne , Tranberg Katrine
Published: April 2024

Introduction

People with severe mental illness (SMI) face a higher risk of premature mortality due to physical morbidity compared to the general population. Establishing regular contact with a general practitioner (GP) can mitigate this risk, yet barriers to healthcare access persist. Population initiatives to overcome these barriers require efficient identification of those persons in need.

Objective

To develop a predictive model to identify persons with SMI not attending a GP regularly.

Method

For individuals with psychotic disorder, bipolar disorder, or severe depression between 2011 and 2016 (n = 48,804), GP contacts from 2016 to 2018 were retrieved. Two logistic regression models using demographic and clinical data from Danish national registers predicted severe mental illness without GP contact. Model 1 retained significant main effect variables, while Model 2 included significant bivariate interactions. Goodness-of-fit and discriminating ability were evaluated using Hosmer-Lemeshow (HL) test and area under the receiver operating characteristic curve (AUC), respectively, via cross-validation.

Results

The simple model retained 11 main effects, while the expanded model included 13 main effects and 10 bivariate interactions after backward elimination. HL tests were non-significant for both models (p = 0.50 for the simple model and p = 0.68 for the extended model). Their respective AUC values were 0.789 and 0.790.

Conclusion

Leveraging Danish national register data, we developed two predictive models to identify SMI individuals without GP contact. The extended model had slightly better model performance than the simple model. Our study may help to identify persons with SMI not engaging with primary care which could enhance health and treatment outcomes in this group.
Sexual harassment and implicit gender-career biases negatively impact women’s life expectancy in the US: a state-level analysis, 2011–2019
Authors: Cunningham George B. , Wicker Pamela
Published: April 2024

Background

Despite some gains, women continue to have less access to work and poorer experiences in the workplace, relative to men. The purpose of this study was to examine the relationships among women’s life expectancy and two work-related factors, sexual harassment and gender-career biases.

Method

We examined the associations at the state level of analysis (and District of Columbia) in the US from 2011 to 2019 (n = 459) using archival data from various sources. Measures of the ratio of population to primary health providers, year, the percent of adults who are uninsured, the percent of residents aged 65 or older, and percent of residents who are Non-Hispanic White all served as controls.

Results

Results of linear regression models showed that, after accounting for the controls, sexual harassment and gender-career biases among people in the state held significant, negative associations with women’s life expectancy.

Conclusion

The study contributes to the small but growing literature showing that negative workplace experiences and bias against women in the workplace negatively impact women’s health.
The Role of Chief Medical officers in making Public Health Overview Documents in Norwegian Municipalities. A qualitative Study
Authors: Rønnevik Dag-Helge , Pettersen Betty J. , Grimsmo Anders , Steinsbekk Aslak
Published: April 2024

Aims

To investigate how Chief Medical Officers experience their role in the municipalities´ work with making the public health overview documents, demanded by the Norwegian Public Health Act from 2012.

Methods

A qualitative study with semi-structured focus group interviews with 21 Chief Medical Officers from 20 different municipalities in Norway. The interviews were conducted in 2017. The data were analyzed thematically.

Results

The Chief Medical Officers were mainly positive to participating in making public health overview documents. They took on roles as leaders of the work, medical advisors, data collectors towards local GPs and listening post to other sectors. Organizational factors like too small positions and a lack of tradition to involve the CMO in public health work were experienced as barriers to their involvement. The collaboration with the public health coordinators was said to be rewarding, and the intersectoral process involved employees from other sectors in a new way in public health. Although there were some positive experiences, several CMOs considered the use and impact of the public health overview document as limited.

Conclusion

There was a large variation in the amount and the type of involvement the Chief Medical Officers had in making the public health overview documents in Norwegian municipalities. More research is needed to understand if this has any consequences for the quality of public health work in the municipalities and whether it is a sign of a changing role of the Chief Medical Officers.
Association between preoperative lactate level and early complications after surgery for isolated extremity fracture
Authors: Nishida Yusho , Yamamoto Ryo , Ono Soichiro , Sasaki Junichi
Published: April 2024

Background

The role of lactate level in selecting the timing of definitive surgery for isolated extremity fracture remains unclear. Therefore, we aimed to elucidate the use of preoperative lactate level for predicting early postoperative complications.

Methods

This was a single-center retrospective observational study of patients with isolated extremity fracture who underwent orthopedic surgery. Patients who underwent lactate level assessment within 24 h prior to surgery were included. The incidence of early postoperative complications was compared between patients with a preoperative lactate level of ≥ 2 and < 2 mmol/L. Moreover, subgroup analyses were performed based on the time from hospital arrival to surgery and fracture type.

Results

In total, 187 patients were included in the study. The incidence of postoperative complications was significantly higher in patients with a preoperative lactate level of ≥ 2 mmol/L than those with a preoperative lactate level of < 2 mmol/L. This result did not change after adjusting for age and severity. Further, a high preoperative lactate level was associated with a greater incidence of postoperative complications in patients who underwent definitive surgery within 6 h after arrival.

Conclusion

A preoperative lactate level of ≥ 2 mmol/L was associated with a greater incidence of early postoperative complications in isolated extremity fractures. Nevertheless, this correlation was only observed among patients who underwent definitive fixation within 6 h after hospital arrival.
C6orf15 promotes liver metastasis via WNT/β-catenin signalling in colorectal cancer
Authors: Yu Jiankang , Sun Jian , Tang Jingtong , Xu Jiayu , Qian Guanru , Zhou Jianping
Published: April 2024

Background

Colon cancer ranks third among global tumours and second in cancer-related mortality, prompting an urgent need to explore new therapeutic targets. C6orf15 is a novel gene that has been reported only in Sjogren’s syndrome and systemic lupus erythematosus patients. We found a close correlation between increased C6orf15 expression and the occurrence of colon cancer. The aim of this study was to explore the potential of C6orf15 as a therapeutic target for colorectal cancer.

Method

RNA-seq differential expression analysis of the TCGA database was performed using the R package ‘limma.’ The correlation between target genes and survival as well as tumour analysis was analysed using GEPIA. Western blot and PCR were used to assess C6orf15 expression in colorectal cancer tissue samples. Immunofluorescence and immunohistochemistry were used to assess C6orf15 subcellular localization and tissue expression. The role of C6orf15 in liver metastasis progression was investigated via a mouse spleen infection liver metastasis model. The association of C6orf15 with signalling pathways was assessed using the GSEA-Hallmark database. Immunohistochemistry (IHC), qPCR and western blotting were performed to assess the expression of related mRNAs or proteins. Biological characteristics were evaluated through cell migration assays, MTT assays, and Seahorse XF96 analysis to monitor fatty acid metabolism.

Results

C6orf15 was significantly associated with liver metastasis and survival in CRC patients as determined by the bioinformatic analysis and further verified by immunohistochemistry (IHC), qPCR and western blot results. The upregulation of C6orf15 expression in CRC cells can promote the nuclear translocation of β-catenin and cause an increase in downstream transcription. This leads to changes in the epithelial–mesenchymal transition (EMT) and alterations in fatty acid metabolism, which together promote liver metastasis of CRC.

Conclusion

Our study identified C6orf15 as a marker of liver metastasis in CRC. C6orf15 can activate the WNT/β-catenin signalling pathway to promote EMT and fatty acid metabolism in CRC.
Construction and preliminary validation of a tool to measure the needs of adolescents and young adults (AYA) diagnosed with cancer: the QUestionnaire nEEd Cancer AYAs: QUEEC-AYAs
Authors: Justafré S. , Marino P. , Touzani R. , Dupeyre-Alvarez F. , Dantin P. , Viens P. , Vey N. , Calvin S.
Published: April 2024

Context

In France, 2300 adolescents and young adults (AYAs, 15–25 years old) are diagnosed with cancer each year. As soon as the disease is diagnosed, a number of physical, psychological and social needs may arise. The aim of this study is to develop a tool to measure unmet needs that will allow the specificities of AYAs to be understood while allowing health care staff to mobilise the necessary actors to resolve them.

Methods

We developed the Questionnaire nEEd Cancer AYAs (QUEEC-AYAs questionnaire), from two existing questionnaires: the Cancer Needs Questionnaire Young People and the Needs Assessment & Service Bridge. A main sample of 103 AYAs then received and completed the questionnaire in order to conduct an exploratory factor analysis.

Results

The final structure of the QUEEC-AYAs is composed of 7 dimensions and 48 items: information (8 items), cancer care team (6 items), Physical health (4 items), Emotional health (14 items), Sexual & reproductive health (6 items), Health behaviors & wellness (4 items), Daily life (6 items). The questionnaire has a good acceptability and all domains have a Cronbach’s alphas value above 0.80.

Conclusion

The QUEEC-AYAs is the first measure of the psychosocial needs of AYAs available in French. Its systematic use in health care services should improve the coordination of care required by AYAs during and after treatment.

Trial registration

This study was approved by the ethics committee of the Paoli-Calmettes Institute (IRB # IPC 2021-041, 2021 May 20).
Biomimetic peroxidase MOF-Fe promotes bone defect repair by inhibiting TfR2 and activating the BMP2 pathway
Authors: Xue Yaxin , Xu Wei , Zhao Danyang , Du Zijing , Jiang Hao , Lv Hao , Zhang Dong , Yu Zhencheng , Cao Yi , Han Dong
Published: April 2024

Background

Large bone defects pose a clinical treatment challenge; inhibiting transferrin receptor 2 (TfR2), which is involved in iron metabolism, can promote osteogenesis. Iron-based metal-organic frameworks (MOF-Fe) particles not only inhibit TfR2 but also serve as biomimetic catalysts to remove hydrogen peroxide in reactive oxygen species (ROS); excess ROS can disrupt the normal functions of osteoblasts, thereby hindering bone regeneration. This study explored the potential effects of MOF-Fe in increasing osteogenic activity and clearing ROS.

Methods

In vitro experiments were performed to investigate the osteogenic effects of MOF-Fe particles and assess their impact on cellular ROS levels. To further validate the role of MOF-Fe in promoting bone defect repair, we injected MOF-Fe suspensions into the femoral defects of SD rats and implanted MOF-Fe-containing hydrogel scaffolds in rabbit cranial defect models and observed their effects on bone healing.

Results

In vitro, the presence of MOF-Fe significantly increased the expression levels of osteogenesis-related genes and proteins compared to those in the control group. Additionally, compared to those in the untreated control group, the cells treated with MOF-Fe exhibited a significantly increased ability to remove hydrogen peroxide from ROS and generate oxygen and water within the physiological pH range. In vivo experiments further confirmed the positive effect of MOF-Fe in promoting bone defect repair.

Conclusion

This study supports the application of MOF-Fe as an agent for bone regeneration, particularly for mitigating ROS and activating the bone morphogenetic protein (BMP) pathway, demonstrating its potential value.
The associations of fatty acids related dietary patterns with overweight and obesity among Chinese children
Authors: Huang Zhi , Ma Keyu , Yin Xiaochen , Li Ziming , Chen Ming , Duan Yujie , Li Li , Hu Yuming
Published: April 2024

Background

Childhood overweight and obesity is becoming an emerging face of malnutrition. The aims of this study were to develop fatty acid (FAs) related dietary patterns and explored the associations of FAs related dietary patterns with overweight and obesity among Chinese children.

Methods

An observational study was conducted on 435 children aged 4 to 7 years old in South Central China. Erythrocyte FAs composition was analyzed by gas chromatography-mass spectrometry. Diet was collected by food frequency questionnaires and dietary patterns were evaluated by reduced rank regression. The logistic regression analysis was used to exploring the association of dietary patterns with overweight and obesity.

Results

The prevalence of overweight, obesity, and overweight or obesity were 6.52, 4.59, and 11.11% in Chinese children, respectively. Twenty five types of FAs were detected in erythrocyte of children and four FAs related dietary patterns were identified. The dietary pattern positively correlated with n-3 PUFAs, but negatively with SFAs,was characterized by high intake of fish, shrimp, crab and shellfish, leaf-off vegetable, nuts, and tubers, which have a significantly decreased overweight risk (OR = 0.580, 95%CI: 0.375 ∼ 0.895, P = 0.014).The pattern positively strong associated with n-6 PUFAs, but negatively strong with n-3 PUFAs, had high intake of snacks, leaf-off vegetable, fresh beans, and coarse cereals, which have a significantly decreased obesity risk (OR = 0.518, 95%CI: 0.325 ∼ 0.827, P = 0.006).

Conclusion

Four FAs related dietary patterns were identified. The dietary pattern with high intake of fish, shrimp, crab and shellfish decreased overweight risk by increasing n-3 PUFAs, and decreasing SFAs. The dietary pattern with high intake of plant food, decreased obesity risk by providing an balanced n-6/n-3 PUFAs ratio.
Landing Page via Perceived Interactivity for Four Generational Cohorts
Authors: Thomas Mary Rani , Mathew Jain
Published: April 2024

Purpose- There are numerous online websites for buying products and services today. The challenge for marketers is to adopt the pull strategy, which attracts customers to the website and creates additional sales. This strategy can materialise only when innovation is brought in. A landing page on the web is considered to be the initial entry point for creating innovation. The current research paper emphasises the importance of creating a landing page for bringing innovation that caters to the four generations.

Design/method /approach-400 responses were obtained equally from male and female respondents of each generational category except the alpha generation. Data was collected through a survey using Google forms. The structural equation model was used for analysis, and generational age was considered the moderator.

Findings-There is a gradual shift in the generational pattern of perceiving and understanding technology to buy from the website. Being tech-savvy, in the case of generation Z the impact of perceived interactivity in creating purchase intention is very strong, followed by generation Y and generation X.

 Practical implications-Age plays a huge role in understanding the landing page leading to better purchase intention. Hence it is evident that a landing page that caters to all generations unambiguously has to be considered by marketers to boost sales.

Originality /value- The research results suggest that every generation seeks exclusivity on the landing page. So, generation-based perceived interactivity features on the landing page can attract all generations.

Keywords: Landing Page, Perceived Interactivity, Generation X, Generation Y, Generation Z and Alpha Generation.

Paper type-Research paper
Attitude of medical university students to elective discipline in weight loss
Authors: Kiselev Yaroslav , Guryanov Maxim
Published: April 2024

The organization of high-quality education in the university is one of the priority tasks of the state. The modernization of medical education in the modern era involves the development and emergence of new elective disciplines related to the subject, physical education and sports. The work cites the attitude of medical students to the weight loss project implemented by the Department of Physical Culture and Sports at the Privolzhsky Research Medical University. The survey of 50 students participating in this project is being analyzed. Research on the opinions of students of the medical university in the future will help improve practical classes and the theoretical basis of the elective discipline of weight loss for students of the medical university.
The relationship of the value-semantic sphere of personality with the quality of life of modern students of a creative university
Authors: Kalmanovich V. , Bitsheva Irina , Abdrashitov Ruslan
Published: April 2024

The quality of human life is an estimated category of human life that generically characterizes the parameters of all components of his life: life potential, life activity and living conditions. The survey we conducted at the stage of the ascertaining experiment included a series of questionnaires, interviews and documentation studies. Analysis of students' opinions on improving the physical culture and wellness space showed that most students of all universities believe that it is necessary to form a powerful, active physical culture and wellness space at the university As a result of analyzing the data of a questionnaire survey of students of the Kazan State Institute of Culture, certain conclusions can be drawn that modern students are responsible for their health, but not many they are clearly aware of the binding of the state of physical health to the quality of their life.
Implementation of the ideas of K.D. Ushinsky in the formation of an aesthetic attitude to the world among younger schoolchildren
Authors: Ovchinnikova A.
Published: April 2024

The article substantiates the idea of K.D. Ushinsky about the relationship between the sensual and the rational in cognitive activity from an epistemological position. The relationship between the real object (original) and the image (model) in the formation of an aesthetic attitude to the world among younger schoolchildren at different stages of cognition is shown; the empirical material of the research activity of children is summarized, modern information methods for the formation of an aesthetic attitude to the world at different stages of cognition of the world are proposed. The article is intended for teachers and students of higher education, educators.
Prevention of risky behavior of high school students in conditions of moral hardening
Authors: Yakunin Vadim
Published: April 2024

The features of the prevention of risky behavior of high school students in the conditions of moral hardening are considered, the conditions determining this process and the content of pedagogical activity are highlighted. The considered model of the organization of work reflects the focus on the prevention of antisocial manifestations in the youth environment, the reduction of social risks accompanying the socialization of the younger generation. The algorithmic nature of the organized activity is built taking into account changes in the level of necessary personal competencies, the social experience gained.
Del liberalismo radical a la insurrección. Una historia del Ejército de Liberación
Authors: Pantoja García Juan Camilo
Published: April 2024

En este libro se analiza la historia política de las Juventudes del Movimiento Revolucionario Liberal (jMRL) y del Ejército de Liberación Nacional (ELN) en los inicios del Frente Nacional. Recurriendo a fuentes oficiales de Colombia y Estados Unidos, así como de prensa de varios países, entrevistas y folletos se reconstruye la historia política de estas organizaciones de Nueva Izquierda con el propósito de ampliar el conocimiento sobre el proceso de construcción del Estado colombiano entre 1960 y 1975. Esta obra evidencia que la creación de las jMRL y del ELN estuvo condicionada por la dinámica política local, en particular, por las críticas a la democracia del Frente Nacional y por la tradición política del liberalismo radical, así como por la dinámica regional que tomó forma con la intensificación de la Guerra Fría tras el triunfo de la Revolución Cubana. Asimismo, muestra cómo esas organizaciones incidieron en la construcción de las prácticas contrainsurgentes del Estado colombiano y en su imagen como un régimen que tan sólo formalmente respetaba el estado de derecho que decía defender.
The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene
Authors: Khattar Georges , Bou Sanayeh Elie , Makram Marina , Rabah Hussein , Abu Baker Saif , Khan Salman , Hong Catherine
Published: April 2024

Background: Fournier’s gangrene represents a life-threatening necrotising infection affecting the perineal region, while hidradenitis suppurativa is characterised by a chronic inflammatory skin condition. The simultaneous occurrence of both conditions is exceedingly rare. Case description: A 42-year-old female with a documented history of severe untreated hidradenitis suppurativa presented for shortness of breath, fever and lethargy, along with extensive wounds and skin breakdown involving the left axilla, perineum, lower back, lumbosacral region and bilateral gluteal areas, extending to the perineum. Upon presentation, the patient was in a state of septic shock, and a diagnosis of actively manifesting Fournier’s gangrene was established at the site of the pre-existing hidradenitis suppurativa lesions. Despite the implementation of an aggressive multidisciplinary approach incorporating surgical interventions, antibiotic therapy and intensive care measures, the patient’s condition deteriorated, culminating in septic shock, multi-organ failure and eventual demise. In this report, we discuss both clinical entities, their similarities and differences, and the possible mechanisms by which they may have co-occurred. Conclusion: The co-existence of hidradenitis suppurativa and Fournier’s gangrene poses unique challenges, given the rapid progression of Fournier’s gangrene within the context of hidradenitis suppurativa, potentially suggesting the latter as a predisposing factor. This case underscores the importance of vigilant screening and management of hidradenitis suppurativa.
UNVEILING FINANCIAL REALITIES: THE SUBSTANTIAL ECONOMIC IMPACT OF CENTRALIZED COMPLEX TIBIAL FRACTURE CARE IN THE UK
Authors: Jido Jamila Tukur , Al-Wizni Ahmed , Rodham Paul , Taylor David Martin , Kanakaris Nik , Harwood Paul
Published: April 2024

Introduction

Management of complex fractures poses a significant challenge. Evolving research and changes to national guidelines suggest better outcomes are achieved by transfer to specialist centres. The development of Major Trauma Networks was accompanied by relevant financial arrangements. These do not apply to patients with closed fractures referred for specialist treatment by similar pathways. Despite a surge in cases transferred for care, there is little information available regarding the financial impact on receiving institutions.

Materials & Methods

This retrospective study examines data from a Level 1 trauma centre. Patients were identified from our electronic referral system, used for all referrals. Transferred adult patients, undergoing definitive treatment of acute isolated closed tibial fractures, were included for a 2-year period. Data was collected using our clinical and Patient Level Information and Costing (PLICS) systems including coding, demographics, treatment, length of stay (LOS), total operative time, number of operations, direct healthcare costs, and NHS reimbursements.

Results

104 patients were identified, 23 patients were treated by internal fixation and 81 with circular frames. Patients required a median of 190 minutes of total operative time and 6 days of hospital stay at a median cost of £16,233 each, median reimbursement was £10,625. The total cost of treatment for all 104 patients was £2,205,611 and total reimbursement was £1,391463, the median deficit per patient being £5825. The overall deficit over the 2 years was £814,148.

Conclusions

This study reveals a considerable economic burden associated with treating complex tibial fractures. It should be emphasised that these do not include patients referred for fracture-related infection or non-union, who may also incur similar deficits in recovered costs. These findings emphasise the importance of understanding and addressing the financial implications of managing tertiary referral orthopaedic trauma patients to ensure efficient and sustainable resource allocation.
SELECTIVE REMOVAL OF ILIZAROV FRAMES WITHOUT A PERIOD OF DYNAMIZATION APPEARS SAFE
Authors: Brown Natasha , King Samuel , Taylor Martin , Foster Patrick , Harwood Paul
Published: April 2024

Introduction

Traditionally, radiological union of fractures treated with an Ilizarov frame is confirmed by a period of dynamization - destabilisation of the frame for a period prior to removal. Reduced clinic availability during the COVID-19 pandemic caused a shift to selective dynamisation in our department, whereby lower risk patients had their frames removed on the same day as destabilisation. This study investigates the effects of this change in practice on outcomes and complication rates.

Materials & Methods

Adult patients treated with circular frames between April 2020 and February 2022 were identified from our Ilizarov database. Patients were divided into 2 groups: - “dynamised” if their frame was destabilised for a period to confirm union prior to removal; or “not dynamised” if the decision was taken to remove the frame without a period of dynamisation, other than a short period in the clinic. A retrospective review of clinical notes was conducted to determine outcome.

Results

175 patients were included in the final analysis, 70 in the dynamised and 103 in the not dynamised groups, median follow-up was 33 months. 3 patients in the dynamised group failed dynamisation and had their period of fixation extended, subsequently having their frames removed without complication. Two patients suffered a refracture or non-union after frame removal in the dynamised group and none in the not dynamised group, this difference was not statistically significant.

Conclusions

In our practice, selective frame removal without a period of dynamisation appears safe. This has the potential to shorten frame time and reduce the number of clinic appointments and radiographic investigations for these patients. Some patients find the period of dynamisation uncomfortable and associated with pin site infection, which can be avoided. We plan to continue this practice and collect further data to confirm these findings in a larger dataset.
AN IN VITRO STUDY EXAMINING WIRE TENSION IN FINE WIRE CIRCULAR EXTERNAL FIXATION CONSTRUCTS
Authors: Howard Anthony , Harwood Paul , Benton Alice , Merrel Charlotte , Culmer Peter , Bolton William , Stewart Todd
Published: April 2024

Introduction

Ilizarov fixators are reliant on tensioned fine wires for stability. The tension in the wires is generated using specific tensioning devices. Loss of wire tension over time may lead of loss a stability and complications. A series of in vitro experiments were undertaken to explore wire tensioner accuracy, the impact of fixation bolt torque and initial tension on loss of tension in ilizarov constructs under static and dynamic loads.

Materials & Methods

Medical grade materials were applied to a synthetic bone analogue using surgical instruments in all experiments. Bolt torque was fixed at 6, 10 or 14 Nm using a torque limiting wrench. Wire tension was assessed using a strain measurement bridge. Wires were tensioned to 90, 110 and 130kg as measured by a commercial dynamometric tensioner. Static and dynamic testing was undertaken using an instron testing machine. Cyclical loads from 50–750N were applied for 5000 cycles.

Results

Actual wire tension was approximately 15% less than indicated by the tensioner device. Using fixation bolt torques of 10Nm and 14Nm achieved final wire tensions of around 60% and 80% of that applied at 90 and 130kg of applied tension. Static load testing demonstrated self stiffening to similar levels in all pre-tensions. Dynamic testing demonstrated significant loss of tension, most of which occured in the first 3 cycles, inversely proportional to the tension initially applied.

Conclusions

These experiments provides insight into the effect of initially applied wire tension on Illizarov mechanical performance. It is important surgeons understand how the different ways that these devices are applied affects mechanical performance. Further research examining what factors affect performance across different manufacturers equipment would therefore be relevant, alongside the development of novel fixation methods to reduce wire slippage and the further development of equipment for clinical use.
THE RESULTS OF TWO-RING HEXAPODS IN THE LOWER LIMB AT KING'S COLLEGE HOSPITAL
Authors: Macey Alistair , Omar Hussain Al , Leitch Patricia , Vaidean Traian , Swaine Suzanne , Santos Eliza , Bond Deborah , Abhishetty Naveen , Shetty Sandesh , Saini Aaron , Phillips Sarah , Groom Graeme , Lahoti Om
Published: April 2024

Introduction

Classical fixation using a circular frame involves two rings per segment and in many units this remains the norm whether using ilizarov or hexapod type frames. We present the results of two ring circular frame at King's College Hospital.

Materials & Methods

A prospective database has been maintained of all frames applied since 2007. Radiographs from frames applied prior to July 2022 were examined. Clinic letters were then used to identify complications.

Included: two ring hexapod for fracture, malunion, nonunion, arthrodesis or deformity correction in the lower limb.

Excluded: patients under 16 years old, diabetic feet, Charcot joints, soft tissue contractures, arthrodiastasis, correction of the mid/forefoot, plate fixation augmentation, fixation off a third ring.

Results

518 two ring hexapods were identified. Mean age was 46 (16–89). 55% were for fracture, 18% for malunion, 11% for nonunion. Mean frame time was 7 months (2–29 months).

All clinic letters from 384 patients showed 203 patients (52%) had at least one pin site infection, 27 nonunions (7%), 16 frame revisions (4%), 25 bone grafting procedures (7%), 5 cases of septic arthritis (1%), 3 periprosthetic fractures (0.8%),), 12 malunions (3%), 4 Amputations (1%).

Conclusions

These results demonstrate the efficacy of a two ring hexapod for patients requiring reconstruction of the lower limb.
Right Here and Out There: A Phenomenological Interpretation of ajjhattaṃṃ and bahiddhā in the Context of Mindfulness of the Body
Authors: Akiñcano Bhikkhu
Published: April 2024

According to the Satipaṭṭhāna Sutta, mindfulness of the body involves seeing the body in a threefold way: ajjhattaṃ, bahiddhā and ajjhattabahiddhā. This paper attempts to show how an investigation of bodily perception, following the approach adopted by the phenomenologist Maurice Merleau-Ponty, can serve as the basis for a philosophically grounded understanding of the Pāli words ajjhattaṃ and bahiddhā. The interpretation that emerges is the distinction between ‘right here’ and ‘out there’: two mutually dependent, internally related domains that are experienced as what Merleau-Ponty (1968) called the ‘chiasm’ or the ‘intertwining’. This is different from the standard interpretations found in the Abhidhamma, the Pāli commentaries, the Visuddhimagga and the instructions of most contemporary meditation teachers. It is hoped that the interpretation offered here can give some exposure to a movement within Theravāda Buddhism, initiated by Ñāṇavīra Thera but slowly gaining traction, characterised by a phenomenological reading of the Pāli suttas.
Meander Morphologic Characteristics in an Alluvial Channel
Authors: Kang Ranbir
Published: April 2024

Meander bends are one of the most common morphological features of rivers. Their formation is the result of interactions between bank erosion and several other river characteristics, such as the bed topography resulting from bank erosion, sinuosity, channel flow, and riffle-pool sequencing. Many studies have emphasized proportional relationships between channel widths and different aspects of meander morphology, such as wavelength, curvature of the radius, and belt width. These relationships have been studied for bankfull level width in high-order channels. It is not clear how such relationships vary in low-order headwater streams. This research addresses those gaps in low-order streams of which little is known. Field surveys were conducted in nine meander bends of a low-order alluvial channel in Virginia. The results suggest that in a low-order channel, the ratios of width with wavelength, the radius of curvature, and belt width are mostly similar between the meanders’ beginning and tail endpoints. The stream also has similar meander morphologic characteristics and ratios as anticipated from the literature on high-order streams.
Scrooge’s Bed Curtains and the Prospect of Discovery
Authors: Stockstill Ellen
Published: April 2024

Abstract: This essay offers a close reading of Scrooge’s bed curtains in A Christmas Carol and posits that Charles Dickens uses the curtains strategically to heighten the stakes of Scrooge’s ghostly encounters and to cue to readers that the man’s bed will be a principal site of discovery. Using Victorian housekeeping manuals, Dickens’s canon of writing, and the histories of curtains in the home and on the stage, the article illuminates a rich tapestry of meaning imbedded in this common household object.
Electro-optomechanical entanglement in two coupled optical cavities with an LC microwave circuit
Authors: Abutalebi B.A. Shabnam , Asghari Nejad Ali , Askari Hassan Ranjbar , Bahrampour Alireza
Published: April 2024

We theoretically investigate entanglement in a hybrid quantum system comprising two optical cavities coupled to a shared microwave cavity via optomechanical interactions. Our results demonstrate that increasing the microwave input power and frequency in the allowed range enhances entanglement between the microwave–optical and optical–optical modes. We also show by change frequency of the one optical cavity in the communication domain that we still have entanglement. This ability to generate robust microwave–optical photon entanglement shows promise for various quantum technologies. Optical photons could enable secure quantum communication in optical fibers, while microwave photons allow transmission to satellites. Overall, this hybrid cavity optomechanical system offers prospects as an efficient source of entangled photon pairs, vital for implementing long-distance quantum communication networks.
Historic Mosques in Sub-Saharan Africa: From Timbuktu to Zanzibar, Stéphane Pradines (2022)
Authors: Hillenbrand Robert
Published: April 2024

Review of: Historic Mosques in Sub-Saharan Africa: From Timbuktu to Zanzibar, Stéphane Pradines (2022)

Leiden: Brill, 350 pp., 213 colour illus.,

ISBN: 9789004445543, $179 (hardback)
Implementation of Rtl as a Part of Multi-tiered Systems of Support: What Teachers, Administrators,Teacher Educators Need to Know
Authors: Polirstok Susan , Hogan Joseph
Published: April 2024

Multi-tiered Systems of Support (MTSS) is an outgrowth of Response to Intervention (RtI). The various systems of support for students and school communities provided through these programs are integral to modern education and embedded in the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004. While there are many benefits to the implementation of MTSS and RtI, there are various obstacles that can hinder successful intervention programs. The absence of consensus across districts and states with respect to program development and implementation creates confusion. This article addresses considerations and concerns related to MTSS and RtI. Discussed are underlying principles, challenges to effective implementation, expertise and training of teachers, and usage for classification for special education services. The roles of general and special education teachers, administrators, and university preparation programs are examined, and recommendation providec
Nucleus Cell Segmentation on Pap Smear Image Using Bradley Modification Algorithm
Authors: Halim Afiqah Abd , Mustafa Wan Azani , Nasir Aimi Salihah Abdul , Ismail Shahrina , Alquran Hiam
Published: April 2024

Early detection of cervical cancer can help patients obtain the best treatment through various means. In general, computer-aided diagnosis has a high impact on the accuracy, reliability, and convenience of cervical cancer. However, several limitations have been faced through the design process in detecting or classifying the cells, such as variation of image features and low-image resolution. Moreover, shape indifference is one of the limitations in terms of image processing scope. The metrics used to measure the size and shape of the cells have not been developed to distinguish the differences between the shape of the objects. This paper focused on the detection and segmentation of the nucleus cell region in Pap smear images based on Bradley local thresholding. The proposed method evolved several steps, such as color adjustment, k-means, and a Bradley modification algorithm. Based on image quality assessment (IQA), the numerical evaluation results indicate that the proposed approach has segmented a full area of the nucleus cell region significantly and efficiently compared to the original Bradley algorithm. We obtained F-measure (98.62%), sensitivity (99.13%), and accuracy (97.96%). It has also been proven that the proposed method can effectively address the issue of low contrast and black noise. Hence, the proposed method differs from the previous research in terms of color disproportion adjustment and the modification of Bradleys algorithm for Pap smear image convenience.
Biotoxicity and repellency of Vitex negundo (L.) oil nanoemulsion towards Rhyzopertha dominica (F.) on stored rice
Authors: Mishra Prajna Prakash , Mishra P R , Adak Totan , Gowda G Basana , Pandi G Guru Pirasanna , Golive Prasanthi , Rath P C , Das Susanta Kumar , B. Patil Naveenkumar
Published: April 2024

Rhyzopertha dominica F. (lesser grain borer) is an important primary pest of stored rice that causes substantial economic loss. This pest developed resistance to a wide range of hazardous chemical pesticides due to its great degree of adaptability. This study proposed to prepare Vitex negundo oil nanoemulsion (VNO NE) to improve its efficacy against this target pest. Vitex negundo oil (VNO) contains key compounds such as Aromandendrene, ?-caryophyllene, Squalene, 3-octen-5-yne,2,7-dimethyl-,(E)-,5-(1-isopropenyl-4,5-dimethylbicyclo[4.3.0]nonan-5-yl)-3-methyl-2-pentenol acetate, Farnesyl bromide, 4-terpineol and Elemol. VNO NEs were prepared using a high-speed homogenizer from which nanoemulsion having 5% VNO mixed at a 1:2 (w/w) ratio with tween80 was found to be optimum considering different characterization parameters. The mean zeta potential, polydispersity index and hydrodynamic diameter of the nanoemulsion were -3.4 mV, 0.263 and 166.62 nm respectively. For contact toxicity lethal dose 50 (LD50) value of VNO NE was 0.517 ?L cm-2 against R. dominica which was 46.03% less, compared to bulk VNO. LD50 value of VNO NE for fumigant toxicity against R. dominica was 245.38 ?L L-1 which was 32.05% less than that of crude oil. The highest repellency increased by 30.14% than VNO, when treated with VNO NE in R. dominica. Significant inhibition of glutathione transferase enzyme was also detected in insects treated with VNO NE than VNO and control. These results indicated that VNO NE is an effective novel pesticide that can be recommended for the management of R. dominica in stored rice.
Exponential stability of non-conformable fractional-order systems
Authors: Echi Nadhem , Mabrouk Fehmi , Omri Faouzi
Published: April 2024

Recently, the authors Guzman et al. (2018) introduced a new simple well-behaved definition
of the fractional derivative called non-conformable fractional derivative. In this paper we study the exponential stability of non-conformable
fractional-order systems by using the Lyapunov function and Gronwall inequality.
These inequalities can be used as handy tools to research stability problems of nonlinear systems.
Sufficient conditions for exponential stability
are given using the Lyapunov theory. Further, deals with the state feedback stabilization problems for a family of nonlinear systems satisfying a Lipschitz continuity condition. The stability of the controller is proved by means of the new Lyapunov stability theorem given in this paper. A numerical example is given to illustrate the efficiency of the obtained result.
On a new variant of cyclic (noncyclic) condensing operators with existence of optimal solutions to an FDE
Authors: Khokhar Gurpreet Kaur , Gabeleh Moosa , Patel Deepesh Kumar
Published: April 2024

The paper is designed to highlight the presence of an optimal solution to a differential system comprising fractional order derivatives, precisely the ψ-Caputo derivative, under the prescribed initial constraints. This is attained through a new variant of cyclic (noncyclic) condensing operators incorporating a pair of maps. The altered notion facilitates in evolving best proximity point (pair) results as well as coupled best proximity point results with supportive corollaries.