bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of commonly used thromboprophylaxis agents following hip and knee arthroplasty
Authors: Cheok Tim , Beveridge Alexander , Berman Morgan , Coia Martin , Campbell Alexander , Tse Tycus T. S. , Doornberg Job N. , Jaarsma Ruurd L.
Published: September 2024

Aims

We investigated the efficacy and safety profile of commonly used venous thromboembolism (VTE) prophylaxis agents following hip and knee arthroplasty.

Methods

A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and OrthoSearch was performed. Prophylaxis agents investigated were aspirin (< 325 mg and ≥ 325 mg daily), enoxaparin, dalteparin, fondaparinux, unfractionated heparin, warfarin, rivaroxaban, apixaban, and dabigatran. The primary efficacy outcome of interest was the risk of VTE, whereas the primary safety outcomes of interest were the risk of major bleeding events (MBE) and wound complications (WC). VTE was defined as the confirmed diagnosis of any deep vein thrombosis and/or pulmonary embolism. Network meta-analysis combining direct and indirect evidence was performed. Cluster rank analysis using the surface under cumulative ranking (SUCRA) was applied to compare each intervention group, weighing safety and efficacy outcomes.

Results

Of 86 studies eligible studies, cluster rank analysis showed that aspirin < 325 mg daily (SUCRA-VTE 89.3%; SUCRA-MBE 75.3%; SUCRA-WC 71.1%), enoxaparin (SUCRA-VTE 55.7%; SUCRA-MBE 49.8%; SUCRA-WC 45.2%), and dabigatran (SUCRA-VTE 44.9%; SUCRA-MBE 52.0%; SUCRA-WC 41.9%) have an overall satisfactory efficacy and safety profile.

Conclusion

We recommend the use of either aspirin < 325 mg daily, enoxaparin, or dabigatran for VTE prophylaxis following hip and knee arthroplasty.

Cite this article: Bone Joint J 2024;106-B(9):924–934.
Sleeve gastrectomy prior to primary total hip and total knee arthroplasty is associated with increased risk of early complications
Authors: Ailaney Nikhil , Guirguis Paul G. , Ginnetti John G. , Balkissoon Rishi , Myers Thomas G. , Ramirez Gabriel , Thirukumaran Caroline P. , Ricciardi Benjamin F.
Published: September 2024

Aims

The purpose of this study was to determine the association between prior sleeve gastrectomy in patients undergoing primary total hip and knee arthroplasty, and 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up.

Methods

This is a retrospective, single-centre analysis. Patients undergoing primary hip or knee arthroplasty with a prior sleeve gastrectomy were eligible for inclusion (n = 80 patients). A morbidly obese control group was established from the same institutional registry using a 1:2 match, for cases:controls with arthroplasty based on propensity score using age, sex, pre-sleeve gastrectomy BMI, Current Procedural Terminology code to identify anatomical location, and presurgical haemoglobin A1C. Outcomes included 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. Multivariable logistic regressions evaluated associations of underlying preoperative demographic and treatment characteristics with outcomes.

Results

Complications within 90 days of surgery were increased in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (odds ratio (OR) 4.00 (95% CI 1.14 to 13.9); p = 0.030). Postoperative revisions were similar in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (OR 17.8 (95% CI 0.64 to 494.3); p = 0.090). Patient-Reported Outcomes Measurement Information System (PROMIS) depression decreased by a greater amount from pre- to postoperative in the obese controls relative to the sleeve gastrectomy group (OR 4.04 (95% CI 0.06 to 8.02); p = 0.047). PROMIS pain interference and physical function change from pre- to postoperative was not associated with sleeve gastrectomy status.

Conclusion

We found a higher rate of complications at 90 days in patients who underwent sleeve gastrectomy prior to primary hip or knee arthroplasty relative to a matched, obese control population. Prosthetic revision rates were similar between the two groups, while improvements in PROMIS depression scores were larger in the obese cohort. This study suggests that sleeve gastrectomy to achieve preoperative weight loss prior to arthroplasty surgery may not mitigate early complication risks in obese patient populations.

Cite this article: Bone Joint J 2024;106-B(9):935–941.
Increased early complications after total hip arthroplasty compared with hemiarthroplasty in older adults with a femoral neck fracture
Authors: Hatano Masaki , Sasabuchi Yusuke , Isogai Toshiaki , Ishikura Hisatoshi , Tanaka Takeyuki , Tanaka Sakae , Yasunaga Hideo
Published: September 2024

Aims

The aim of this study was to compare the early postoperative mortality and morbidity in older patients with a fracture of the femoral neck, between those who underwent total hip arthroplasty (THA) and those who underwent hemiarthroplasty.

Methods

This nationwide, retrospective cohort study used data from the Japanese Diagnosis Procedure Combination database. We included older patients (aged ≥ 60 years) who underwent THA or hemiarthroplasty after a femoral neck fracture, between July 2010 and March 2022. A total of 165,123 patients were included. The THA group was younger (mean age 72.6 (SD 8.0) vs 80.7 years (SD 8.1)) and had fewer comorbidities than the hemiarthroplasty group. Patients with dementia or malignancy were excluded because they seldom undergo THA. The primary outcome measures were mortality and complications while in hospital, and secondary outcomes were readmission and reoperation within one and two years after discharge, and the costs of hospitalization. We conducted an instrumental variable analysis (IVA) using differential distance as a variable.

Results

The IVA analysis showed that the THA group had a significantly higher rate of complications while in hospital (risk difference 6.3% (95% CI 2.0 to 10.6); p = 0.004) than the hemiarthroplasty group, but there was no significant difference in the rate of mortality while in hospital (risk difference 0.3% (95% CI -1.7 to 2.2); p = 0.774). There was no significant difference in the rate of readmission (within one year: risk difference 1.3% (95% CI -1.9 to 4.5); p = 0.443; within two years: risk difference 0.1% (95% CI -3.2 to 3.4); p = 0.950) and reoperation (within one year: risk difference 0.3% (95% CI -0.6 to 1.1); p = 0.557; within two years: risk difference 0.1% (95% CI -0.4 to 0.7); p = 0.632) after discharge. The costs of hospitalization were significantly higher in the THA group than in the hemiarthroplasty group (difference $2,634 (95% CI $2,496 to $2,772); p < 0.001).

Conclusion

Among older patients undergoing surgery for a femoral neck fracture, the risk of early complications was higher after THA than after hemiarthroplasty. Our findings should aid in clinical decision-making in these patients.

Cite this article: Bone Joint J 2024;106-B(9):986–993.
Tendon transfers for the management of irreparable subscapularis tears
Authors: De Rus Aznar Ignacio , Ávila Lafuente José L. , Hachem Abdul-ilah , Díaz Heredia Jorge , Kany Jean , Elhassan Bassem , Ruiz Ibán Miguel Á.
Published: September 2024

Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears.

The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane – anterior to the rib cage – is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use.

Cite this article: Bone Joint J 2024;106-B(9):970–977.
Dysregulated neutrophil extracellular traps and haemostatic biomarkers as diagnostic tools and therapeutic targets in periprosthetic joint infection
Authors: Oto Julia , Herranz Raquel , Fuertes Manuel , Plana Emma , Verger Patricia , Baixauli Francisco , Amaya José V. , Medina Pilar
Published: September 2024

Aims

Bacterial infection activates neutrophils to release neutrophil extracellular traps (NETs) in bacterial biofilms of periprosthetic joint infections (PJIs). The aim of this study was to evaluate the increase in NET activation and release (NETosis) and haemostasis markers in the plasma of patients with PJI, to evaluate whether such plasma induces the activation of neutrophils, to ascertain whether increased NETosis is also mediated by reduced DNaseI activity, to explore novel therapeutic interventions for NETosis in PJI in vitro, and to evaluate the potential diagnostic use of these markers.

Methods

We prospectively recruited 107 patients in the preoperative period of prosthetic surgery, 71 with a suspicion of PJI and 36 who underwent arthroplasty for non-septic indications as controls, and obtained citrated plasma. PJI was confirmed in 50 patients. We measured NET markers, inflammation markers, DNaseI activity, haemostatic markers, and the thrombin generation test (TGT). We analyzed the ability of plasma from confirmed PJI and controls to induce NETosis and to degrade in vitro-generated NETs, and explored the therapeutic restoration of the impairment to degrade NETs of PJI plasma with recombinant human DNaseI. Finally, we assessed the contribution of these markers to the diagnosis of PJI.

Results

Patients with confirmed PJI had significantly increased levels of NET markers (cfDNA (p < 0.001), calprotectin (p < 0.001), and neutrophil elastase (p = 0.022)) and inflammation markers (IL-6; p < 0.001) in plasma. Moreover, the plasma of patients with PJI induced significantly more neutrophil activation than the plasma of the controls (p < 0.001) independently of tumour necrosis factor alpha. Patients with PJI also had a reduced DNaseI activity in plasma (p < 0.001), leading to a significantly impaired degradation of NETs (p < 0.001). This could be therapeutically restored with recombinant human DNaseI to the level in the controls. We developed a model to improve the diagnosis of PJI with cfDNA, calprotectin, and the start tail of TGT as predictors, though cfDNA alone achieved a good prediction and is simpler to measure.

Conclusion

We confirmed that patients with PJI have an increased level of NETosis in plasma. Their plasma both induced NET release and had an impaired ability to degrade NETs mediated by a reduced DNaseI activity. This can be therapeutically restored in vitro with the approved Dornase alfa, Pulmozyme, which may allow novel methods of treatment. A combination of NETs and haemostatic biomarkers could improve the diagnosis of PJI, especially those patients in whom this diagnosis is uncertain.

Cite this article: Bone Joint J 2024;106-B(9):1021–1030.
Comparing the risk of reoperation between pneumatic tourniquet and non-tourniquet use in surgical treatment of ankle fractures
Authors: El-Khaldi Issam , Gude Mads H. , Gundtoft Per H. , Viberg Bjarke
Published: September 2024

Aims

Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets.

Methods

This was a population-based cohort study using data from the Danish Fracture Database with a follow-up period of 24 months. Data were linked to the Danish National Patient Registry to ensure complete information regarding reoperations due to complications, which were divided into major and minor. The relative risk of reoperations for the tourniquet group compared with the non-tourniquet group was estimated using Cox proportional hazards modelling.

Results

A total of 4,050 ankle fractures treated with open reduction and internal fixation between 15 March 2012 and 31 December 2016 were included, with 669 (16.5%) undergoing surgery with a tourniquet and 3,381 (83.5%) without a tourniquet. The overall reoperation risk was 28.2% with an adjusted relative risk of 1.46 (95% CI 0.91 to 2.32) for group comparison. The reoperation risk due to major complications was 3.1% with a tourniquet and 4.4% without a tourniquet, resulting in an adjusted relative risk of 1.45 (95% CI 0.91 to 2.32). For minor complications, there were 24.7% and 23.9% reoperations, resulting in an adjusted relative risk of 0.99 (95% CI 0.84 to 1.17).

Conclusion

We found no significant difference in the reoperation rate when comparing ankle fractures treated surgically with and without the use of pneumatic tourniquets.

Cite this article: Bone Joint J 2024;106-B(9):994–999.
The bone trauma and soft-tissue injury classification system in total hip arthroplasty (BOSTI Hip)
Authors: Kayani Babar , Wazir Mohammed U. K. , Mancino Fabio , Plastow Ricci , Haddad Fares S.
Published: September 2024

Aims

The primary objective of this study was to develop a validated classification system for assessing iatrogenic bone trauma and soft-tissue injury during total hip arthroplasty (THA). The secondary objective was to compare macroscopic bone trauma and soft-tissues injury in conventional THA (CO THA) versus robotic arm-assisted THA (RO THA) using this classification system.

Methods

This study included 30 CO THAs versus 30 RO THAs performed by a single surgeon. Intraoperative photographs of the osseous acetabulum and periacetabular soft-tissues were obtained prior to implantation of the acetabular component, which were used to develop the proposed classification system. Interobserver and intraobserver variabilities of the proposed classification system were assessed.

Results

The BOne trauma and Soft-Tissue Injury classification system in total Hip arthroplasty (BOSTI Hip) grades osseous acetabular trauma and periarticular muscle damage during THA. The classification system has an interclass correlation coefficient of 0.90 (95% CI 0.86 to 0.93) for interobserver agreement and 0.89 (95% CI 0.84 to 0.93) for intraobserver agreement. RO THA was associated with improved BOSTI Hip scores (p = 0.002) and more pristine osseous surfaces in the anterior superior (p = 0.001) and posterior superior (p < 0.001) acetabular quadrants compared with CO THA. There were no differences between the groups in relation to injury to the gluteus medius (p = 0.084), obturator internus (p = 0.241), piriformis (p = 0.081), superior gamellus (p = 0.116), inferior gamellus (p = 0.132), quadratus femoris (p = 0.208), and vastus lateralis (p = 0.135), but overall combined muscle injury was reduced in RO THA compared with CO THA (p = 0.023).

Discussion

The proposed BOSTI Hip classification provides a reproducible grading system for stratifying iatrogenic bone trauma and soft-tissue injury during THA. RO THA was associated with improved BOSTI Hip scores, more pristine osseous acetabular surfaces, and reduced combined periarticular muscle injury compared with CO THA. Further research is required to understand if these intraoperative findings translate to differences in clinical outcomes between the treatment groups.

Cite this article: Bone Joint J 2024;106-B(9):898–906.
Giant Cell Tumor of First Metatarsal: A Rare Case Report with Literature Review
Authors:   Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India., Kumar Rajnand , Kumar Nitish ,   Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India., Bharti Ajay ,   Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India., Kushwaha Sudhir Shyam ,   Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India., Kumar Vivek ,   Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
Published: September 2024

Introduction: Giant cell tumor (GCT) is a benign locally aggressive tumor with features of frequent recurrence and metastatic potential. GCT of small bones of hand and feet is rare with high recurrence and potential to metastasis. This study aims to provide a case report of GCT of the first metatarsal treated with wide excision, autologous fibular grafting, and fixation with locking plate. Case Report: An 18-year-old male patient presented with progressive swelling over the dorsomedial aspect of foot for 1 year. Upon clinical examination, the swelling was firm with local signs suggestive of a benign bony tumor arising from the base of first metatarsal of the left foot. Radiology reveals an expansile osteolytic lesion arising from the base of 1st metatarsal with coarse septations and features suggestive of a benign bone lesion. A core biopsy was obtained under local anesthesia and histopathology report suggested a GCT. Surgical intervention by en bloc excision and reconstruction by fibular autograft and stabilized with a locking plate was done. The patient was given a below-knee cast for 6 weeks postoperatively. Full weight bearing was started after 6 weeks. At 12 months of follow-up, the graft was well taken up and there were no signs of recurrence both clinically and radiologically. Conclusion: GCT of 1st metatarsal is a rare entity with higher recurrence rate compared to conventional GCT. En bloc excision and autologous fibular graft with plate fixation are preferred treatment options. Keywords: Giant cell tumor, first metatarsal, rare entity.
October 2024 Medical Image of the Month: Lofgren syndrome with Erythema Nodosum
Authors:   Banner University Medical Center - Tucson, Tucson, AZ USA, Jamison Mary
Published: September 2024

No abstract available. Article truncated after 150 words. A 33-year-old man with a past medical history of non-metastatic right sided testicular cancer status post radical orchiectomy 10 years prior presented to the emergency department for 1 week of bilateral lower extremity swelling and pain. He had associated shortness of breath, right sided chest pain, fatigue, and night sweats. Physical exam revealed bilateral ankle swelling with erythema and warmth and there was noted an erythematous nodule over the medial right knee and anterior right thigh (Figure 1). He was tachycardic to a rate of 110 bpm, but otherwise had an unremarkable physical exam and review of systems. The lower extremity lesions were consistent with erythema nodosum. Sarcoidosis was an amounting differential but as this is a diagnosis of exclusion, alternate causes needed to be ruled out. Deep vein thrombosis was excluded. CT angiogram did not show pulmonary embolus but it did show diffuse multifocal sub centimeter pulmonary nodules measuring …
Confronting the Medical Leviathan: Reading a Report from the Front Lines
Authors: Frank Arthur W.
Published: September 2024

abstract: This essay discusses how two physicians in Britain's National Health Service describe and analyze the conditions of their work: how algorithms and protocols structure the care they can provide and create the dilemmas they and their patients face. In these issues, the NHS is a canary in the mineshaft of contemporary Western health care. NHS practices are understood as how states and state-like entities, Leviathans, seek to render their subjects legible ; in this instance, to make both physicians and patients transparently visible to surveillance and administration by standardizing medical work and patient need. Physicians respond by engaging in workarounds, finding ways to provide care despite systemic restrictions.
Concurrent disease burden from multiple infectious diseases and the influence of social determinants in the contiguous United States
Authors: Blake Emma , Stringham Este , Sloan-Aagard Chantel
Published: September 2024

Social determinants of health are known to underly excessive burden from infectious diseases. However, it is unclear if social determinants are strong enough drivers to cause repeated infectious disease clusters in the same location. When infectious diseases are known to co-occur, such as in the co-occurrence of HIV and TB, it is also unknown how much social determinants of health can shift or intensify the co-occurrence. We collected available data on COVID-19, HIV, influenza, and TB by county in the United States from 2019–2022. We applied the Kulldorff scan statistic to examine the relative risk of each disease by year depending on the data available. Additional analyses using the percent of the county that is below the US poverty level as a covariate were conducted to examine how much clustering is associated with poverty levels. There were three counties identified at the centers of clusters in both the adjusted and unadjusted analysis. In the poverty-adjusted analysis, we found a general shift of infectious disease burden from urban to rural clusters.
Knowledge, attitude, and practice towards enhanced recovery after surgery among patients underwent thoracoscopy surgery
Authors: Huang Yinping , Wang Xingbang , Li Jiajia , He Qing , Wang Rui
Published: September 2024

Objective

Thoracoscopy has gained extensive utilization in managing pleural disorders, and enhanced recovery after surgery (ERAS) can improve patients’ prognosis and expedite post-surgical recovery. This study aimed to investigate the knowledge, attitudes, and practices (KAP) towards ERAS among patients underwent thoracoscopy surgery.

Methods

This cross-sectional study was conducted between September 2022 and August 2023, among patients underwent thoracoscopy surgery in 6 Secondary or Tertiary hospitals in the author’s area. Demographic characteristics and KAP scores were collected by questionnaires, and clinical data were extracted from medical records.

Results

A total of 309 valid questionnaires were collected, with 165 (53.40%) males and 202 (65.37%) aged ≤65 years old. The mean scores for KAP were 28.92±7.21 (possible range: 9–45), 53.60±6.73 (possible range: 13–65), and 43.45±5.50 (possible range: 10–50), respectively. SEM confirmed the positive associations between knowledge and attitude (β = 0.108, P = 0.019), knowledge and practice (β = 0.096, P = 0.004), and attitude and practice (β = 0.438, P<0.001). However, the KAP were found not associated with prognosis.

Conclusion

Patients underwent thoracoscopy surgery showed moderate knowledge, positive attitude, and appropriate practice towards ERAS. Preoperative education, personalized counseling, peer support groups, peer support groups, and follow-up care were recommended in further clinical practice.
Research on different modes of energy conservation and emission reduction: A differential game model based on carbon trading perspective
Authors: Zhu Xueli
Published: September 2024

In recent years, due to global climate change, increasing resource scarcity, and environmental constraints, countries have prioritized energy conservation and emissions reduction. However, enterprises are primarily responsible for energy saving and emissions reduction. To encourage industrial enterprises to engage in energy conservation and emissions reduction, high-carbon enterprises must purchase carbon emission rights from low-carbon counterparts. Common modes of energy conservation and emission reduction of industrial enterprises include reducing production scale, improving energy utilization efficiency, and expanding renewable energy. This article constructs three differential game models to identify the applicable scope of various energy conservation and emission reduction strategies, comparing and analyzing the equilibrium results. The study concludes that when the cost of changing the production mode and the income obtained from the production of unit product is large, the low-carbon enterprise can obtain the maximum benefit by reducing the production scale mode. Otherwise, low carbon enterprises can be maximized through improving energy efficiency mode. For both low-carbon and high-carbon enterprises, reducing production scale is the fastest way to enhance efficiency when the costs of energy conservation and emission reduction are substantial.
FROM RITUAL TO REALITY:
Authors: Ramdani Idan
Published: September 2024

The tahlilan tradition in Sindangjaya Village is a religious practice rich in Islamic values, functioning as a medium for socialization and actualizing religious values. Not only does it function as a religious ritual to pray for people who have died, but also as an effective da'wah medium to spread Islam. This research aims to explore the role of tahlilan in cultivating religious values among the Nahdliyin community. Through interviews with religious leaders and local communities, it was found that tahlilan functions as a ritual to pray for people who have died and as a means to convey religious messages that include aspects of aqidah, worship, and morals. The process of socializing religious values in tahlilan involves two crucial aspects: the application of religious values in spiritual and social aspects. Tahlilan is a forum to strengthen people's relations with Allah (hablum minallah) and with fellow humans (hablum minannas). In addition, this tradition also serves as a tool to strengthen social solidarity and maintain good relations between citizens. The results of the study show that tahlilan has a significant impact on shaping the character and attitude of the community, as well as in internalizing religious values that are inherited from generation to generation. Thus, tahlilan is not only a religious ritual, but also an integral part of the cultural identity of the Nahdliyin people that needs to be preserved and developed.
Uma entrevista com Fernando Lima, presidente do CIALACIBU 2027 - Rio de Janeiro
Authors: Lima Fernando
Published: September 2024

Colégio Brasileiro de Cirurgia e Traumatologia Buco-Maxilo-Facialentrevista, nessa edição da Revista, Fernando Lima, presidentedo CIALACIBU 2027.
New approaches
Authors: Stewart Terry Mark , McKenzie Joanna S. , Vink Willem D.
Published: September 2024

Interactive scenarios were used in an on-line international Masters degree programme for veterinary and public health professionals launched in 2010. For two courses in the programme, students were required to play the role of a senior advisor, analyzing data, determine the cause of an unfolding disease outbreak and critiquing recommendations. The scenario was presented in six episodes. Each episode was designed to be completed in one sitting and these also contained the history of previous episodes. On-line forums were used for group activities which included a vote on the diagnosis. Students were also required to give a critique of the diagnosis and solution proposed in the scenario. A student survey rated the use of the scenario-based approach highly with motivation and engagement being the most obvious benefits. This paper illustrates how an interactive scenario can deliver student outcomes when be embedded at the very core of a course.
Moodle and the Living Curriculum
Authors: Roder Tabitha , Rata-Skudder Nicoletta
Published: September 2024

This paper discusses how Moodle can act as a catalyst in transforming teaching practice. During Unitec?s implementation of a new eLearning Development Strategy, framed within a broader teaching and learning initiative referred to as the Living Curriculum, the institute migrated from Blackboard to Moodle. Reflecting on this transition period, the authors identify how the social constructivist approach underpinning Moodle complements and can be employed to facilitate and incorporate the characteristics of Living Curricula. An overview of Unitec?s characteristics of Living Curricula is given, with four themes providing a framework for their application. An investigation of the Moodle tools through the lens of these themes enables us to relook, rethink, and redesign our learning spaces. Examples illustrate some of the affordances of Moodle in enabling a Living Curriculum, and lead to a reflection on the support required to encourage teachers as learners to recognise these affordances for their pedagogical potential. Discussion around the design and intent of Moodle leads to a consideration of how teachers dispositions ultimately impact on the tool?s employment.
Authentic learning and Web 2.0
Authors: Narayan Vickel , Lovegrove Chris
Published: September 2024

While new technologies are explored as a way of creating authentic learning environments for the learner, for example, creating simulations and web-quest, there is little research on the potential use and application of Web 2.0 tools and technologies in enhancing the learning process in an authentic environment. The participatory nature of Web 2.0 tools, amplified by portable mobile technologies, empowers users by enabling the ability to create, co-create, collaborate and communicate, and has the potential to bridge the gap between authentic learning activities and the learner?s interaction with the surroundings (context), self (cognitive and meta-cognitive) and peers. This paper outlines the findings of a one-year-long project where authentic learning formed the underlining platform for learning and teaching in a Boat Building course (Certificate in Applied Technology, Level 4) where Web 2.0 tools and learner owned mobile devices were integrated to enhance the learning process.
Peirce’s philosophy of language
Authors: Zhu Zhifang
Published: September 2024

Peirce’s philosophy of language is woven around his pragmatic maxim. From early on in his scholarship to late, Peirce expanded his pragmatism into a fabric of semiotics. In this paper, Peirce’s pragmatism is taken to be an integral part of his semiotic system, and his method of making ideas clear is accounted for in terms of his theory of signs. For Peirce, a sign stands for or represents something in connection with some interpretant. This claim applies to linguistic expressions: words and sentences. A sign or a term refers to an object determined by its interpretant. In further analysis, object represented goes the way from immediate object to dynamic object, and interpretant from immediate through dynamic to logical interpretant. Departing from the prevailing scheme of sense–reference ascription, Peirce’s pragmatism is a method of determining meaning rather than a theory of what meaning is, and further, it is a semantic theory rather than a linguistic pragmatics. Making meaning clear goes through a semiotic process where linguistic signs, objects in the world, and the minds of speaker and hearer are intimately interrelated; it follows that Fregean anti-psychologism goes astray in the search for meaning.
Percutaneous nephrolithotomy versus open surgery for the treatment of unilateral staghorn stone, Erbil province
Authors: Al Bazzaz Wishyar , Alkhayat Omar
Published: September 2024

Background and objective: Staghorn stones are large branching stones that completely or partially occupy the renal pelvis and renal calyces. The developments in the urological field have decreased the role of open surgery (OS) and currently percutaneous nephrolithotomy (PCNL) is considered as the gold standard procedure for the management of staghorn stone. This study aimed to determine the outcomes of open surgery and percutaneous nephrolithotomy for the treatment of unilateral staghorn stone. Methods: This retrospective analysis included 76 patients with unilateral staghorn stone who had been treated with either percutaneous nephrolithotomy (57) or open surgery (19). A comparison was made between the mentioned groups (PCNL vs. OS). Results: The differences between the two groups were not significant in term of preoperative characteristics. In addition, there was no significant difference between the two groups for intraoperative, postoperative complications and the rate of stone clearance (P = 0.447, P = 0.180, P = 0.259 respectively). The means of postoperative hospital stay (days) and recovery time (weeks) were significantly lower in the PCNL than OS (P <0.001). However, the mean operative time was significantly less in the OS group (P = 0.018). Conclusion: The PCNL is a very efficient treatment option for staghorn stones. However, the open surgery still has a role in the treatment of kidney stones (especially staghorn stone).
Evaluation of hexagonal flap for Syndactyly repair
Authors: Putris Lavin , Fattah Jalal
Published: September 2024

Background and objective: Syndactyly is among the most commonly treated hand anomalies by plastic surgeons. Since the 1800s,over 46 corrective procedures have been described. These techniques involve using different flap designs and full-thickness skin graft or depending on graftless techniques to achieve the goals. Some articles concluded that graftless techniques have shorter operative times and fewer postoperative complications. The aim of the study is to evaluate the use of a local "hexagonal" dorsal advancement flap (HDAF) for syndactyly repair without using a skin graft. Methods: Between March 2021 and March 2022, we operated on 18 subjects (25 web spaces) in Rizgary and Hawler teaching hospitals in Erbil. Our study subjects were children and adults with different types of syndactyly (congenital, recurrent, and post-burn). We studied the early outcomes of using HDAF and straight-line incision for syndactyly repair. Results: The patients' ages ranged from 1.5 to 50 years, and the mean follow-up period was 6.3 months (1-13 months). The mean operation time was 98.5 minutes (40-160 minutes). Wounds were closed primarily without skin graft in 96% of the cases. We encountered neither a flap loss nor recurrences of syndactyly. The mean abduction angle achieved was 36.5º. All patients and their caregivers were satisfied with the aesthetic outcome. Conclusion: Syndactyly repair using a hexagonal dorsal advancement flap and straight-line separation of the fingers is a safe and straightforward technique regardless of age and syndactyly class or type. It results in a relatively short procedure with good-looking and well-functioning fingers.
Pattern of eye disease among obese population in Erbil city, Iraq
Authors: Nemat Roaa , Joma Ahmed
Published: September 2024

Background and objective: Obesity is a multifactorial disease. It is a multifactorial pathology that can be related to an altered nutritional behaviour or secondary to genetic, hypothalamic, iatrogenic or endocrine diseases. Obesity and visual acuity are negatively correlated, obesity may be linked to dysfunction of the mechanical and vascular components of the eye. The aim of the study is to find out the impact of obesity on eye health and the pattern of eye disease. Methods: Across-sectional study was conducted in the Ophthalmology Department/ Erbil Teaching Hospital during the period from 1st of August 2021 to 31st of March 2022. A simple random sampling method was adopted, and a total of 300 participants with an age of more than 18 years old were enrolled. Results: The percentage of cataract, glaucoma, age-related maculopathy, papilloedema, keratoconus, and retinal vein occlusion was higher in the case group than in the control group. Obesity is a significant risk factor for cataracts, age-related maculopathy, and papilloedema, while it was insignificant regarding keratoconus and retinal vein occlusion. The mean of internal ocular pressure and central corneal thickness was higher in the case group compared to the control group. Conclusion: The prevalence of ocular disease was higher among the obese population than in those with normal weight. Obesity is a significant risk factor for ocular disease. Age and gender represented additional risk factors in some of the ocular diseases in obese people.
Formulation and evaluation of melatonin as fast dissolving oral strips using combined polymers
Authors: Taher Muhannad , Gardy Huner
Published: September 2024

Background and objective: Fast-dissolving oral thin film (FDOF) is a novel and most advanced form of solid dosage form that dissolves or disintegrates in 1 minute when put in the mouth without water or chewing. Pre-gastric absorption of FODFs from the mouth, pharynx, and esophagus as saliva flows down into the stomach would improve the therapeutic benefit of the drug as oral films disintegrated in the mouth. The study is designed and purposed to use most water soluble, best type and concentration of polymers to be selected for use in combination to formulate melatonin oral thin films. Different types of synthetic water soluble polymers were utilized the preparation of films (hydroxypropyl methyl cellulose HPMC15M, sodium carboxy methyl cellulose NACMC). Methods: Solvent casting method was performed for preparation of twelve placebo films at the beginning, to obtain and select suitable polymer type and concentration for use in combination to be formulated for drug loading. The films were evaluated for their characteristics like mechanical properties (thickness and folding endurance), surface pH and disintegration time. Percentage of release and assay of melatonin was taken. Comparison studies were performed on melatonin films from this study with melatonin oral disintegrating tablets release profiles. Best batch could be selected. Drug-excipient compatibility carried out as pre formulation study to see whether there is interaction between the drug and excipients used. Results: Results from FT-IR showed no interaction between melatonin and polymers used, the prepared formulations were clear, transparent, non-sticky and easily removed from the plate surface with the thickness ranging from (0.04-0.07) mm depending on the polymer concentration. The times required for the films to disintegrate was ranging from 21-26 seconds, and the majority of melatonin was released within first 2 minutes within the dosage form. Conclusion: Melatonin can be formulated as fast dissolving oral films using combination of water-soluble polymers by solvent casting method to obtain ease of administration without using water during administration, fast onset of action resulted from rapid disintegration.
Role of targeted ultrasound for the diagnosis of rib fracture, a comparative study with plain x-ray
Authors: Hussein Adeeb , Rashid Sameeha
Published: September 2024

Background and objective: Thoracic injuries are a common presentation in emergency hospitals in the Kurdistan region, mainly caused by road traffic accidents. Early and accurate diagnosis of rib fractures is essential in saving lives and preventing complications. The objective was to assess the validity of ultrasound in the diagnosis of rib fractures in comparison to plain x-ray. Methods: Present study was a cross-sectional study carried out in the Emergency department of Rozhalat Hospital in Erbil city-Kurdistan region/Iraq over ten months, from August 2021 to May 2022, on a sample of fifty-five (55) patients with suspected rib fractures. Rib fractures were diagnosed by the researcher based on clinical, ultrasound, and x-ray findings, and the findings of rib fracture were confirmed by CT-scan. All imaging methods were done at the Radiology department of Rozhalat hospital. Results: The validity findings of ultrasound examination taking CT scan as the gold standard was as follow: (97.7% sensitivity, 63.6% specificity, and 90.0% accuracy), while the validity findings of x-ray examination taking CT scan as the gold standard were (56.8% sensitivity, 54.5% specificity and 56.3% accuracy). The validity of ultrasound in detecting cortical disruption or hematoma was (93.8% sensitivity, 43.6% specificity, and 58.1% accuracy), while the validity of CXR in the detection of displacement was (31.3% sensitivity, 84.6% specificity, and 48.7% accuracy). Conclusion: Sonograph is an accurate diagnostic tool for detecting rib fracture with superior validity compared to a chest x-ray.
A Very Special Episode of Expats
Authors: Ouellette Laurie
Published: September 2024

FQ columnist Laurie Ouellette examines “Central,” the penultimate episode of Lulu Wang’s Expats, a television adaptation of Janice Y.K. Lee’s bestselling novel The Expatriates, which follows the lives of several privileged American women living in Hong Kong. The feature-length special episode shifts the focus onto two foreign domestic workers who are employed by the show’s wealthy female protagonists. In redirecting attention onto these two female migrant workers, “Central” challenges viewers’ investments in the protagonists’ lives and the genre of women’s prestige television that celebrates their class status as being won through “meritocracy and neoliberal self-reliance.” Further, Wang uses the “special episode” and the creative liberties that streaming has afforded for such a format not simply for representational purposes but to underline the geopolitical forces and class hierarchies that structure these women’s lives.
Hybrid Deep Learning with GloVe and Genetic Algorithm for Sentiment Analysis on X: 2024 Election
Authors: Fitria Mahrunissa Azmima Fitria , Setiawan Erwin Budi
Published: September 2024

Purpose: This research analyzes sentiment on the 2024 Indonesian Presidential Election using  data from X, employing a hybrid CNN-GRU model optimized with a Genetic Algorithm (GA) to improve accuracy and efficiency. It also explores GloVe feature expansion for enhanced sentiment classification, aiming for deeper insights into public opinion through advanced deep learning and optimization techniques.
Methods: This research employs a deep learning approach that integrates Convolutional Neural Network (CNN) and Gated Recurrent Unit (GRU) models, Term Frequency-Inverse Document Frequency (TF-IDF), Global Vectors (GloVe), and GA. The dataset comprises  62,955 Indonesian tweets focusing on the 2024 General Election using various keywords.
Result: The results indicated that the Genetic Algorithm significantly improved model accuracy. The CNN-GRU + GA model achieved 84.72% accuracy for the Top 10 ranking, a 1.94% increase from the base model. In comparison, the GRU-CNN + GA model achieved 84.69% accuracy for the Top 5 ranking, a 2.76% increase from the base model, demonstrating enhanced performance with GA across configurations.
Novelty: This research uses a hybrid CNN-GRU model to introduce a novel sentiment analysis approach for the 2024 Indonesian Presidential Election. The model enhances accuracy by combining CNN's spatial feature extraction with GRU's temporal context capture and GloVe's word semantics. Genetic Algorithm optimization further refines performance. Comprehensive pre-processing ensures high-quality data, and focusing on election-specific keywords adds relevance. This study advances sentiment analysis through its innovative hybrid model, feature expansion, and optimization techniques.
Trampa de fondo como una alternativa en el control integrado del ácaro Varroa destructor en colmenas de abejas africanizadas
Authors: Calderón-Fallas Rafael A. , Ramírez-Arias Fernando , Sánchez-Chaves Luis
Published: September 2024

The effectiveness of the bottom board trap to control the mite Varroa destructor in Africanized honey bee colonies was evaluated from June to September 2017 in Atenas, Alajuela. Naturally fallen mites were collected during a 30-day period with a bottom board trap, which consisted of a wooden bottom (50 x 42 cm) modified with a metal lattice and a screen of six holes per cm2. A white piece of cardboard previously gridded and coated with a thin layer of Vaseline to help count the number of fallen mites was placed inside the trap. The cardboard was replaced every seven days. After 30 days, the remaining mites were eliminated, and the effectiveness of the method was determined by applying four strips of flumethrin to each hive for six weeks. Furthermore, the mortality of the different Varroa stages in a sealed (operculated) worker brood was evaluated. Naturally fallen Varroa mites were 715 ± 531 (n= 5) during a 30-day period. Mite mortality occurred mainly during day 22 with 335 ± 285, whereas the lowest number was collected on day one with 30 ± 13 mites. After applying flumethrin, mite mortality was 2072 ± 1874. The above allows us to establish that the number of mites that fell naturally and those eliminated from the hive by means of the bottom trap corresponded to 25.7%. In addition, it was determined that Varroa mortality in capped worker brood cells was less than 10.0%. In conclusion, the bottom board trap eliminated more than a quarter of the mites in the beehives; consequently, this method may be considered as an alternative in the integrated Varroa management in Africanized honey bees.
Effect of Hot-rolling Deformation on Microstructure and Mechanical Properties of Nd2Fe14Bp/Al-5Co-0.4Sm Composites
Authors: Jun-jie Huang , You-wei Huang , Jia-xin He , Ma Kang , Hong-ming Wang
Published: September 2024

Nd2Fe14Bp/Al-5Co-0.4Sm composites were prepared via microwave sintering and hot rolling. The effects of hot-rolling deformation on the microstructure and mechanical properties of Nd2Fe14Bp/Al-5Co-0.4Sm composites were studied. The results showed that the internal porosity of the composites significantly decreased when the hot-rolling deformation rate was 45%. The Nd2Fe14B particles were broken into fine particles under rolling stress. Consequently, the particles were uniformly distributed. Moreover, numerous high-density dislocations were observed around the particles, which improved the strength and toughness of the material. When the deformation rate was 45%, the micro-nano hardness and elastic modulus of the interface of the composites were 3.6 and 91 GPa, respectively. The interfacial deformation resistance of the composites was significantly higher than that of the composites before rolling. The tensile strength of Nd2Fe14Bp/Al-5Co-0.4Sm composites increased as the deformation rate increased, whereas the elongation gradually decreased. Furthermore, when the deformation rate was 45%, the tensile strength and elongation of the composites were 161 MPa and 6.5%, respectively. The tensile strength was 14.2% higher than that of the unrolled sample.
A Practical, Systematic Approach to Genetic Diagnosis in a Fetus or Neonate with Congenital Anomalies
Authors: Mangla Mishu , Nerakh Gayatri , Anne Rajendra Prasad , Kaliappan Ariyanachi , Kaur Harpreet , Singla Deepak
Published: September 2024

Congenital anomalies contribute significantly to perinatal, neonatal, and infant morbidity and mortality. The causes of these anomalies vary, ranging from teratogen exposure to genetic disorders. A high suspicion for a genetic condition is especially important because a genetic diagnosis carries a risk of recurrence in future pregnancies. Various methods are available for genetic testing, and each plays a role in establishing a genetic diagnosis. This review summarizes a practical, systematic approach to a fetus or neonate with congenital anomalies.