Search

Temperature-dependent Hall measurements and electron paramagnetic resonance spectroscopy reveal that three different transport mechanisms contribute to the electronic properties of the inorganic electride [Ca24Al28O64]4+(4e−).

The outcomes of total joint arthroplasty during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We sought to compare early postoperative complications in total hip arthroplasty (THA) and total knee arthroplasty (TKA) prior to and during the COVID-19 pandemic.Patients in the American College of Surgeons National Surgical Quality Improvement Program database who had THA or TKA in the latter halves (July to December) of 2019 and 2020 were identified. Patients were divided into pre-COVID-19 (2019) and during-COVID-19 (2020) cohorts. Propensity score matching and logistic regression were used to detect correlations between operative period and outcomes. Statistical significance was set at α = 0.05.A total of 38,234 THA and 61,956 TKA patients were included. There was a significantly higher rate of outpatient procedures in 2020 than that in 2019 for both THA (41.68% vs 6.59%,Total joint arthroplasty surgery remains safe despite the COVID-19 pandemic. A statistically significant increase was detected in superficial surgical site infection and myocardial infarction risk during 2020 compared to 2019; however, the clinical significance of this is questionable. A shift away from inpatient stay was also present, possibly reflecting efforts to minimize nosocomial exposure to COVID-19.

Background Approximately 23% of patients develop hip pain after total hip arthroplasty (THA). In this systematic review, we aimed to identify risk factors associated with postoperative pain after THA to optimize preoperative surgical planning. Methods Six literature databases were searched for articles published from January 1995 to August 2020. Controlled trials and observational studies that reported measurements of postoperative pain with assessments of preoperative modifiable and non-modifiable risk factors were included. Three researchers performed a literature review independently. Results Fifty-four studies were included in the study for analysis. The most consistent association between worse pain outcomes and the female sex is poor preoperative pain or function, and more severe medical or psychiatric comorbidities. The correlation was less strong between worse pain outcomes and preoperative high body mass index value, low radiographic grade arthritis, and low socioeconomic status. A weak correlation was found between age and worse pain outcomes. Conclusions Preoperative risk factors that were consistently predictive of greater/server postoperative pain after THA were identified, despite the varying quality of studies that prohibited the arrival of concrete conclusions. Modifiable factors should be optimized preoperatively, whereas non-modifiable factors may be valuable to patient education, shared decision-making, and individualized pain management.

Rapidly developing societies in East-Africa impose increasing pressures on wetlands due to rising food demand and degradation of upland soils. Reconciling wetland conservation with human needs for food and energy is therefore becoming an increasing contentious issue. Stakeholders and actor coalitions generate and apply a great variety of meanings, values, and interests when interacting with wetlands which are hardly predictable. Wetland policy-making is hence fraught with uncertainties which need to be managed for finding solutions to this problem. Based on experiences of a collaborative wetland research in East-Africa we developed a new wetland policy process framework which promotes social deliberation and reconciliation of plural wetland values to reduce these uncertainties. A new cognitive-driven information design (CDID) method has been developed to assist wetland policy-analysts in achieving these aims and also to overcome limitations of prescriptive decision-making. The method employs information and communication technologies to analyze, integrate and visualize complex socio-ecological wetland information for developing policy scenarios. It is applied at all stages of the wetland policy process including agenda setting, identification of plural wetland values, establishment of decision-scenarios, social deliberation during policy formulation, governmental decision-taking, policy implementation and evaluation. A three-stage implementation process is recommended.

Background: Cassava (Manihot esculenta Crantz) is staple food and major source of calories for over 500 million people in sub-Saharan Africa. The crop is also a source of income for smallholder farmers, and has increasing potential for industrial utilization. However, breeding efforts to match the increasing demand of cassava are impeded by its inability to flower, delayed or unsynchronized flowering, low proportion of female flowers and high fruit abortions. To overcome these sexual reproductive bottlenecks, this study investigated the effectiveness of using red lights to extend the photoperiod (RLE), as a gateway to enhancing flowering and fruit set under field conditions. Methods: Panels of cassava genotypes, with non- or late and early flowering response, 10 in each case, were subjected to RLE from dusk to dawn. RLE was further evaluated at low (LL), medium (ML) and high (HL) red light intensities, at ~ ≤ 0.5; 1.0 and 1.5PFD (Photon Flux Density) in µmol m-2 s-1 respectively. Additionally, the effect of a cytokinin and anti-ethylene as plant growth regulators (PGR) and pruning under RLE treatment were examined. Results: RLE stimulated earlier flower initiation in all genotypes, by up to 2 months in the late-flowering genotypes. Height and number of nodes at first branching, particularly in the late-flowering genotypes were also reduced, by over 50%. Number and proportion of pistillate flowers more than doubled, while number of fruits and seeds also increased. Number of branching levels during the crop season also increased by about three. Earlier flowering in many genotypes was most elicited at LL to ML intensities. Additive effects on flower numbers were detected between RLE, PGR and pruning applications. PGR and pruning treatments further increased number and proportion of pistillate flowers and fruits. Plants subjected to PGR and pruning, developed bisexual flowers and exhibited feminization of staminate flowers. Pruning at first branching resulted in higher pistillate flower induction than at second branching. Conclusions: These results indicate that RLE improves flowering in cassava, and its effectiveness is enhanced when PGR and pruning are applied. Thus, deployment of these technologies in breeding programs could significantly enhance cassava hybridizations and thus cassava breeding efficiency and impact.

Up to 1,000 drowning deaths occur every year on Lake Victoria in East Africa. Nocturnal thunderstorms are one of the main culprits for the high winds and waves that cause fishing boats to capsize. The High Impact Weather Lake System (HIGHWAY) project was established to develop an Early Warning System for Lake Victoria. Prior to HIGHWAY, weather forecasts for the lake were overly general and not trusted. Under the HIGHWAY project, forecasters from weather service offices in East Africa worked with leaders of fishing communities and Beach Management Units to develop marine forecasts and hazardous-weather warnings that were meaningful to fishermen and other stakeholders. Forecasters used high-resolution satellite, radar, and lightning observations collected during a HIGHWAY field campaign, along with guidance from numerical weather prediction models and a 4.4-km resolution Tropical Africa model, to produce specific forecasts and warnings for 10 zones over the lake. Forecasts were communicated to thousands of people by radio broadcasters, local intermediaries, and via smartphones using the WhatsApp application. Fishermen, ferry-boat operators, and lakeside communities used the new marine forecasts to plan their daytime and nighttime activities on the lake. A socioeconomic benefits study conducted by HIGHWAY found that ∼75% of the people are now using the forecasts to decide if and when to travel on the lake. Significantly, a 30% reduction in drowning fatalities on the lake is likely to have occurred, which, when combined with the reduction in other weather-related losses, generates estimated socioeconomic benefits of $44 million per year due to the HIGHWAY project activities; the new marine forecasts and warnings are helping to save lives and property.

The purpose of this study was to establish how tuition financing of secondary education affects students’ participation in public secondary schools in Siaya County. The researcher used mixed methods approach and descriptive research design where both qualitative and quantitative data was collected. The target population was 21,017 comprised of 276 school principals, 6 Sub County Directors of Education and 20,735 Form IV students with a sample size of 2,160. The researcher adopted stratified simple random sampling technique to get respondents from categories of the schools. Data collection instruments were questionnaires, interview schedules and document analysis. Both descriptive and inferential data analysis methods were used in analysing data. The study findings established that tuition financing, had a significant influence on students’ participation on public secondary schools in Siaya County.

Osteosarcoma is the malignant tumor with the highest incidence rate among primary bone tumors and with a high mortality rate. The anti-osteosarcoma materials are the cross field between material science and medicine, having a wide range of application prospects. Among them, biological materials, such as compounds from black phosphorous, magnesium, zinc, copper, silver, etc., becoming highly valued in the biological materials field as well as in orthopedics due to their good biocompatibility, similar mechanical properties with biological bones, good biodegradation effect, and active antibacterial and anti-tumor effects. This article gives a comprehensive review of the research progress of anti-osteosarcoma biomaterials.

Mushrooms are being extensively researched due to their nutritional value and medicinal importance. The genus Pleurotus is the second most cultivated mushroom and is known for its high nutritional value, therapeutic properties, taste, flavor, as well as their application in biotechnology and environmental study. Also, tyrosinase is prevalent in most living organisms. The enzyme catalyzes the oxidation of monophenols to ortho-quinones in a two-step reaction process. This study was aimed to assess the amino acid composition and anti-tyrosinase activity of metabolites obtained from edible Pleurotus species. Assessment of the nutritional content and inhibitory studies of mushroom tyrosinase produced from four Pleurotus strains was carried out using high-performance liquid chromatography (RP-HPLC). The results of the study showed that seventeen different amino acids were identified in the crude and partially purified protein metabolites. Also, the crude extract metabolite had the highest quantity of amino acids than the partially purified. The highest and lowest amino acids value Glutamic acid (1343.26 µmol/mL) and valine (0.34 µmol/mL). The anti-tyrosinase inhibition studies of the four Pleurotus strains showed varying results from significantly inhibitory effects to slightly inhibitory effects on mushroom tyrosinase. The highest inhibition was 14.86% (Pleu-W), while the lowest inhibition was 51.42% (Plof-30) respectively. The high point of this study is that the Pleurotus species contains a significant number of amino acids and also, they possess good anti-tyrosinase activity. Therefore, these are a good source of nutritional and therapeutic metabolites and these can be explored further for their nutritional and medicinal importance to man.

Diarrhea is a prevalent gastrointestinal problem associated with fatal implications. It is a huge public health concern that requires better alternatives to current drugs. This study investigated the mechanisms involved in the antidiarrheal activity of Anacardium occidentale (Ao) stem bark extract, a plant commonly used in the management of diarrhea in Nigeria. Methanolic stem bark extract of the plant was partitioned into 3 fractions; hexane fraction (AoHF), ethyl acetate fraction (AoEF) and methanol fraction (AoMF). In vitro studies on the effect of these fractions using guinea pig ileum (GPI) muscle contraction, as well as the modulatory effect of standard agonists and antagonists on such contraction, revealed AoEF as the most active fraction. In vivo studies to assess the effect of AoEF on the dopaminergic, muscarinic and serotonergic pathways were carried out using gastric emptying (GE) and gastrointestinal transit (GT) as experimental end points. AoEF was subjected to GC-MS analysis, while the identified compounds were docked with the muscarinic acetylcholinesterase receptor (M3) using AutodockVina. Results indicated that AoEF inhibited GE and GT via inhibition of M3. In addition, GC-MS analysis revealed the presence of 24 compounds in AoEF; while docking indicated that octadecanoic acid 2-(2-hydroxylethoxy) ethyl ester exhibited the highest binding affinity for M3. This study indicated that the antidiarrheal activity of Ao is through its antimotility effect via the inhibition of the muscarinic pathway. And since none of the identified compounds exhibited higher binding affinity for M3 relative to loperamide, the antimotility activity of these phytoconstituents may be via synergism.

PURPOSE: There are limited prospective data on predictors of patient-reported outcomes (PROs) after whole-breast irradiation (WBI) plus a boost. We sought to characterize longitudinal PROs and cosmesis in a randomized trial comparing conventionally fractionated (CF) versus hypofractionated (HF) WBI. METHODS AND MATERIALS: From 2011 to 2014, women aged ≥40 years with Tis-T2 N0-N1a M0 breast cancer who underwent a lumpectomy with negative margins were randomized to CF-WBI (50 Gray [Gy]/25 fractions plus boost) versus HF-WBI (42.56 Gy/16 fractions plus boost). At baseline (pre-radiation), at 6 months, and yearly thereafter through 5 years, PROs included the Breast Cancer Treatment Outcome Scale (BCTOS), Functional Assessment of Cancer Therapy−Breast (FACTB), and Body Image Scale; cosmesis was reported by the treating physician using Radiation Therapy Oncology Group cosmesis values. Multivariable mixed-effects growth curve models evaluated associations of the treatment arm and patient factors with outcomes and tested for relevant interactions with the treatment arm. RESULTS: A total of 287 patients were randomized, completing a total of 14,801 PRO assessments. The median age was 60 years, 37% of patients had a bra cup size ≥D, 44% were obese, and 30% received chemotherapy. Through 5 years, there were no significant differences in PROs or cosmesis by treatment arm. A bra cup size ≥D was associated with worse BCTOS cosmesis (P < .001), BCTOS pain (P = .001), FACT-B Trial Outcome Index (P = .03), FACT-B Emotional Well-being (P = .03), and Body Image Scale (P = .003) scores. Physician-rated cosmesis was worse in patients who were overweight (P = .02) or obese (P < .001). No patient subsets experienced better PROs or cosmesis with CF-WBI. CONCLUSIONS: Both CF-WBI and HF-WBI confer similar longitudinal PROs and physician-rated cosmesis through 5 years of follow-up, with no relevant subsets that fared better with CF-WBI. This evidence supports broad adoption of hypofractionation with boost, including in patients receiving chemotherapy and in a population with a high prevalence of obesity. The associations of large breast size and obesity with adverse outcomes across multiple domains highlight the opportunity to engage at-risk patients in lifestyle intervention strategies, as well as to consider alternative radiation treatment regimens.

Surgery for prosthetic joint infection (PJI) can often lead to significant blood loss, necessitating allogeneic blood transfusion (ABT). The use of ABT is associated with higher rates of morbidity and death in revision total joint arthroplasty, particularly in the treatment of PJI. We compared ABT rates by procedure type among patients treated for PJI. We retrospectively reviewed 143 operative cases of hip and knee PJI performed at our institution between 2016 and 2018. Procedures were categorized as irrigation and debridement (I&D) with modular component exchange (modular component exchange), explantation with I&D and placement of an antibiotic spacer (explantation), I&D with antibiotic spacer exchange (spacer exchange), or antibiotic spacer removal and prosthetic reimplantation (reimplantation). Rates of ABT and the number of units transfused were assessed. Factors associated with ABT were assessed with a multilevel mixed-effects regression model. Of the cases, 77 (54%) required ABT. The highest rates of ABT occurred during explantation (74%) and spacer exchange (72%), followed by reimplantation (36%) and modular component exchange (33%). A lower preoperative hemoglobin level was associated with higher odds of ABT. Explantation, reimplantation, and spacer exchange were associated with greater odds of ABT. Antibiotic spacer exchange and explantation were associated with greater odds of multiple-unit transfusion. Rates of ABT remain high in the surgical treatment of PJI. Antibiotic spacer exchange and explantation procedures had high rates of multiple-unit transfusions, and additional units of blood should be made available. Preoperative anemia should be treated when possible, and further refinement of blood management protocols for prosthetic joint infection is necessary. [ Orthopedics . 2022;45(6):353–359.]

Background: Total joint arthroplasty (TJA) is one of the most common procedures performed in the United States. Outcomes of this elective procedure may be improved via preoperative optimization of modifiable risk factors. Purposes: We sought to summarize the literature on the clinical implications of preoperative risk factors in TJA and to develop recommendations regarding preoperative optimization of these risk factors. Methods: We searched PubMed in August 2019 with an update in September 2020 for English-language, peer-reviewed publications assessing the influence on outcomes in total hip and knee replacement of 7 preoperative risk factors—obesity, malnutrition, hypoalbuminemia, diabetes, anemia, smoking, and opioid use—and recommendations to mitigate them. Results: Sixty-nine studies were identified, including 3 randomized controlled trials, 8 prospective cohort studies, 42 retrospective studies, 6 systematic reviews, 3 narrative reviews, and 7 consensus guidelines. These studies described worse outcomes associated with these 7 risk factors, including increased rates of in-hospital complications, transfusions, periprosthetic joint infections, revisions, and deaths. Recommendations for strategies to screen and address these risk factors are provided. Conclusions: Risk factors can be optimized, with evidence suggesting the following thresholds prior to surgery: a body mass index 2, serum albumin ≥3.5 g/dL, hemoglobin A1C ≤7.5%, hemoglobin >12.0 g/dL in women and >13.0 g/dL in men, and smoking cessation and ≥50% decrease in opioid use by 4 weeks prior to surgery. Surgery should be delayed until these risk factors are adequately optimized.

Purpose: Agriculture is the main stay and driver of Kenyan rural economy. Despites the critical role of agriculture in Kenya, poor access to extension support services persist. This study sought to assess the influence of selected socio-economic factors on farmers’ awareness of devolution of agricultural extension services in Kitui County. Methodology: The study used an ex post facto descriptive survey design. A total sample of 99 farmers drawn from the population of 222,781 households in 40 wards (GOK – Economic Survey 2019.) was selected from Kitui County using a stratified random sampling approach. Questionnaires were administered to the sampled farmers. Data analysis was carried out using descriptive, inferential statistics (binary logistic regression). Findings: This study established that older farmers were aware about devolution of agricultural extension services. This study also found that male farmers were more aware about devolution of agricultural extension services as compared to their female counterparts. Moreover, educated farmers were more aware about devolution of agricultural extension services as compared to their less educated counterparts. Family heads from wealthier households (with greater income) were more aware about devolution of agricultural extension services as compared to their counterparts from low income households. The respondents that had larger sizes of land were more likely to be more aware of about devolution of agricultural extension services as compared to household heads with smaller sizes of land. Unique Contribution to Practice and Policy: This study recommends that more campaigns and sensitization should be made in the vast Kitui County to create awareness about the devolution of agricultural extension services and encourage more women smallholder farmers to take advantage of this service especially through organised groups. Key campaigns should especially be implemented through women groups, since women farmers had the least awareness of the devolution of agricultural extension services.

A design optimality criterion, such as D-, A-, I-, and G- optimality criteria, is often used to analyze, evaluate and compare different designs options in mixture modeling test. A mixture test is an experiment where the descriptive variable and response rely only on the mixture's relative ratio in the mix but not its composition. The study geared toward exploring D-, A-, I-, and G- optimality criteria and their efficiency in determining an optimal split-plot design in mixture modeling within the presences of process variables. We evaluated and discussed in detail D-, A-, I-, and G- optimality criteria based on literature review. We also explored and examine why I- and D-optimal criteria are often involved within the formulation of an optimal design in the context of mixture process variable settings. We recommend that optimality criterion must always be used when assessing the various styles of designs so as to search out a desirable design that matches a combination model.

In the presence of process variables, a mixture design has become well-known in statistical modeling due to its utility in modeling the blending surface, which empirically predicts any mixture's response and serves as the foundation for optimizing the expected response blends of different components. In the most common practical situation involving a mixture-process variable, restricted randomization occurs frequently. This problem is solved when the split-plot layout arrangement is used within the constraints. This study's primary goal was to find the best split-plot design (SPD) for the settings mixture-process variables. The SPD was made up of a simplex centroid design (SCD) of four mixture blends and a factorial design with a central composite design (CCD) of the process variable and compared six different context split-plot structure arrangement. We used JMP software version 15 to create D-optimal split-plot designs. The study compared the constructed designs' relative efficiency using A-, D-, I-, and G- optimality criteria. Furthermore, a graphical technique (fraction of design space plot) was used to display, explain, and evaluate experimental designs' performance in terms of precision of the six designs' variance prediction properties. We discovered that arranging subplots with more SCD points than pure mixture design points within SPD with two high process variables is more helpful and provides more precise parameter estimates. We recommend using SPDs in experiments involving mixture process settings developments to measure the mixture components' interaction effects and the processing conditions. Also, the investigation should be set up at each of the points of a factorial design.

Background Falls are associated with morbidity and death in the elderly. The consequences of falls after total joint arthroplasty (TJA) are known, but the consequences of preoperative falls are unclear. We assessed associations between preoperative fall history and hospital readmission rates and discharge disposition after primary TJA. Methods We queried the National Surgical Quality Improvement Program Geriatric Pilot Project for cases of primary total hip arthroplasty (THA) (n = 3671) and total knee arthroplasty (TKA) (n = 6194) performed between 2014 and 2018 for patients aged ≥65 years. Patient characteristics, comorbidities, functional status indicators, and 30-day outcomes were compared among patients with falls occurring within 3 months, from >3 to 6 months, and from >6 to 12 months before surgery, and patients with no falls in the year before surgery. The timing of falls was assessed for independent associations with hospital readmission and discharge to a skilled care facility (SCF). Alpha = 0.05. Results Patients who fell within 3 months before surgery had greater odds of SCF discharge (for THA, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.8-3.4; for TKA, OR 1.8, 95% CI 1.4-2.3) and hospital readmission (for THA, OR 1.8, 95% CI 1.1-3.0; for TKA, OR 2.4, 95% CI 1.6-3.5) compared with the no-fall cohort. No such associations were observed for the other two fall cohorts. Conclusion Falls within 3 months before primary TJA are associated with SCF discharge and readmission for patients aged ≥65 years. Fall history screening should be included in preoperative evaluation. Level of Evidence III.

INTRODUCTION Postoperative anemia is associated with substantial morbidity and mortality in total joint arthroplasty (TJA). Our primary objective was to determine whether perioperative iron supplementation improves postoperative hemoglobin levels in TJA. Secondary objectives were to determine the effects of perioperative iron on adverse events, quality of life, and functional measures in TJA. METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using six databases. We included English-language, randomized controlled trials investigating intraoperative or postoperative iron supplementation in elective TJA that reported postoperative hemoglobin levels in patients aged 18 years or older. Seven eligible studies were identified, among which substantial heterogeneity was noted. Bias risk was low in four studies, unclear in two studies, and high in one study. Three studies assessed oral iron supplementation, three assessed intravenous iron supplementation, and one compared oral and intravenous iron supplementation. All intravenous iron was administered intraoperatively, except in the oral versus intravenous comparison. RESULTS Postoperative oral iron supplementation had no effect on postoperative hemoglobin levels. Intraoperative and postoperative intravenous iron supplementation was associated with higher postoperative hemoglobin levels and greater increases in hemoglobin levels. Two studies reported rates of anemia and found that intraoperative and postoperative intravenous iron supplementation reduced rates of postoperative anemia at postoperative day 30. No adverse events were associated with iron supplementation. One study found that intravenous iron improved quality of life in TJA patients with severe postoperative anemia compared with those treated with oral iron. Perioperative iron had no effects on functional outcomes. DISCUSSION We found no evidence that postoperative oral iron supplementation improves hemoglobin levels, quality of life, or functional outcomes in elective TJA patients. However, intraoperative and postoperative intravenous iron supplementation may accelerate recovery of hemoglobin levels in these patients. LEVEL OF EVIDENCE Level I, systematic review of randomized controlled trials.

The recent outlook of leishmaniasis as a global public health concern coupled with the reportage of resistance and lack of efficacy of most antileishmanial drugs calls for a concerted effort to find new leads. The study combined In silico and in vitro approaches to identify novel potential synthetic small-molecule inhibitors targeting the Leishmania donovani sterol methyltransferase (LdSMT). The LdSMT enzyme in the ergosterol biosynthetic pathway is required for the parasite’s membrane fluidity, distribution of membrane proteins, and control of the cell cycle. The lack of LdSMT homologue in the human host and its conserved nature among all Leishmania parasites makes it a viable target for future antileishmanial drugs. Initially, six known inhibitors of LdSMT with IC50 < 10 μM were used to generate a pharmacophore model with a score of 0.9144 using LigandScout. The validated model was used to screen a synthetic library of 95,630 compounds obtained from InterBioScreen limited. Twenty compounds with pharmacophore fit scores above 50 were docked against the modelled three-dimensional structure of LdSMT using AutoDock Vina. Consequently, nine compounds with binding energies ranging from −7.5 to −8.7 kcal/mol were identified as potential hit molecules. Three compounds comprising STOCK6S-06707, STOCK6S-84928, and STOCK6S-65920 with respective binding energies of −8.7, −8.2, and −8.0 kcal/mol, lower than 22,26-azasterol (−7.6 kcal/mol), a known LdSMT inhibitor, were selected as plausible lead molecules. Molecular dynamics simulation studies and molecular mechanics Poisson–Boltzmann surface area calculations showed that the residues Asp25 and Trp208 were critical for ligand binding. The compounds were also predicted to have antileishmanial activity with reasonable pharmacological and toxicity profiles. When the antileishmanial activity of the three hits was evaluated in vitro against the promastigotes of L. donovani, mean half-maximal inhibitory concentrations (IC50) of 21.9 ± 1.5 μM (STOCK6S-06707), 23.5 ± 1.1 μM (STOCK6S-84928), and 118.3 ± 5.8 μM (STOCK6S-65920) were obtained. Furthermore, STOCK6S-84928 and STOCK6S-65920 inhibited the growth of Trypanosoma brucei, with IC50 of 14.3 ± 2.0 μM and 18.1 ± 1.4 μM, respectively. The identified compounds could be optimised to develop potent antileishmanial therapeutic agents.

Objectives Postoperative delirium, associated with negative consequences including longer hospital stays and worse cognitive and physical outcomes, is frequently accompanied by sleep-wake disturbance. Our objective was to evaluate the efficacy and short-term safety of ramelteon, a melatonin receptor agonist, for the prevention of postoperative delirium in older patients undergoing orthopedic surgery. Design A quadruple-masked randomized placebo-controlled trial (Clinical Trials.gov NCT02324153) conducted from March 2017 to June 2019. Setting Tertiary academic medical center. Participants Patients aged 65 years or older, undergoing elective primary or revision hip or knee replacement. Intervention Ramelteon (8 mg) or placebo Measurements Eighty participants were randomized to an oral gel cap of ramelteon or placebo for 3 consecutive nights starting the night before surgery. Trained research staff conducted delirium assessments for 3 consecutive days starting on postoperative day (POD) 0, after recovery from anesthesia, and on to POD2. A delirium diagnosis was based upon DSM-5 criteria determined by expert panel consensus. Results Of 80 participants, five withdrew consent (one placebo, four ramelteon) and four were excluded (four ramelteon) after randomization. Delirium incidence during the 2 days following surgery was 7% (5 of 71) with no difference between the ramelteon versus placebo: 9% (3 of 33) and 5% (2 of 38), respectively. The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21–7.93; z-value 0.27; p-value = 0.79). Adverse events were similar between the two groups. Conclusion In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium.

Power supply has remained a challeng issue in developing coutries. The aim of this study was to evaluate the potentials of selected yeast species for bioelectricity generation. Different yeast species were isolated from cassava wastewater, whey wastewater, human urine, and rabbit dung using the spread plate method. These isolates were identified using analytical profile index (API). Results obtained revealed the identity of the isolated yeast species as Candida famata, Candida hellenical. Candida tropicalis and Saccharomyces cerevisia (using API method).The isolated yeast species were used singly, and as a consortium for bioelectricity generation, and yeast in continuous mode. The same wastes as used for the isolation process were evaluated as possible substrates for the generation of bioelectricity. Out of the four wastes used, cassava processing wastewater gave the highest bioelectricity potential and was subsequently used as substrate for further study. Saccharomyces cerevisiae elicited the highest electricity generation when the four yeast species were used singly (1.08V). A consortium of the four isolates elicited a synergis effect, generating 1.57V of voltage. Stacking of the Microbial Fuel Cell(MFC) components improved voltage to 2.4V due to its lower internal resistance within the stacked materials. It is apparent from the results obtained in this study that when properly harnessed, microbial fuel cells (MFCs) technology could serve as alternate source of renewable energy. Keywords: Microbial fuel cells, Waste, yeasts, Salt- Bridge, Nafion117.

BackgroundSurgical volunteer organizations have been severely limited during the ongoing coronavirus disease pandemic. Our purpose was to identify obstacles to surgical volunteer organizations secondary to COVID-19 and their responses.MethodsForty-one surgical volunteer organizations participated in a web-based survey (156 invited, 26% response rate). Respondents were separated into two groups: low donations surgical volunteer organizations (≤50% donations of previous year; n = 17) and high donations surgical volunteer organizations (≥75%; n = 24). Univariate analyses were used to compare the two cohorts.ResultsOf responding surgical volunteer organizations, 34 (83%) were unable to maintain full functionality due to COVID-19; 27% of high donations vs. 0% of low donations surgical volunteer organizations (p = 0.02). The three leading obstacles were finances/donations (78%), fewer volunteers (38%), and inadequate personal protective equipment (30%). In response, 39% of surgical volunteer organizations developed novel E-volunteering opportunities. For support, 85% of surgical volunteer organizations suggested monetary donations, 78% promotion through social media platforms, and 54% donation of personal protective equipment.ConclusionThe majority of surgical volunteer organizations were unable to maintain full functionality due to stressors caused by COVID-19, including limitations on finances, volunteers, and personal protective equipment.

Total hip arthroplasty (THA) procedures have been identified as high-volume procedures with growing prevalence. During the procedure, orthopedic surgeons largely rely solely on qualitative assessment to ensure an excessive limb length discrepancy (LLD) is not introduced from the implant selection. LLD can result in back pain and gait complications, with some cases of LLD requiring a revision procedure to mitigate. To address this issue, we evaluated several methods of sensing distance intraoperatively to determine the best approach to measure leg length during the THA procedure. A testing setup using a sawbones model of hip anatomy in the decubitus position was used as a simulation of the THA procedure to test the accuracy of each of the sensing modalities.

Urban green spaces are known to generate environmental, social and health benefits that accrue to urban residents mainly through direct and indirect use. However, information on how such green spaces are used, reasons behind their use and individual factors influencing such use is not readily available especially in Sub-Saharan Africa (SSA). This study sought to fill this gap by examining green spaces’ characteristics, visitation patterns and reasons for their visitation in Kisumu City and Eldoret Municipality of Kenya. The study further examined the association between visitors’ socio-economic attributes and frequency of green space use. Data collected from seven public green spaces purposively selected was used. An observation checklist was employed to assess the characteristics of sampled green spaces while a questionnaire survey was used to obtain information on reasons for green space visitation and users’ socio-economic attributes. Data was analyzed descriptively to elicit green spaces’ characteristics, visitation patterns and visitors’ socio-economic attributes. Adjusted logistic regression model was employed to determine the association between visitors’ socio-economic attributes and visitation frequency. Findings reveal lack of uniformity in characteristics exhibited across green spaces. Green spaces that exhibited most attributes were also highly visited and the main reason for visitation was relaxation and ‘waiting for someone’. Being male, having been divorced, separated or widowed and having secondary or tertiary education were found to be significant socio-economic predictors of green space use. The paper recommends the need to increase density of green spaces in urban areas as well as provision of requisite facilities and amenities to enhance access and utility of green spaces for different needs by majority of urban residents.

The global spread of multidrug-resistant

Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case–control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1–150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80–254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37–142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42–141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22–56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated.

Sedimentary successions and igneous rocks exposed in Eastern Sayan provide an important geological record on the tectonic evolution of the southwestern margin of the Siberian Craton during the Neoproterozoic. Here we present sedimentological and detrital zircon provenance data from key stratigraphic units, complemented by a new U-Pb zircon age of 718 ± 6 Ma from the mafic Nersa magmatic complex. Sedimentological and provenance data from the lower part of the stratigraphic succession (Karagasy Group) show that these rocks were deposited in a passive margin setting after 750 Ma and before the emplacement of the Nersa magmatic complex. The upper part of the stratigraphic succession (Oselok Group) consists of Cryogenian and Ediacaran glaciogenic deposits and associated cap carbonates, overlain by mid to late Ediacaran sequences of dominantly shallow-marine and fluvial siliciclastic rocks. Provenance data indicate that rocks from the Tuva-Mongolia and Zavkhan terranes provided a significant input of detrital material into the sedimentary basin that was the source of the glacial deposits. Orogenic processes during the late Ediacaran (ca 570–540 Ma) in Eastern Sayan were likely associated with the accretion of the Tuva-Mongolia terrane, as indicated by the detrital zircon data.

We used quantitative analytics to assess the efficiency of the clinical workflow for radiation therapy delivery in children and adults focusing on our experience with volumetric modulated arc therapy (VMAT) craniospinal irradiation (CSI). We retrospectively collected clinical and treatment specific data between June 2013 and November 2018 for 614 VMAT CSI sessions of 41 pediatric patients and 48 VMAT CSI sessions of 6 adult patients treated at two hospitals within the same academic institution. Descriptive statistics were generated and a multiple linear regression model was created to predict total radiation time (TRT) based on these predictors. Prolonged treatment sessions were filtered using the interquartile range outlier detection method for quality assurance review. The median pediatric TRT for all VMAT CSI treatment sessions was 21.07 min (interquartile range (IQR) 9.05). Pediatric patient height, fraction number (fractions 1–3 vs. fractions > 3), and number of isocenters were significant predictors for TRT (p

Background Current estimates of operative time (OT) for total hip arthroplasty (THA) are reported as the mean OT across all procedures. This method does not reflect variability among surgeons and surgical settings and should not be used to infer individual surgeon work. We hypothesized that this method would underestimate the time it takes individual surgeons to perform THA. Therefore, we compared the mean OT for all THA cases (“overall OT”) with the mean OT for individual surgeons (“individual surgeon OT”) and examined which factors were associated with each. Methods Mean OT was calculated for 3972 primary THA cases (“overall OT”) by 41 surgeons from 2015 to 2018 in a single health system. The mean OT for each surgeon was determined (“individual surgeon OT”), averaged across surgeons, and compared with overall OT. Overall OT and individual surgeon OT were assessed for associations with surgeon-related (adult reconstruction fellowship training, THA volume, years’ experience), hospital-related (hospital type, trainee presence), and patient-related (age, body mass index category, American Society of Anesthesiologists physical status classification) factors (alpha = 0.05). Results Mean individual surgeon OT was significantly longer (106 ± 21 minutes) than overall OT (96 ± 28 minutes) (P = .03), with 73% of individual surgeon OTs being greater than overall OT. Although all surgeon-, hospital-, and patient-related factors were associated with significant differences in overall OT, only hospital type was associated with differences in individual surgeon OT. Conclusion Individual surgeon OT was longer than overall OT for most surgeons and provides a better estimate of surgeon work.

Polyscias fulva (Hiern) Harms stem bark is used in traditional folk medicine in Kenya for diabetes mellitus and obesity management. This study sought to examine the antidiabetic effects of ethanolic stem bark extract of P. fulva in streptozotocin (STZ)–induced diabetic Wistar albino rats. Diabetes in rats was induced by intraperitoneal injection of STZ (50 mg/kg bwt) in experimental groups. Rats were divided into five groups (n = 5 per group): group 1, control; group 2, diabetic untreated rats; groups 3 and 4, diabetic rats on 200 and 400 mg/kg bwt/day of extract, respectively; and group 5, diabetic rats on metformin (100 mg/kg bwt/day). The rats received oral treatments daily for 21 days, and fasting blood glucose levels and body weights were determined weekly. Liver histopathological analysis and malondialdehyde (MDA) assay as well as serum analysis of lipid profile, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total proteins (TP), albumin (ALB), and globulins were performed at the end of the treatment period. Extract had significant hypoglycemic and hypolipidemic effects in the diabetic rats compared with diabetic untreated rats (p

Background Preoperative identification of knee arthroplasty is important for planning revision surgery. However, up to 10% of implants are not identified prior to surgery. The purposes of this study were to develop and test the performance of a deep learning system (DLS) for the automated radiographic 1) identification of the presence or absence of a total knee arthroplasty (TKA); 2) classification of TKA vs. unicompartmental knee arthroplasty (UKA); and 3) differentiation between two different primary TKA models. Method We collected 237 anteroposterior (AP) knee radiographs with equal proportions of native knees, TKA, and UKA and 274 AP knee radiographs with equal proportions of two TKA models. Data augmentation was used to increase the number of images for deep convolutional neural network (DCNN) training. A DLS based on DCNNs was trained on these images. Receiver operating characteristic (ROC) curves with area under the curve (AUC) were generated. Heatmaps were created using class activation mapping (CAM) to identify image features most important for DCNN decision-making. Results DCNNs trained to detect TKA and distinguish between TKA and UKA both achieved AUC of 1. Heatmaps demonstrated appropriate emphasis of arthroplasty components in decision-making. The DCNN trained to distinguish between the two TKA models achieved AUC of 1. Heatmaps showed emphasis of specific unique features of the TKA model designs, such as the femoral component anterior flange shape. Conclusions DCNNs can accurately identify presence of TKA and distinguish between specific arthroplasty designs. This proof-of-concept could be applied towards identifying other prosthesis models and prosthesis-related complications.

Flash flood is a natural disaster caused by the sudden onset of rainfall resulting in runoff waters from high to low altitude areas. This runoff waters leads to loss of lives, destruction of property, and environment; a problem experienced by residents of Marigat Sub-County. The purpose of the study was to investigate the management strategies of flash floods in Marigat Sub-County. The study used descriptive research management practices of flash floods on qualitative and quantitative methods. The target population was 120,263 people with 24,893 households. Purposive sampling method for three locations which were Ilng’arua, Ng’ambo and Salabani experiencing flash floods with a population of 13,885 translating to 3168 households, from which a sample size of 355 respondents was obtained. Stratified proportionate random sampling method was used to select household heads for the survey. Purposive sampling method was adopted for identifying key informants and one disaster management officer. Primary and secondary data were used. Questionnaires, key informants interview schedules, and observations were used to collect data. The validity of the study was achieved through the construction of relevant instruments to the objective of the study. To ensure reliability, piloting of the questionnaire was done and results obtained were 0.76 Cronbach’s alpha level. Collected data were coded and analysed using the SPSS software, where descriptive and inferential statistics were generated to test the study hypothesis. The findings of this study will be beneficial to Baringo County and the Kenyan government in the management of flash floods and the achievement of sustainable development goals.

Introduction: The purpose of this study was first, to assess the relationship between preoperative INR (international normalised ratio) and postoperative complication rates in patients with a hip fracture, and second, to establish a threshold for INR below which the risk of complications is comparable to those in patients with a normal INR. Methods: We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program and found 35,910 cases who had undergone surgery for a hip fracture between 2012 and 2018. Cases were stratified into 4 groups based on their preoperative INR levels: Results: Of the 35,910 cases, 33,484 (93.2%) had a preoperative INR Conclusions: We found that an INR of

Background High-quality care is essential in total joint arthroplasty. Multiple initiatives such as centers of excellence, patient optimization, and alternative payment models have demonstrated improved outcomes and decreased cost. Many studies have shown that longer operative times (OTs) are associated with increased frequency of postoperative complications. These findings often come from large data sets and may not accurately represent the average OT of individual surgeons. The purpose of this study was to determine the hospital and patient-related factors that influence OT. Methods This retrospective study reviewed OT of 6003 total knee arthroplasty cases performed by 41 surgeons at 4 hospitals in a single health-care system. Mean OT was calculated for each surgeon. The effect of surgeon, hospital-, and patient-related factors on OT was assessed. Results Among the 41 surgeons, the mean OT was 105 ± 25 minutes. Two community hospitals had significantly faster OT compared with the tertiary care academic hospital. Surgeons’ OT for morbidly obese patients was significantly longer compared with normal, overweight, and obese patients. Surgeon volume, surgeon experience, trainee presence, and American Society of Anesthesiologists status did not significantly affect surgical time. Conclusions Operative time was influenced by hospital-related (tertiary, community) and patient-related (morbid obesity vs lower body mass index groups) factors. However, specific surgeon factors (surgical volume, experience), surgical team factors (presence or absence of trainee), and patient factors (American Society of Anesthesiologists status) did not significantly alter the OT. Additional studies of larger health systems are needed to examine additional patient, surgeon, and hospital factors which may influence the OT.

The global spread of multidrug-resistant Acinetobacter baumannii infections urgently calls for the identification of novel drug targets. We solved the electron cryo-microscopy structure of the F 1 F o –adenosine 5′-triphosphate (ATP) synthase from A. baumannii in three distinct conformational states. The nucleotide-converting F 1 subcomplex reveals a specific self-inhibition mechanism, which supports a unidirectional ratchet mechanism to avoid wasteful ATP consumption. In the membrane-embedded F o complex, the structure shows unique structural adaptations along both the entry and exit pathways of the proton-conducting a-subunit. These features, absent in mitochondrial ATP synthases, represent attractive targets for the development of next-generation therapeutics that can act directly at the culmination of bioenergetics in this clinically relevant pathogen.

Objectives Diarrhea, an abnormal state in which the individual has about three or more daily bowel movements, is now considered one of the most challenging global public health problems. Using plant products, such as Bridelia ferruginea is an alternative treatment option. The objective of this study was to investigate the antidiarrheal activity of B. ferruginea bark methanolic extract (BfME) and the mechanisms involved. Methods BfME antidiarrheal activity was evaluated in mice model of castor oil-induced diarrhea and enteropooling. To evaluate motility, gastrointestinal transit time was carried out using phenol red meal, while intestinal activities of selected ATPases were also evaluated. Furthermore, the active components in BfME were detected by GC-MS analysis, while molecular docking of the most abundant compounds with muscarinic acetylcholine receptor (M3) and prostaglandin E2 receptor 3 (EP3) were conducted. Results BfME at 400 and 800 mg/kg showed antidiarrheal activity by delaying onset of diarrhea, reduced gastrointestinal transit and increased intestinal activities of Na+ K+-ATPase, Ca2+ Mg2+-ATPase and Mg2+-ATPase. Molecular docking revealed that γ-sitosterol, α-amyrin, and stigmasterol have outstanding binding affinity for M3 and EP3. Conclusions In view of these results, the observed antidiarrheal activity possibly occurs via the activation of ATPases activities and inhibition of M3 and EP3.

The following information was missing in the original manuscript [...]

In January 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient Only (IPO) list. This study aimed to compare patient-level payments in TKA cases with a length of stay (LOS)2 midnights before and after removal of TKA from IPO list.In this retrospective cohort study, all Medicare patients who received a primary elective TKA from 2016-2019 with a LOS2 midnights at an academic tertiary center were identified. Total and itemized charges and patient-level payments were compared between eligible TKA cases performed in 2016-2017 and those in 2018-2019. There were 351 eligible TKA cases identified: 151 in 2016-2017 and 200 in 2018-2019.The percentage of patients making any out-of-pocket payment increased in 2018-2019 from 2016-2017 (51.0% versus 10.6%), as did median patient-level payment ($7.30 [range, $0.00-$3,389] versus $0.00 [range, $0.00-$1,248], P.001 for both). A greater proportion of patients in 2018-2019 paid $1-$50 than in 2016-2017 (37.5% versus 1.3%, P.001) with no change in the proportion of patients who made payments$50. Total charges were less in 2018-2019 than in 2016-2017 (P = .001). Charges for drugs, laboratory tests, admissions/floor, and therapies decreased in 2018-2019, whereas charges for the operating room and radiology increased (P.001 for all).Patients receiving outpatient TKA in 2018-2019 were more likely to have out-of-pocket payments than patients with comparable hospital stay who were designated as inpatients, although most of these payments were less than $50.

BACKGROUND Restrictive transfusion practices have decreased transfusions in total joint arthroplasty (TJA). A hemoglobin threshold of