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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.

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

The need for preservation of wood to prolong it serviceable life is necessary and thus developing a new safer ecofriendly preservative is of importance because of the damages caused by the chemical preservatives. This study, therefore, investigates the bio preservative potentials of Mangifera indica seed oil extract against termite attack on Triplochiton scleroxcylon and Terminalia superba wood. The pods of M. indica were collected and dehulled after which the seeds were removed from the pods, sundried, and blended to fine powder. The fine cotyledon was subjected to solvent extraction for oil using a Soxhlet apparatus and N-hexane as the solvent. Data collected was analyzed using simple statistics and analysis of variance at α = 0.05. The wood was dimensioned into 5 x 5 x 30 cm and 200 ml of seed oil was applied to it using a brush. The treated wood was exposed to field termites and the absorption rate and weight loss to termite attack were determined. Data collected were analysed with t-test at α = 0.05. The percentage weight loss of wood samples due to T. scleroxcylon and T. superba were 13.76 and 11.52 % respectively. These values are lower than the mean values obtained for the control (14.84 and 12.44 %). The absorption of seed oil extract by the wood samples differ significantly (P≤0.05). Meanwhile, there was no significant differences (p>0.05) in the weight loss due to termite between treated wood samples but untreated wood samples differ significantly (p≤0.05). The M. indica seed extract can serve as an alternative preservative against termite attack thereby reducing environmental pollution that may arise from the use of conventional chemical preservatives.

The orthopedic surgical specialty is strongly tied to partnerships with industry that have fostered innovation and greatly enhanced patient care. A substantial number of orthopedic surgeons currently receive some form of industry support. These relationships are highly scrutinized because they present the possibility of both personal and financial conflicts of interest (COI). The authors examined orthopedic patients' awareness of existing regulation and perceptions of financial COI by performing a prospective survey-based study of patients seen in an academic orthopedic department. Data were collected during 1 year, in a cross-section of hospital-based and community clinical settings. The authors collected 513 surveys during a 1-year period between 4 clinical locations. Of all respondents, 55% were unconcerned regarding gifts or direct compensation their physicians received from industry, and only 16% were very or extremely concerned regarding these benefits. Patients' opinions regarding possible influence of benefits were similarly ambivalent, with 54% of patients minimally or not at all concerned regarding the potential influence of industry gifts or compensation. Seventy-six percent of patients had never heard of the Sunshine Act, and only 3% indicated that they were aware of the legislation and its intention. The income of the respondents and their level of education were positively correlated with increased concern about handling of COI, as well as knowledge regarding the Sunshine Act. These data suggest that orthopedic surgery patients are widely unconcerned regarding physician COI, but specific subsets of patients may be more likely to have concerns regarding these relationships. [ Orthopedics . 2021;44(5):e682–e686.]

Background Patients continue to utilize physician review websites (PRWs) to assist in their selection of a health care provider. Studies on PRWs and how they affect patient care have recently become popular in the literature. This study analyzes PRW ratings of a previously unexamined subspecialty, pediatric orthopaedic surgeons. Methods Three hundred ninety-nine randomly selected Pediatric Orthopaedic Society of North America member's PRW ratings were examined from May 4, 2020 to July 18, 2020. Healthgrades.com, Vitals.com, RateMDs.com, and Google.com were reviewed. Number of ratings and average ratings (0 to 5.0) were recorded. Provider sex, years in practice (0 to 10, 11 to 20, and 21+), practice type (academic, private), geographic location (Northeast, Southeast, Midwest, Southwest, West), degree (Medical Doctor, Doctor of Osteopathic Medicine), and fellowship training (yes, no) were recorded. Kruskal-Wallis testing was performed to determine factors affecting positive surgeon ratings. Results 98.5% (393) of Pediatric Orthopaedic Society of North America surgeons were rated on a PRW at least once and were highly rated with an average rating of 4.14 of 5.0. Surgeons in practice 1 to 10 years had higher ratings than those in practice 11 to 20 and 21+ years, on Healthgrades.com (P=0.049) and RateMDs.com (P=0.011). Academic surgeons were found to have higher ratings than those in private practice on Google.com (P=0.007). Sex, region of practice, degree type, and fellowship training status did not have an effect on online ratings across all PRWs. Conclusions Pediatric orthopaedic surgeons are frequently and highly rated, similar to other orthopaedic subspecialties. Surgeons in practice 1 to 10 years were found to have statistically higher ratings on some websites. Academic surgeons were found to have statistically higher ratings on some websites.

The growing resistance to the current antimalarial drugs in the absence of a vaccine can be effectively tackled by identifying new metabolic pathways that are essential to the survival of the malaria parasite and developing new drugs against them. Triterpenes and steroids are the most abundant group of natural products with a great variety of biological activities. However, lanosterol is not known to possess any significant biological activity. In this study the binding and interactions of a dinitrophenyl hydrazine (DNP) derivative of lanosterol, LAN (a derivative that incorporates a substantially polar moiety into the steroid) with P. falciparum transketolase was studied by molecular docking and MD simulation with the view to exploit the DNP derivative as a lead in antimalarial chemotherapy development considering that the P. falciparum transketolase (PfTk) is a novel target in antimalarial chemotherapy. The enzyme catalyses the production of ribose sugars needed for nucleic acid synthesis; it lacks a three-dimensional (3D) structure necessary for docking because it is difficult to obtain a crystalline form. A homology model of PfTk was constructed using Saccharomyces cerevisiae transketolase (protein data bank ID of 1TRK) as the template. The compound was observed to have Free Energy of Binding higher than that of the cofactor of the protein (Thiamine Pyrophosphate, TPP) and a synthetic analog (SUBTPP) used as reference compounds after MD Simulation. The compound was synthesized in a two-step, one-pot reaction, utilizing a non-acidic and mild oxidant to oxidize the lanosterol in order to avoid the rearrangement that accompanies the oxidation of sterols using acidic oxidants. The LAN was characterized using IR spectroscopy and NMR experiments and tested in-vivo for its antimalarial chemo suppression using a murine model with Chloroquine as a standard. The LAN at a concentration of 25 mg/kg was found to have a comparable activity with Chloroquine at 10 mg/kg and no mortality was observed among the test animals 24 days post drug administration showing that the compound indeed has potential as an antimalarial agent and a likely inhibitor of PfTk considering that there is a strong agreement between the in-silico results and biological study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40203-021-00097-8.

The chemical composition of Melanthera scandens (MS) methanol (MeOH) extract is yet to be fully comprehended. Chemical composition of a plant extract is closely related to the biological activity of the plant material, in phytomedicine. In this study, chemical analyses of MS extracts were carried out with the aim of identifying the organic chemical constituents.

Joint P- and S-wave measurements for tomographic cross-borehole analysis can offer more reliable interpretational insight concerning lithologic and geotechnical parameter variations compared with P-wave measurements on their own. However, anisotropy can have a large influence on S-wave measurements, with the S-wave splitting into two modes. We have developed an inversion for parameters of transversely isotropic with a vertical symmetry axis (VTI) media. Our inversion is based on the traveltime perturbation equation, using cross-gradient constraints to ensure structural similarity for the resulting VTI parameters. We first determine the inversion on a synthetic data set consisting of P-waves and vertically and horizontally polarized S-waves. Subsequently, we evaluate inversion results for a data set comprising jointly measured P-waves and vertically and horizontally polarized S-waves that were acquired in a near-surface ([Formula: see text]) aquifer environment (the Safira research site, Germany). The inverted models indicate that the anisotropy parameters [Formula: see text] and [Formula: see text] are close to zero, with no P-wave anisotropy present. A high [Formula: see text] ratio of up to nine causes considerable SV-wave anisotropy despite the low magnitudes for [Formula: see text] and [Formula: see text]. The SH-wave anisotropy parameter [Formula: see text] is estimated to be between 0.05 and 0.15 in the clay and lignite seams. The S-wave splitting is confirmed by polarization analysis prior to the inversion. The results suggest that S-wave anisotropy may be more severe than P-wave anisotropy in near-surface environments and should be taken into account when interpreting cross-borehole S-wave data.