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Hepatitis C is a prevalent disease in the world. Around 3 to 4 million new cases of Hepatitis C are reported every year across the globe. Effective, timely prediction of the disease can help people know about their Stage of Hepatitis C. To identify the Stage of disease, various noninvasive serum biochemical markers and clinical information of the patients have been used. Machine learning techniques have been an effective alternative tool for determining the Stage of this chronic disease of the liver to prevent biopsy side effects. In this study, an Intelligent Hepatitis C Stage Diagnosis System (IHSDS) empowered with machine learning is presented to predict the Stage of Hepatitis C in a human using Artificial Neural Network (ANN). The dataset obtained from the UCI machine learning repository contains 29 features, out of which the 19 most reverent are selected to conduct the study; 70% of the dataset is used for training and 30% for validation purposes. The precision value is compared with the proposed IHSDS with previously presented models. The proposed IHSDS has achieved 98.89% precision during training and 94.44% precision during validation.

Objective To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. Methods Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. Results A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. Conclusions This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.

Background and Aim: Polycystic ovary syndrome (PCOS) is a new rising disorder of reproductive, metabolic, and endocrine disorders of young females of reproductive age suffering from insulin resistance, increased levels of androgens, and altered morphology of ovaries with multiple cysts, and oligoanovulation. The burden of disease is significantly high with a global prevalence of 5% - 10% of reproducing females. Literature has reported a positive correlation between diabetes mellitus in the family and the resultant risk of developing PCOS among the female population. This study will aim to assess the correlation between the familial history of diabetes mellitus and concurrent risk of developing PCOS in a tertiary care hospital in Lahore, Pakistan. Methodology: A cross sectional study was conducted in the Medicine and Gynecology department of Sir Ganga Ram Hospital, Lahore for duration of four months from October 2021 to January 2022. Participants were recruited following inclusion and exclusion criteria. Sample population was estimated to be 150 females. Participants were recruited by convenient sampling. After recruitment participants underwent physical, clinical, and serological assessment. Diagnosis of PCOS was made by following Rotterdam criteria. Data collection was done by 14 points questionnaire and history interview. Results: This study showed that all participants diagnosed with PCOS have a history of early menarche, increased level of heartbeats, a large volume of ovaries, and a lesser volume of uterus. Patients also showed increased peripheral follicles. Serologic outcomes of participants showed a generalized increase in TT levels and a generalized decrease in SHBG levels with 1.71 (1.04-2.23) nmol/L and 45.39 ± 24.44 nmol/L respectively. About 56.2% (n= 83) of the participants gave a history of the abnormal menstrual cycle and 70.3% (n= 104) of the population agreed to abnormal hair growth on the body. When assessing the history of diabetes mellitus prevalence among families of the participants, the results showed that 19% of the population (n= 28) gave a positive history of diagnosed diabetes mellitus of both mother and father, 21.1% of the participants (n= 31) suggested that their parents were never tested for diabetes mellitus before, whereas remaining 43.8% (n= 89) gave no familial history of diabetes mellitus. Conclusion: The study concludes that the most common characteristics of PCOS among the population of Pakistan is increased weight followed by abnormal hair growth, participants present with increased TT and decreased SHBG levels. Familial history of diabetes mellitus is considered a risk factor for developing PCOS. Keywords: Familial diabetes, Diabetes mellitus, Polycystic ovary syndrome, Risk factors of PCOS

Objective: The purpose of this study is to determine the prevalence of hypocalcemia among patients after thyroid surgery. Study Design: Descriptive study/ Cross-sectional Place and Duration: The study was conducted at the surgical department of Mayo Hospital, Lahore for the duration of eighteen months from July 2020 to December 2021. Methods: Fifty-five male and female subjects participated in this research. Patients ranged in age from 17 to 62 years. After obtaining written permission from the patient, demographic information such as age, sex, BMI, and tumors type was collected. Contralateral lobe cancer was also shown to be a problem. Before surgery and on the first post-operative day, the blood calcium levels of the patients were measured. Patients who received a full thyroidectomy were evaluated for signs of hypocalcemia. Analysis was performed using SPSS 22.0. Results: Among 55 patients, majority of the cases were females 30 (54.5%) were females and the rest were males 25 (45.5%). The patients mean age was 37.16±14.52 years and had mean BMI 24.45±6.62 kg/m2. Papillary cancer was the most common tumor found in 42 (76.4%) cases, followed by follicular cancer in 9 (16.4%) case and 4 (7.3%) cases had hurthle cell carcinoma. We found frequency of hypocalcemia in 14 (25.5%) cases. Among 14 patients of hypocalcemia 10 (71.4%) were females and 4 (38.6%) were males. Retrosternal of goiter found in 5 (35.7%) cases and no retrosternal extension found in 9 (64.3%) case. Post-operative other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Conclusion: In this study we found higher frequency of hypocalcemia in 25.5% cases after thyroid surgery. Majority of the cases were females and had no retrosternal extension. Except hypocalcemia other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Keywords: Thyroid Surgery, Tumors, Complications, Hypocalcemia

Odontoid fractures are one of the most common injuries to the cervical spine in geriatric patients. Congenital C1 arch absence, however, is a very rare anomaly found in the population. We describe the first reported case of a congenital C1 posterior arch absence and C1 anterior cleft presenting with odontoid fracture. We present the case of a 58-year-old male who was found to have a comminuted type III odontoid fracture with significant angulation and displacement. CT scan demonstrated this fracture and also demonstrated congenital cleft of his left anterior arch and absence of left C1 posterior arch. Given his anatomic anomaly, we elected to perform occipitocervical fusion. The patient underwent occipito-cervical fusion to avoid iatrogenic vertebral artery injury. He was also immobilized in a halo vest given patient-specific social factors and compromised bone quality. The patient had no intra- or post-operative complications, but a prolonged hospital stay due to alcohol withdrawal. At 3-month postoperatively the patient had no neck pain and return to baseline function. This case highlights the importance of obtaining a CT scan preoperatively to not only to further characterize the fracture but also for surgical planning and recognition of anatomic anomalies as this may significantly impact the operative strategy.

Objectives: This study is done to determine knowledge and attitude of cancer patients towards COVID-19 pandemic. Methods: The study was conducted at Oncology Department, Mayo Hospital Lahore during August-October 2020. A questionnaire was used to determine knowledge and attitude of cancer patients towards COVID-19 pandemic. Data was analyzed using Spss version.23. Descriptive variables like gender, marital status, residence and disease characteristics were reported as means and frequencies. Intergroup analysis was done using Chi square test with p

BACKGROUND The anterior approach to the cervical spine is commonly used to treat cervical pathology. It is, however, associated with high rates of dysphagia, which may be associated with substantial patient morbidity. Perioperative corticosteroid administration has been advocated to decrease dysphagia rates; its efficacy, however, remains uncertain. We conducted a meta-analysis of randomized trials to determine the efficacy of perioperative corticosteroid administration in reducing postoperative dysphagia as well as any adverse effects, such as pseudarthrosis and infection. METHODS We conducted a systematic search of electronic databases (MEDLINE, Embase, CENTRAL [Cochrane Central Register of Controlled Trials], ClinicalTrials.gov) to identify randomized controlled trials (RCTs) that evaluated corticosteroids versus any comparator for prevention of postoperative dysphagia after anterior cervical spine procedures. Two independent reviewers used the GRADE (Grades of Recommendation Assessment, Development and Evaluation) criteria to assess eligibility and risk of bias, perform data extraction, and rate the quality of evidence. The primary outcome was severity of postoperative dysphagia. We conducted meta-analyses of dysphagia (both overall and by delivery method), pseudarthrosis, and postoperative infection. RESULTS After screening of 927 articles, a total of 7 studies were eligible for final inclusion. These included 431 patients, of whom 247 received corticosteroids and 184 received placebo or a control treatment. Moderate-quality evidence demonstrated a significant improvement in postoperative dysphagia rates (odds ratio, 0.35; 95% confidence interval, 0.20 to 0.63; p < 0.001), and this finding was robust to both permutation analyses and sensitivity analyses removing the studies with a high risk of bias. There was no significant difference between intravenous and local steroid administration (p = 0.16). There were no documented infections. There was no significantly increased risk of pseudarthrosis in those receiving steroids compared with placebo or a control treatment (p = 0.13). CONCLUSIONS This meta-analysis found moderate-quality evidence supporting the use of perioperative corticosteroid administration as an adjunct to anterior cervical spinal procedures. Patients treated with corticosteroids intravenously or locally had significantly decreased severity of dysphagia. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

To combat health challenges associated with mosquito-borne diseases, the larvicidal activity of metallic nanoparticles, food-grade polymeric nano-capsules and insecticides was investigated against larvae of Aedes albopictus as an effective alternate control approach. The Ae. albopictus was identified using sequencing and phylogenetic analyses of COXI, CYTB and ITS2 genes. The characterization of synthesized nanostructures was performed through Zetasizer, UV-VIS spectroscopy, atomic force microscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy. The mosquito larvae were exposed to varying concentration of nanostructures and insecticides, and their percentage mortality was evaluated at different time intervals of 24 h and 48 h exposure. The highest efficacy was observed in zinc oxide nanoparticles (ZnO-NPs) and polymeric nanocapsules FG-Cur E-III (LC50 = 0.24 mg/L, LC90 = 0.6 mg/L) and (LC50 = 3.8 mg/L, LC90 = 9.33 mg/L), respectively, after 24 h; while (LC50 = 0.18 mg/L, LC90 = 0.43 mg/L) and (LC50 = 1.95 mg/L, LC90 = 6.46 mg/L), respectively, after 48 h against fourth instar larvae of Ae. albopictus. Ag, CuO, NiTiO3 and CoTiO3 nanoparticles evaluated in this study also showed promising larvicidal activity. Although ZnO-NPs proved to be effective larvicides, their possible toxicity (producing ROS species) can limit their use. The curcumin nanostructures (FG-Cur E-III) stabilized by food-grade materials are thought to exert their larvicidal activity by binding to sterol carrier protein-2, and depriving the larvae from the essential dietary cholesterol, and bears effective larvicidal potential as safe alternative for chemical larvicides, due to their environment friendly, food-grade and easy biodegradability.

The use of antimicrobial growth promoters in chicken farming has been commonly associated with high levels of antimicrobial resistance (AMR) in humans. Most of this work, however, has been focused on intensive large-scale operations. Intensive small-scale farming that regularly uses antibiotics is increasing worldwide and has different exposure pathways compared with large-scale farming, most notably the spatial connection between chickens and households. In these communities, free-ranging backyard chickens (not fed antibiotics) can roam freely, whereas broiler chickens (fed antibiotics) are reared in the same husbandry environment but confined to coops. We conducted an observational field study to better understand the spatial distribution of AMR in communities that conduct small-scale farming in northwestern Ecuador. We analyzed phenotypic resistance of Escherichia coli sampled from humans and backyard chickens to 12 antibiotics in relation to the distance to the nearest small-scale farming operation within their community. We did not find a statistically significant relationship between the distance of a household to small-scale farming and antibiotic-resistant E. coli isolated from chicken or human samples. To help explain this result, we monitored the movement of backyard chickens and found they were on average 17 m (min-max: 0-59 m) from their household at any given time. These backyard chickens on average ranged further than the average distance from any study household to its closest neighbor. This level of connectivity provides a viable mechanism for the spread of antimicrobial-resistant bacteria and genes throughout the community.

A number of spinal pathologies result in fusion of the spine, including ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), as well as severe degenerative arthropathies. This fusion of spinal elements may result in spinal deformity affecting any region of the spine. Cervicothoracic deformity resulting in chin on chest deformity is poorly tolerated due to inability to maintain a horizontal gaze. Surgical treatment options for this condition are complex and require extensive discussion between the patient and surgical team. Here we present a case report of a 26-year-old transgender female (male to female) patient with severe chin on chest deformity and a unique pattern of spinal fusion involving only the posterior elements. She underwent C2–T8 posterior spinal fusion with thoracic pedicle subtraction osteotomy and multiple cervical facet osteotomies with good functional result. She did have severe dysphagia and required feeding tube for several weeks but did very well by 1 year postoperatively. While posterior elements of the spine are normally affected first in spondyloarthropathies such as ankylosing spondylitis, the lack of anterior spinal involvement is unique and could be attributed to hormonal therapy in this patient. This case describes a unique pattern of spondyloarthropathy and highlights the importance of a having a multi-disciplinary team for the treatment of patients with complex spinal pathologies.

Intraoperative stereotactic navigation in spine surgery is quickly becoming popularized for accurate placement of spinal instrumentation as well as assisting in the verification of anatomic landmarks. Navigation is less commonly utilized in anterior cervical spine surgery due to instrumentation being able to be placed under direct visualization. The utility of navigation in anterior cervical spine surgery is its ability to aid in the verification of anatomic location, particularly when anatomy is distorted or pathology comes close to critical neurovascular structures. We present a technique guide for anterior cervical spine navigation that we have applied at our institution and have found to be very beneficial in select patients, particularly those with complex anatomy, large body mass index, undergoing revision surgery, sustained spinal trauma and those patients with severe anterior ossification where depth or medial-lateral landmarks are difficult to visualize. We describe utilization of the technique using a case examples and specifically in a patient with significant ossification of the posterior longitudinal ligament and severe spinal cord compression that underwent multilevel cervical corpectomy. The described technique was found to be reproducible and effective, allowing cervical spine surgeons to perform more complex or minimally invasive procedures with safety and accuracy. We emphasize that navigation does not replace knowledge of anatomy or technical aspects of the procedure.

Non-governmental organizations (NGOs) often implement overseas development aid through intensive small-scale animal agriculture to alleviate food insecurity in low- and middle-income countries. Intensive animal farming can pose unclear outcomes to households engaged in the practice because of the reliance on industrial animal breeds that are reared with antibiotics and raised in higher densities compared to traditional scavenging husbandry systems. As a result, intensive small-scale farming operations that lack proper infrastructure, training, and financial resources could facilitate the spread of antimicrobial resistance and infectious diseases. We applied a mixed-methods framework towards analyzing the effectiveness of small-scale broiler chicken farming in northern Ecuador. First, from May 2016 – May 2017, our observational surveys indicated that intensive small-scale poultry farming follows a boom-and-bust cycle that is extremely vulnerable to environmental stressors. Second, in May 2016, we followed a cohort of households enrolled in a poultry development project led by an NGO. We observed a substantial decline in chicken survivorship from Survey period 1 to 2 (mean chicken count decrease from 50 to 35 corresponding to a 70% survivorship) and from Survey period 2 to 3 (mean chicken count decrease from 35 to 20.3 corresponding to a 58% survivorship). Heads of households were self-reporting broiler chicken survivorship substantially higher than our recorded observations during survey period two (46 compared to 35 respectively) and three (44.3 compared to 20.3 respectively). We speculate that if households continue to inaccurately report poultry demographics, then it could perpetuate a negative feedback loop where NGOs continue to conduct the same intervention practices without receiving accurate outcome metrics. Third, we used semi-structured questionnaires to determine that access to financial resources was the major motivation for determining when to farm broiler chickens. Intensive small-scale poultry farming can be unreliable and disease-enhancing, yet also associated with dubious self-reports of success.

Wildlife poaching has been and continues to be of significant concern to environmental sustainability. While descriptions of poaching often include vivid details about the animal victims and the heroics of those fighting to conserve biodiversity, ambiguity still surrounds ‘the poacher.’ Clarifying the identity of a poacher is necessary to expose a societal tendency to enforce stereotypes on others that perpetuate violence and inequality. Without knowing the identity of a poacher, it becomes easy for society to impose unsubstantiated beliefs upon them that legitimize unjust and violent policies. This research examines how (1) the media and (2) conservation actors construct the identity and context of the poacher to understand how and why violent protected area policies like shoot-to-kill have become accepted conservation strategies. Through a systematic analysis of news articles and primary interviews with conservation actors, we demonstrate how poachers are anonymized, dehumanized, and placed in a space of exception to become legitimate and justifiable targets of violence. We conclude by examining a central paradox that emerges from the state's biopolitical use of violent anti-poaching policies: how does a form of authority that is fundamentally justified in its claims to protect life condone the use of deadly force on its own subjects?

BACKGROUND: Numerous techniques of C1 lateral mass screw placement have been described. We sought to delineate the radiographic angle of safety medially and laterally and describe a novel surgical technique of C1 lateral mass screw placement. We sought to (I) determine the angle of safety medially and laterally of the C1 lateral mass; (II) assess the size available of the lateral mass in the AP and coronal planes; (III) describe novel technique of insertion of a C1 lateral mass screw utilizing navigation and a novel start point. METHODS: We retrospectively reviewed cervical computed tomography (CT) images of normal adults. Radiographic measurements were then obtained using these images including the angle (degrees) of safety medially and lateral of the C1 lateral mass bilaterally, as well as the length and width (mm) of the C1 lateral masses. A novel surgical technique was used by identifying the confluence of the medial aspect of the posterior arch and the lateral mass. This confluence is then marked out as the C1 screw start point. Under navigation guidance, lateral mass screws were placed with 0 degrees of medial-lateral angulation from posterior to anterior. RESULTS: Forty-five patients with a mean age of 52.6±25.6 years (33% female) were included. The mean medial and lateral angle of safety of the C1 lateral mass bilaterally was 23±3.8 degrees and 32±5 degrees, respectively. Average length and width of the lateral mass was 17.7 and 13.3 mm respectively. CONCLUSIONS: This study describes the radiographic window of safety medially and laterally for safe and reproducible placement of C1 lateral mass screws. Further, a novel technique using a medial start point and navigation guidance with 0 degrees of angulation in the coronal plane is described. Further research is required to assess outcomes of patients utilizing this method as well as biomechanical studies to assess this construct strength compared to others that are frequently used.

Using digital data collection devices in the field is now commonplace among many faculty and students. However, there is less attention to how the use of GPS units, tablets and devices transforms o...

In response to national attention on questions of how racial justice is still unrealized, different academic institutes have sought to increase diversity and justice in their curricula, institutional practices, and immersive experiences for their students. This has normally taken the form of diversity, equity, and inclusion principles. Yet there remain significant obstacles to how inequities and lack of attention to power differential across race, class, and gender continue to create imbalances that affect the ability to conduct just research. In this piece, I describe six critical points of engagement for sustainable engagement for just research. These concerns range from the field to the classroom and identify how existing structures can reinforce dominant narratives and understandings linked to colonial histories of extraction and the exploitation of knowledge. I offer tangible and credible alternatives for grounding knowledge generation in ways that are less restrictive than the coercive practices of the past.

The fast‐growing electricity demand in Pakistan and other developing countries has posed a severe challenge to electricity distribution systems. Indeed, most of the utility companies have to follow a trend of load shedding to face this difficulty. Load shedding is the “art” of managing the load demand by shedding loads in critical situations where the demand is higher than the total generation to avoid system failure. Although electricity utilities are suggesting consumers reduce the load during peak hours in their monthly bills, the consumers are not willing or aware of this. It is clear how tedious and tiresome it is to remind the customers what the peak hours are, and manually switch off/on the heavy load during peak and off‐peak hours. The estimated cost of the system is around 43$ and 28$ with and without Global System for Mobile Communications module for message notification. Moreover, the distribution feeder has a specific capacity to bear the load in peak hours after this is automatically shut down the whole feeder. In this paper, the simulation analysis of a single‐family house is performed for automatic load reduction during peak hours in Proteus software. A hardware prototype is then designed and applied so as to validate the proposed control system. The results show that the proposed scheme allows for an efficient peak shaving during peak hours. For some typical domestic and commercial consumers, the financial benefits are also calculated. It is concluded that the payback period of this device is almost 1 month if it reduces 50% of load during the 4‐hour peak time. The proposed system may be implemented as a single additional tool/span is already available energy meters and may quickly be adopted by electric utilities of developing countries to avoid the load shedding trend.

BACKGROUND CONTEXT Although patient-reported outcomes (PROs) have become important in the evaluation of spine surgery patients, the accuracy of patient recall of pre or post-intervention symptoms following epidural steroid injection remains unknown. PURPOSE The purpose of this study was 1) to characterize the accuracy of patient recollection of back/leg pain following epidural steroid injection; 2) characterize the direction and magnitude of recall bias; 3) characterize factors that impact patient recollection. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Consecutive patients 18 years and older undergoing lumbar epidural steroid injection presenting with neurogenic claudication or radiculopathy secondary to degenerative lumbar spinal stenosis OUTCOME MEASURES Numeric pain scale (NPS) for back pain and leg pain. METHODS Using standardized questionnaires, we recorded numeric pain scores (NPS) for patients undergoing lumbar epidural steroid injections at our institution. Baseline pain scores were obtained prior to injection, 4 hours and 24-hours post-injection. At a minimum of 2 weeks following the injection, patients were asked to recall their symptoms pre-injection and at 4 hours and 24-hours post-injection. Actual and recalled scores at each time point were compared using paired t-tests. Multivariable linear regression was used to identify factors that impacted recollection. RESULTS Sixty-one patients with a mean age of 61.4 years (56% female) were included. Compared to their pre-injection pain score, patients showed considerable improvement at both 4 hours [Mean Difference (MD) = 2.18, 95% Confidence Interval (CI) 1.42 to 2.94)) and 24 hours (MD = 2.64, 95% CI 1.91 to 3.34) post-injection. Patient recollection of pre-injection symptoms was significantly more severe than actual (MD = 1.39, 95% CI 4.82 to 6.08). The magnitude of recall bias was moderate to severe and exceeded the minimal clinically important difference (MCID). Patient recollection of symptoms was also significantly more severe than actual at 24 hours (MD = 0.63, 95% CI -1.17 to -0.07), mild magnitude of bias that did not exceed MCID. No significant recall bias was noted on patient recollection of post-injection symptoms at 4 hours (MD = 0.41, 95% CI -1.05 to 0.23). Linear regression models for differences between actual and recalled pain scores reveal that for recall at 4 hours post-injection, older patients were better at recalling pain. CONCLUSIONS Relying on patient recollection does not provide an accurate measure of pre-injection status after lumbar epidural steroid injection, although patients did recall their 4 hour and 24-hour post-injection status. These findings support previous studies indicating that relying on patient recollection does not provide an accurate measure of pre-intervention symptoms. Patient recollection of post-intervention symptoms, however, may have some clinical utility and requires further study. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Study Design: This is a systematic review. Objective: To systematically review (1) the reliability of the physical examination of the spine using telehealth as it pertains to spinal pathology and (2) patient satisfaction with the virtual spine physical examination. Methods: We searched EMBASE, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2020. Eligible studies included those that reported on performing a virtual spine physical examination. Two reviewers independently assessed all potential studies for eligibility and extracted data. The primary outcome of interest was the reliability of the virtual spine physical exam. Secondary outcomes of interest were patient satisfaction with the virtual encounter. Results: A total of 2321 studies were initially screened. After inclusion criteria were applied, 3 studies (88 patients) were included that compared virtual with in-person spine physical examinations. These studies showed acceptable reliability for portions of the low back virtual exam. Patient satisfaction surveys were conducted in 2 of the studies and showed general satisfaction (>80% would recommend). Conclusions: These results suggest that the virtual spine examination may be comparable to the in-person physical examination for low back pain, though there is a significant void in the literature regarding the reliability of the physical examination as it pertains to specific surgical pathology of the spine. Because patients are overall satisfied with virtual spine assessments, validating a virtual physical examination of the spine is an important area that requires further research.

Study design A systematic review and meta-analysis. Objective The objective of this study was to compare surgical, clinical, and radiographic outcomes of 3-dimensional printed (3DP) drill guides to the fluoroscopic-guided, freehand placement of pedicle screws in the spine. Summary of background data 3DP is a budding technology in spine surgery and has recently been applied to patient-specific drill guides for pedicle screw placement. Several authors have reported the benefits of these drill guides, but no clear consensus exists on their utility. Materials and methods A comprehensive search of the literature was conducted and independent reviewers assessed eligibility for included studies. Outcomes analyzed included: total operation time, estimated blood loss, screw accuracy, pain score, Japanese Orthopedic Association score, and postoperative complications. Weighted mean differences (WMD) and weighted risk differences were calculated using a random-effects model. Results Six studies with a total of 205 patients were included. There were significantly lower operation times [WMD=-32.32 min, 95% confidence interval (CI)=-53.19 to -11.45] and estimated blood loss (WMD=-51.42 mL, 95% CI=-81.12 to -21.72) in procedures performed with 3DP drill guides as compared with freehand technique. The probability of "excellent" screw placement was significantly higher in 3DP guides versus freehand (weighted risk difference=-0.12, 95% CI=-0.17 to 0.07); however, no differences were observed in "poor" or "good" screw placement. There were no significant differences between groups in pain scores or Japanese Orthopedic Association scores. No difference in the rate of surgical complications was noted between the groups. Conclusions Pedicle screws placed with 3DP drill guides may result in shorter operative time, less blood loss, and a greater probability of excellent screw placement as compared with those placed with freehand techniques. We conclude that 3DP guides may potentially develop into an efficient and accurate option for pedicle screw placement. However, more prospective, randomized controlled trials are needed to strengthen the confidence of these conclusions. Level of evidence Level III.

In recent decades, the use of environmental indicators has become ubiquitous across the public, policy, and scientific spheres. Indicators provide information to guide decisions about environmental changes and leverage political power. In line with this special issue, I engage with how indicators are information dissemination interventions. I demonstrate that the reliance of indicators as key metrics for environmental governance should be treated with caution given that indicators are derived from a process of commensuration. This paper reviews some of the assumptions made in the development of indicators, and describes their use and efficacy in environmental governance. In doing so, I argue that there needs to be more careful attention to how environmental indicators are derived and deployed in place-based settings.

The field of therapeutic nuclear medicine is emerging rapidly as choice of treatment in oncology and other cellular malignancies. The growth of this branch of nuclear medicine is greatly facilitated by the introduction of a number of new radiopharmaceuticals and radionuclides. 90Y-radiopharmaceuticals have confirmed their worth in medical and clinical areas in a very short span of time. The 90Y is a radioisotope widely used for therapeutic purposes and considerable perfection has been made to understand the chemistry of 90Y-labeled radiopharmaceuticals. The development of these radiopharmaceuticals can be made favorable by using appropriate buffer, incubation period, optimal pH, specific activity and reaction temperature. In this review, we have discussed the preparation of range of 90Y transporting biological molecules such as antibodies radiolabeled peptides, antigens and microsphere with their clinical applications.

Summary Protected areas are the cornerstone of global conservation, yet financial support for basic monitoring infrastructure is lacking in 60% of them. Citizen science holds potential to address these shortcomings in wildlife monitoring, particularly for resource-limited conservation initiatives in developing countries – if we can account for the reliability of data produced by volunteer citizen scientists (VCS). This study tests the reliability of VCS data vs. data produced by trained ecologists, presenting a hierarchical framework for integrating diverse datasets to assess extra variability from VCS data. Our results show that while VCS data are likely to be overdispersed for our system, the overdispersion varies widely by species. We contend that citizen science methods, within the context of East African drylands, may be more appropriate for species with large body sizes, which are relatively rare, or those that form small herds. VCS perceptions of the charisma of a species may also influence their enthusiasm for recording it. Tailored programme design (such as incentives for VCS) may mitigate the biases in citizen science data and improve overall participation. However, the cost of designing and implementing high-quality citizen science programmes may be prohibitive for the small protected areas that would most benefit from these approaches. Synthesis and applications. As citizen science methods continue to gain momentum, it is critical that managers remain cautious in their implementation of these programmes while working to ensure methods match data purpose. Context-specific tests of citizen science data quality can improve programme implementation, and separate data models should be used when volunteer citizen scientists' variability differs from trained ecologists' data. Partnerships across protected areas and between protected areas and other conservation institutions could help to cover the costs of citizen science programme design and implementation.

In this review, the author discusses how pastoralism, and its many constituent components, is increasingly being recognised as in tune with the changing political and ecological nature of rangelands. He describes ways in which the literature reflects this changing attitude, outlines how rangelands respond to changes in climate and explores the evolving use of livestock resources. In addition, he describes the growing recognition of factors other than livestock density that affect rangeland vegetation (i.e. density-independent relationships). The author explains how terms such as 'carrying capacity', 'overgrazing' and 'desertification' are often taken out of their social and political context when describing rangeland pastoralism. Next, he describes the growing recognition by the development community of the importance of the mobility model, particularly in relation to changing ecologies and politics. Finally, he outlines how labour, a central focus of pastoral herd management, is a fluid component of pastoral systems in response to changing political and ecological circumstances.

Prior efforts to conserve biodiversity in sub-Saharan Africa have resulted in numerous human rights failures. In an attempt to move beyond this troublesome past, new initiatives increasingly consider the participation of local peoples in the conservation and development process. Part of this movement has resulted in the creation of “new” conservation areas carved out of former communal areas, which ostensibly provide better social and economic benefits of wildlife to local people who reside around protected areas. A concurrent shift from communal to individual land tenure has attracted the attention of investors who seek to create private conservation spaces (i.e. conservancies) outside neighboring state management protected areas. These investors invoke neoliberal tenets where privatization and market exchange are presumed to hold the key to the sustainability of people, wildlife, and livestock in a fragile ecosystem. By drawing on a case study from southern Kenya, I demonstrate that such initiatives dispossess people by: 1) relying on coercive tactics on land leasing, and 2) discounting the geographies of indigenous resource use, access, and control. In particular, I highlight how the resource managers fail to adequately consider the varied spatiality and temporality of local livelihood production systems and how the land leasing process is fraught with difficulties. I argue that dispossession leads to the further displacement and marginalization of local people, and hampers the sustainability of people, livestock, and wildlife in dry lands.

Environmental categories are simplifications of reality meant to enable generalization, which is necessary to produce predictive physical geographic knowledge. We argue here that these categories are social constructions related to ideas shared broadly in society, including environmental deterministic explanations of human difference. The biophysical, philosophical, and sociocultural problems associated with environmental categories are exemplified by ‘savanna’ in Africa. Examining environmental categorization is an important point of engagement in critical physical geography because it is a social process, explicitly centered on simplification and generalization, and significant broadly across scientific practice and society.

The foraging ecologies of reticulated giraffe (Giraffa camelopardalis reticulata) and domestic camels (Camelus dromedarius) were examined in the Laikipia District of Kenya, where these species have recently become sympatric. Camels increased popularity in the region has lead to concerns about their environmental impacts and possible competition with wild giraffe for resources. We gathered foraging data on both species using 2-min group scans that recorded feeding heights and plant food preferences. Transects sampled the vegetation in areas where foraging observations were recorded. Giraffe females feed at lower elevations than males, while female camels feed below both sexes of giraffe. There was very little observed overlap in food preferences between the species. However, habitat type has an effect on foraging ecologies of both giraffe sexes, but habitat did not influence camel foraging. Camel herder husbandry techniques also influence camel foraging dynamics. These findings have important implications in achieving the twin objectives of wildlife conservation and pastoralist livestock production in northern Kenya. Resume L'ecologie alimentaire de la girafe reticulee (Giraffa camelopardalis reticulata) et celle du dromadaire (Camelus dromedarius) ont ete etudiees dans le District de Laikipia, au Kenya, ou ces especes sont recemment devenues sympatriques. La popularite croissante des dromadaires dans la region a suscite des inquietudes au sujet des impacts sur l'environnement et d'une eventuelle competition pour les ressources avec les girafes sauvages. Nous avons recolte des donnees sur l'alimentation des deux especes au moyen de scan de groupe de deux minutes, qui enregistraient la hauteur a laquelle les animaux mangeaient et les plantes preferees. Des transects ont permis de recolter des echantillons de vegetation dans les zones ou les observations alimentaires ont ete faites. Les girafes femelles se nourrissent plus bas que les mâles et les dromadaires femelles se nourrissent plus bas que les girafes des deux sexes. Nous avons observe tres peu de recouvrement des preferences alimentaires des deux especes. Le type d'habitat a un effet sur l'ecologie alimentaire des girafes des deux sexes mais il n'influence pas l'alimentation des dromadaires. Les techniques d'elevage des dromadaires influencent aussi la dynamique alimentaire des dromadaires. Ces resultats ont d'importantes implications pour atteindre le double objectif de la conservation de la faune sauvage et de la production d'un betail pastoral dans le nord du Kenya.

Over the last decade, the number of people who rely on mobile phones in sub-Saharan Africa has grown rapidly. The ubiquity of mobile phones in rural livestock communities is thought to “transform” or “revolutionize” the way different social groups interact as they manage social, political and environmental challenges to their livelihood strategies. This research among pastoralists in Kenya examines the political, economic, ecological and socio-spatial contexts in which mobile phones are used and places these contexts within pre-existing resource struggles in order to understand the prevalence of mobile phone use among pastoralists. Results indicate that, while the use of mobile phones for herding is widespread, the extent and efficacy of information sharing is strongly influenced by pre-existing social struggles to gain access to prohibited grazing locations.

A new approach was developed to evaluate the implications of the spatiotemporal variability of green vegetation for the dispersion of livestock that is required to access quality forage in semi-arid Africa. Maximum NDVI (Normalized Difference Vegetation Index) at 1 km2 resolution was determined for concentric rings (0–31 km radii) around 227 individual sample locations within the study area for 14 dates (between 1 April to 1 November) annually over the 2000–2010 period. A sigmoidal curve was fitted to points within the maximum NDVI × distance radii space to determine the asymptote distance (AD) – the radius at which further dispersion from the sample location does not lead to significant gains in access to green forage. AD was found to: increase with latitude (or increasing aridity); decline as the rainy season proceeds; and show no trend over the 2000–2010 period. These results introduce much-needed empirical data to current debates surrounding the scales of governance to support livestock mobility.

Across the world, the presence of domestic animals in protected areas (PAs) is considered an ‘incursion’ that threatens the economic and ecological viability of these areas. Dominant narratives about incursions inaccurately describe the relationships between people and PAs because they lack adequate contextualization. In this paper, I rely on a political-ecological framework to argue for an alternative narrative. Through a case study from a PA in southern Kenya, I demonstrate how incursions are instead modern co-productions that arise from the intersections between changing political geographies of resource control and variable animal geographies of resource utilization – thus clarifying a longstanding debate about the presence of domestic animals in PAs. I rely on direct empirical and supporting evidence from place-based studies to illustrate the spatial and temporal differences in resource access strategies of wildlife and livestock within and outside the PA. I contrast these against changing land tenure and resource management policies to highlight how livestock movements into PAs are patterned in ways that reflect the changing nature of PA management, the material conditions of the landscape, and the agency of animals. Through these investigations, this paper provides a more accurate and nuanced explanation for livestock movements into PAs. RESUME: Partout dans le monde, la presence d’animaux domestiques dans les zones protegees (ZP) est consideree comme une « incursion » qui menace la viabilite economique et ecologique de ces zones. Les recits dominants sur les incursions decrivent de maniere inexacte les relations entre les populations et les ZP par manque de contextualisation adequate. Dans cet article, l’auteur s’appuie sur un cadre politico-ecologique pour faire valoir un autre recit. A travers l’etude de cas d’une ZP dans le sud du Kenya, l’auteur demontre que les incursions sont plutot des coproductions modernes resultant des intersections entre des geographies politiques changeantes de controle des ressources et des geographies animales variables d’utilisation des ressources, clarifiant par la-meme un debat de longue date sur la presence d’animaux domestiques dans les ZP. Il s’appuie sur des elements probants empiriques directs tires d’etudes sur place pour illustrer les differences spatio-temporelles de strategies d’acces aux ressources de la faune et du betail a l’interieur et a l’exterieur de la ZP. Il les met en contraste avec les politiques changeantes en matiere de foncier et de gestion des ressources pour souligner que les schemas de mouvements de betail vers les ZP refletent la nature changeante de la gestion des ZP, des conditions materielles du paysage et de l’action des animaux. A travers ces etudes, l’article fournit une explication plus exacte et nuancee des mouvements de betail vers les ZP.

This paper focuses on a conundrum that has dominated the literature on pastoral mobility and institutions in dryland regions of the world, where livestock production is the main livelihood system. High spatiotemporal variability of rainfall and forage resources are seen to require flexible rules and porous social boundaries to facilitate pastoral mobility—characteristics that run counter to conventional views of the requirements for effective common property institutions. We seek to explore this paradox by investigating the spatiotemporal variability of forage availability (using satellite derived vegetation indices as a proxy for green forage) in four transhumance zones (“transhumance sheds”) in Mali, West Africa. For each transhumance shed, three characteristics with important institutional implications are evaluated over an eleven-year period between 2000 and 2010: the inter-annual variability of forage phenology, seasonal changes in connectivity of green forage patches, and the degree to which key forage locations exist in the form of consistently early green-up and/or late senescence. Periods of vegetation green-up and senescence, which determine the timing of transhumant livestock movements, are found to be sufficiently regular from year to year to be governed by conventional institutions. Seasonal changes in the north-south connectivity of green patches are sufficiently rapid for customary systems of sharing of pasture information to be effective (rather than more technologically sophisticated systems of pasture information). Moreover, transhumance sheds contain key pastoral forage sites, which because of their consistently early greening or late senescence, are strong candidates for territorial protection from alternative land uses such as agriculture. These findings support local herders’ views of transhumance as composed of regular patterns of herd movements along prescribed corridors between key pastoral sites. The seasonal regularity of key pastoral resources has been obscured by an overemphasis on environmental unpredictability that characterizes dryland systems at certain spatial and temporal scales. This paper suggests that policies directed at improving pastoral resource governance must focus instead on securing pastoralists’ access rights to movement corridors, specific pastures and water points.

Degenerative lumbar spinal stenosis (LSS) and lumbar spondylolisthesis (DS) can lead to significant disability and impaired quality of life. In select patients with predominantly leg-dominant symptoms that have exhausted nonoperative treatment, surgical treatment can provide significant improvement in symptoms. The present paper reviews the clinical evaluation, radiographic findings, and surgical decision making of both spinal stenosis and degenerative spondylolisthesis using the current best available evidence.

BACKGROUND CONTEXT Three-dimensional printing (3DP) is a budding technology in spine surgery. Initially utilized for preoperative planning using 3DP biomodels, the technology has recently been applied to 3DP drill guides for pedicle screw placement. Several authors have demonstrated the benefits of these drill guides on operative, clinical and radiographic outcomes in the last three years. Though still in its infant stages, additive manufacturing has shown immense promise. The technology's accessibility and customization may help to reduce the cost, complexity and, often, patient-specific needs of spine surgery. PURPOSE To determine surgical, clinical and radiographic outcomes of 3DP drill guides as compared to fluoroscopic-guided freehand placement of pedicle screws in cervical, thoracic and lumbar spine. STUDY DESIGN/SETTING Systematic review and meta-analysis. OUTCOME MEASURES Total operation time, estimated blood loss, screw accuracy (as measured using the Richter grading scale), pain score, Japanese Orthopedic Association (JOA) score, and postoperative complications. METHODS A comprehensive search of the literature was conducted using Ovid MEDLINE, Embase and Scopus, which resulted in 1,801 unique articles. Two independent reviewers (NW, BB) assessed eligibility and risk of bias for included studies. Weighted mean differences (WMD), standardized mean differences (SMD) and risk reduction (RR) were calculated for pooled data using a random-effects model. RESULTS Seven studies with a total of 208 patients were included in the meta-analysis. Operation time (WMD: −24.62min [95% CI: −36.91, −12.33]) and estimated blood loss (WMD: −51.42 ml [95% CI: −81.12, −21.72]) were significantly lower in procedures performed with 3DP drill guides as compared to freehand technique. In addition, probability of “excellent” screw placement was significantly higher in 3DP guides vs freehand (RR: −0.13 [95% CI: −0.18, −0.08]); however, no differences were observed in “poor” and “good” screw placement. There was no significant difference between 3DP and freehand groups in pain scores or JOA scores at baseline and one-year follow-up. There was also no group difference in rates of postoperative complications. CONCLUSIONS This meta-analysis indicates that pedicle screws placed with 3DP drill guides result in shorter operative time, less blood loss and greater probability of excellent screw placement as compared to pedicle screws placed with the traditional freehand technique. Similar clinical outcomes and postoperative complication rates were seen in both groups. We conclude that 3DP drill guides can offer a more efficient and accurate option for pedicle screw placement in challenging spinal anatomy. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The gamma radiation-induced degradation of environmental pollutant methoxychlor in water was investigated. A 60Co gamma radiation source with a dose rate of 372 Gy h−1 was used for gamma irradiation of 1 mg L−1 and 10 mg L−1 methoxychlor in water with a varied absorbed dose of 1–5 kGy. A single step clean up and pre-concentration procedure based on solid phase micro-extraction was optimized. The extent of radiolytic degradation was monitored by reversed phase HPLC-UV and GC-ECD. The trace and ultra trace level degradation products were identified using GC-MS-SPME by comparing their mass spectra with the NIST 98 m mass spectral library. Most of the generated products for 4 kGy dose are substituted chlorophenols. The reaction pathways of these substituted chlorophenols and benzophenone formation are also proposed. However, generated chlorophenols disappeared along with methoxychlor for an absorbed dose of 5 kGy. The attained degradation of methoxychlor is ∼ 95% that reflects the potential use of ionization radiation for wastewater treatment.

The article describes the electrochemical fabrication of modified lead dioxide (PbO2) electrodes through a simple but efficient electrodeposition method. One of the goals was to assess the properties of the modified PbO2 as an electroanalytical electrode. A second objective was its use in bulk electrolysis against persistent organic pollutants in water. PbO2 was deposited galvanostatically at a current density of 10 mA cm−2 over the as-obtained and anodized Pd/Ag alloy substrate at 10 V. The electroanalytical studies of the modified PbO2 showed satisfactory electrochemical activity for ferrocene compared to that on commercial glassy carbon. The modified PbO2 electrode having an area of 4 cm2 was employed to eradicate phenol and 2-nitrophenol from water samples. 2-Nitrophenol was completely removed (99 %) and phenol (>50 %) was partially removed by bulk electrolysis at the optimized current density of 20 mA cm−2 for 3 h. Incomplete degradation in the latter case was due to the adsorption of electrochemically generated intermediates. The degradation monitoring was performed by cyclic voltammetry, UV–vis spectroscopy, and HPLC methods and the results were in good agreement with each other. The assays and morphological studies by SEM revealed the role of Nafion in the modified PbO2 electrode for efficient degradation of phenols through the bulk electrolysis.

Phenol and its three chloro derivatives were electrooxidized on glassy carbon electrode under optimized conditions of concentration, number of repeated scans, scan rate, and pH of the medium. Next, the aqueous solutions of the phenols were degraded under controlled dose of gamma (γ) radiations in the range of 1–5 kGy. The post γ-irradiated phenols were investigated by cyclic voltammetry (CV) and the response was quantitated in terms of radiolytic yields (G values) and degradation efficiencies. The calculated theoretical charge densities were also in support of phenols degradation via hydroxyl radical attack. The proposed use of CV as a new monitoring method for the degradation of organic pollutants was validated with the well-established HPLC method.