Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice

BACKGROUND: The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. MATERIALS AND METHODS: Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. RESULTS: A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ (2) (1, N = 512) = 0.10, p = 0.757]. CONCLUSIONS: Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable. LEVEL OF EVIDENCE: III

CRITICAL THINKING SKILL OF STUDENT THROUGH TOP DOWN APPROACH IN PHYSICS LEARNING

This article was a research which describes student’s critical thinking skills in learning physics through top down approach. In top down approach, student learned how to solve a challenge which was given by a teacher in classroom. To finish the challenge, student identified physical quantities which they need to solve it. After they had identified the quantities, they thought how to collect data then they conduct an experiment to find it. The experiment result was used to conclude the answer of the challenge. Learning by top down approach guided the student in thinking processes. They learn from the challenge and identify what they need to solve it. They learn how to analyze the data and conclude it as an evidence to answer the challenge. The test of critical thinking skills showed that the students were some proficiency where they able to identify data and information that counts as evidence but fault to thoroughly evaluate its credibility.Keywords: top down approach, critical thinking skills

Birmingham Mid-Head Resection Periprosthetic Fracture.

Total hip arthroplasty in the young leads to difficult choices in implant selection. Until recently bone conserving options were not available for younger patients with deficient femoral head bone stock. The novel Birmingham Mid-Head Resection (BMHR) device offers the option of bone conserving arthroplasty in spite of deficient femoral head bone stock. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. It is unknown whether this remains to be the case for the BMHR neck preserving implants. We report a case of a 57-year-old male, who sustained a periprosthetic fracture following surgery with a BMHR arthroplasty. This paper illustrates the first reported case of a BMHR periprosthetic fracture. The fracture pattern is spiral in nature and reaches to the subtrochanteric area. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem. We have illustrated the surgical technique to manage this rare complication

Relationship Between Surfactant and Population of Heterotrophic Bacteria in Estuary of Dumai River Dumai City Riau Province

This research was conducted on April 2017. Sampling was conducted in estuary of Dumai River, Dumai City, Riau Province. A study aims to determine the relationship between concentration of surfactant and population of heterotrophic bacteria in the estuary waters of Dumai River Dumai City Riau Province. Sampling was done at 6 sampling points (stations). The analysis of surfactant concentration was conducted at the Chemical Laboratory of the Sea and the total analysis of heterotrophic bacteria at the Marine Microbiology Laboratory of Department of Marine Science Faculty of Fisheries and Marine University of Riau, Pekanbaru. The results showed that the highest concentration of surfactant was found at Station 5 (0.8538 mg / l) and the lowest at Station 1 (0.2025 mg / l). Then, the logarithm of the highest average total colony was found at Station 1 (6.18 cells / ml) while the lowest at Station 5 (5.66 cells / ml). The correlation concentration models of surfactant with the total colony using regression was negative correlation Y = 6.3745 - 0.7882 (X), R2 = 0.8622, r = 0.9285 showed that the value of surfactant concentration (X) increased by 1 unit will decrease the total of colony (Y) was 0,7882 cells/ml, with the effect of surfactant to bacteria equal 85% and the level of closeness of the relationship was 93%

DAMPAK PEMBELAJARAN DARING TERHADAP HASIL BELAJAR SISWA SD INPRES 6 LOLU

The aims of this study are, (1) To find out how the implementation of learning in class II SD Inpres 6 Lolu, (2) To find out the benefits of learning from class II SD Inpres 6 Lolu, (3) To find out what efforts are being made by the school during the brave learning in class II SD Inpres 6 Lolu so that the learning process continues. This type of research is a qualitative research with a descriptive approach. Sources of data or research subjects were the principal, teachers, and second grade students of SD Inpres 6 Lolu. The number of students is 28 people. Data collection was done by interview and documentation. The informants in this interview were the principal, and the homeroom teacher for class II SD Inpres 6 Lolu. Based on the results of research conducted in class II SD Inpres 6 Lolu can guarantee the implementation of courageous learning in accordance with applied educational standards and have a good impact on student learning outcomes. Student learning outcomes during bold learning have increased. This is evidenced at the time before learning dared to obtain classical learning completeness of 85.7%. After the implementation of online learning, the classical learning completeness is 100%. Various efforts have been made by the school so that bold learning continues. Such efforts include facilitating the learning process by providing data packages, textbooks, and modules

INCREASING ABILITY READING THE UNDERSTANDING OF STUDENTS IN CLASS V SD KRANJINGAN 05 JEMBER THROUGH COOPERATIVE MODEL TYPE TPS

Based on preliminary observations carried out by researchers at SD Kranjingan 05 Jember, it shows that the learning process of reading is still done individually. Weaknesses in individual learning, can be overcome by using a type of cooperative learning model. Improving the process and reading comprehension results are the main objectives of this research. The process of reading comprehension includes aspects of planning and implementation. While reading comprehension results, refer to the evaluation of learning. The method used in this study is the classroom action research method. The target in this research is fifth grade elementary school students. Kranjingan 05 Jember, which is divided into 15 couples. The study was conducted in two cycles. The results of the study using the type of TPS cooperative learning model showed that students' reading comprehension skills improved with the acquisition of test scores obtained by students in each group in the first cycle 69.6% and the second cycle 80.8%. This shows that in the second cycle the test score increased and had reached the target of the KKM of 75%

Dielectric properties of PbSrWO4 and PbBaWO4 compounds

PbSrWO4 and PbBaWO4 have been synthesised by the solid state reaction technique XRD patterns show them to be tetragonal. Dielectric constant (K/) and Dielectric loss (K//) of PbSrWO4 and PbBaWO4 have been measured at 1 kHz in the temperature range of 300 to 1050 K. The log K/ vs T as well as log K// vs T plot of PbSrWO4 and PbBaWO4 shows rapid increase of dielectric constant above 590 K and 640 K, respectively.Author Affiliation: S V Singh, A N Thakur, O P Singh, S C Kumar and Aqil Ahmad 1.Department of Physics, T D Post Graduate College Jaunpur-222 002, Uttar Pradesh, India E-mail : [email protected] of Physics, T D Post Graduate College Jaunpur-222 002, Uttar Pradesh, Indi