Unusual presentation: fracture neck femur in 18 months old child

An 18 months old child was brought to the emergency department with alleged history of trauma due to hit by two wheeler and sustained injury over right hip. Child was not able to move the right lower limb. Physical examination of child revealed contusion over right hip region and injury over perineal region. There was no active vaginal bleeding. Rest of the systemic examination was normal. Routine blood was normal. On X-ray of pelvis with both hip showed fracture of neck femur on right side without any pelvic injury. Patient was treated with hip spica cast and complete bed rest for 1 month. After 1 month of the treatment, on follow-up the patient was able to weight bear and fractured was united on X-ray

Pharmacy-Student Outreach: Bridging the Gap from an Inner-City High School to Pharmacy School

A poster describing a program at Thomas A. Edison High School that aimed to educate students on the educational requirements for pharmacy school and career opportunities within the profession

Implementing a Substances of Abuse Outreach Program in the Rochester City School District.

Objective: This program aims to provide substances of abuse education to local high school students. Methods: An outreach program, modeled after the National Institute on Drug Abuse instructional materials, was developed by student pharmacists and faculty for delivery to the Rochester City School District. Strict regulations prevented admittance into any classrooms until the program was presented to all health teachers at a district-wide meeting. Approval was given to begin working in the classrooms in April 2011. The program was first adopted in two health education classes at Edison Tech (May 2011). Information was presented to students using lecture, small group discussion, and printed materials. The topic covered, marijuana, was based on the teacher\u27s preference. A formative assessment was used to address student perceptions of the program due to the small number of students in each of the classes (n = 5–7). The teacher of record in the classroom conducted the assessment interviews. Results: Student feedback included comments such as, “We liked them and appreciate the time they took to come in,” “I didn\u27t know about pharm parties” and, “I learned a lot”. Feedback from the teacher also reflected the positive impact of the program in his classroom: “There is a perception that the outside community does not care about urbanites and this program at the very root reverses that dynamic very clearly. My hope is that we can develop an ongoing relationship.” Conclusion: The timing of program approval by the school district impeded broad implementation for spring 2011; however, plans are in place for several schools in spring 2012. The opportunity to pilot the program with Edison Tech was beneficial and provided valuable feedback for improvement. Student pharmacists are in a unique position to provide this education and are viewed as approachable and non-threatening to high school–aged students

Orthopaedic aspect of anatomy and radiology of proximal femur

Femoral pathology is common in relation to the orthopedic. There is complex anatomy of the proximal femur and hip joint. So, its knowledge regarding anatomy and radiological correlation is necessary to the well-known fact for the orthopedics for the routine day to day practice. This review article briefly illustrates important anatomical and radiological aspect of the proximal femur

Adapting to domiciliary non-invasive ventilation in chronic obstructive pulmonary disease:a qualitative interview study

Background: Domiciliary non-invasive ventilation may be used in palliative care of patients with chronic obstructive pulmonary disease, although there is uncertainty regarding effect on quality of life. Aim: Explore experiences of domiciliary non-invasive ventilation in chronic obstructive pulmonary disease, to understand decision-making processes and improve future palliative care. Design: Qualitative interview study, based on constructivist grounded theory, and using the framework method for data management and analysis. Participants: 20 chronic obstructive pulmonary disease patients, 4 carers and 15 healthcare professionals. Results: Most patients had very severe chronic obstructive pulmonary disease. Data were categorised into four domains – clinical, technical, socio-economic and experiential. Healthcare professionals felt uncertain regarding clinical evidence, emphasising social support and tolerance as deciding factors in non-invasive ventilation use. Conversely, patients reported symptomatic benefit, which generally outweighed negative experiences and led to continued use. Healthcare professionals felt that patients chose to be on non-invasive ventilation; however, most patients felt that they had no choice as healthcare professionals recommended non-invasive ventilation or their poor health mandated it. Conclusions: Our study identifies ‘adapting to non-invasive ventilation’ as the central process enabling long-term use in palliative care, although the way in which this is approached by healthcare professionals and patients does not always converge. We present ideas emerging from the data on potential interventions to improve patient experience and adaptation. </jats:sec

Diabetic foot ulcer and its surgical management

Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years.  Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer

Protocol for a systematic review and economic evaluation of the clinical and cost-effectiveness of non-hospital-based non-invasive ventilation (NIV) in patients with stable end-stage COPD with hypercapnic respiratory failure

BACKGROUND: Chronic obstructive pulmonary disease (COPD) remains a significant public health burden. Non-invasive ventilation (NIV) is a method of supported breathing used as standard care for acutely unwell patients in hospital with COPD, but there is uncertainty around the potential benefits of using NIV in the treatment of stable patients in a non-hospital setting. This is a protocol for systematic reviews of the clinical and cost-effectiveness of NIV in this context, being undertaken in support of a model based economic evaluation. METHODS/DESIGN: Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction for both the clinical and economic systematic reviews. Bibliographic databases (for example MEDLINE, EMBASE) and ongoing trials registers will be searched from 1980 onwards. The search strategy will combine terms for the population with those for the intervention. Studies will be selected for review if the population includes adult patients with COPD and hypercapnic respiratory failure, however defined. Systematic reviews, randomised controlled trials and observational studies (with n >1) will be included, and quality assessment will be tailored to the different study designs. The primary outcome measures of interest are survival, quality of life, and healthcare utilisations (hospitalisation and Accident and Emergency attendances). Meta-analyses will be undertaken where clinical and methodological homogeneity exists, supported by predefined subgroup analyses where appropriate. A systematic review of the evidence on the cost-effectiveness of non-hospital NIV will be completed, and a model-based cost-utility analysis undertaken to determine the cost-effectiveness of non-hospital-based NIV compared with standard care. DISCUSSION: These reviews will attempt to clarify the clinical effectiveness of non-hospital NIV in COPD patients as well as the cost-effectiveness. The findings may indicate whether NIV in a non-hospital setting should be considered more routinely in this patient group, and what the likely cost implications will be. PROSPERO REGISTRATION: 2012:CRD42012003286

Parallelization and performance-tuning: Automating two essential techniques in the multicore era

In today’s multicore era, parallelization of serial code is essential in order to exploit the architectures’ performance potential. Parallelization, especially of legacy code, however, proves to be a challenge as manual efforts must either be directed towards algorithmic modifications or towards analysis of computationally intensive sections of code for the best possible parallel performance, both of which are difficult and time-consuming. Automatic parallelization uses sophisticated compile-time techniques in order to identify parallelism in serial programs, thus reducing the burden on the program developer. This work considers the implementation of important parallelization techniques such as Data dependence analysis and advanced Points-to and Alias analysis in a source-to-source parallelizing compiler, Cetus. Auto-parallelization results are provided across a set of benchmarks from the NAS Parallel and SPEC OMPM2001 suites. A key difficulty in using automatic parallelization, however, is that optimizing compilers are generally unable to estimate the performance of an application or even a program section at compile-time, and so the task of performance improvement invariably rests with the developer. Automatic tuning uses static analysis and runtime performance metrics to determine the best possible compile-time approach for optimal application performance. This work describes an offline tuning approach that uses Cetus with an additional tuning framework to tune parallel application performance. An existing, generic tuning algorithm called Combined Elimination is used to study the effect of serializing parallelizable loops based on measured whole program execution time. The outcome is a combination of parallel loops that ensures to equal or improve performance over the original program. The results from the autotuning approach are compared against hand-parallelized C benchmarks from the SPEC OMPM2001 and NAS Parallel suites. The auto-parallelized and auto-tuned versions are close to serial performance or better than serial in most cases and always out-perform state-of-the-art parallelizers such as Intel’s ICC. Additional parallelization techniques and more extraction of beneficial parallelism can help improve the tuning results further

The Cetus Source-to-Source Compiler Infrastructure: Overview and Evaluation

This paper provides an overview and an evaluation of the Cetus source-to-source compiler infrastructure. The original goal of the Cetus project was to create an easy-to-use compiler for research in automatic parallelization of C programs. In meantime, Cetus has been used for many additional program transformation tasks. It serves as a compiler infrastructure for many projects in the US and internationally. Recently, Cetus has been supported by the National Science Foundation to build a community resource. The compiler has gone through several iterations of benchmark studies and implementations of those techniques that could improve the parallel performance of these programs. These efforts have resulted in a system that favorably compares with state-of-the-art parallelizers, such as Intel’s ICC. A key limitation of advanced optimizing compilers is their lack of runtime information, such as the program input data. We will discuss and evaluate several techniques that support dynamic optimization decisions. Finally, as there is an extensive body of proposed compiler analyses and transformations for parallelization, the question of the importance of the techniques arises. This paper evaluates the impact of the individual Cetus techniques on overall program performance