Primary treatment of type B post-axial ulnar polydactyly: A systematic review and meta-analysis

Optimal management of pedunculated ulnar polydactyly is not defined. This systematic review summarises objective and patient-reported outcomes following primary treatment. Two authors screened articles for inclusion according to a PROSPERO published protocol. The meta-analysis of adverse events was performed, and a narrative synthesis of satisfaction and patient-reported outcomes was reported. The risk of bias was assessed using Cochrane's ROBINS-I tool. Of 1650 articles identified, 15 were eligible, including 13 single-arm and 2 multi-arm studies. Complications were 6 times as likely with ligation procedures (22%), compared to surgical removal (1%) whether this was performed in the outpatient setting or operating theatre (OR 6.89 [95% CI 1.73, 27]). Parent-reported satisfaction was high for all treatments. Studies were at high risk of bias and low methodological quality. Outcome measurement and follow-up were heterogenous. Well-designed prospective observational and experimental studies are required to inform practice, incorporating clinician and parent-reported outcomes and economic analyses

An integrated organic farming system: innovations for farm diversification, sustainability, and livelihood improvement of hill farmers

IntroductionOrganic farming is a promising solution for mitigating environmental burdens related to input-intensive agricultural practices. The major challenge in organic agriculture is the non-availability of large quantities of organic inputs required for crop nutrition and sustaining soil health, which can be resolved by efficient recycling of the available on- and off-farm resources and the integration of the components as per the specific locations.MethodsAn integrated organic farming system (IOFS) model comprising agricultural and horticultural crops, rainwater harvesting units, livestock components, and provisions for nutrient recycling was developed and disseminated in the adopted organic villages Mynsain, Pynthor, and Umden Umbathiang in the Ri-Bhoi District, Meghalaya, India, to improve the income and livelihood of farmers. Harvested rainwater in farm ponds and Jalkunds was used for live-saving irrigation in the winter months and diversified homestead farming activities, such as growing high-value crops and rearing cattle, pigs, and poultry.ResultsMaize, french bean, potato, ginger, tomato, carrot, and chili yields in the IOFS model increased by 20%−30%, 40%−45%, 25%−30%, 33%−40%, 45%−50%, 37%−50%, and 27%−30%, respectively, compared with traditional practices. Some farmers produced vermicompost in vermibeds (made of high-density polyethylene) and cement brick chambers, generating 0.4−1.25 tons per annum. Two individual farmers, Mr. Jrill Makroh and Mrs. Skola Kurbah obtained net returns (without premium price) of Rs. 46,695 ± 418 and Rs. 31,102 ± 501 from their respective 0.27- and 0.21-ha IOFS models, which is equivalent to Rs. 172,944 ± 1,548/ha/year and Rs. 148,105 ± 2,385/ha/year, respectively. The net returns obtained from the IOFS models were significantly higher than those obtained from the farmers' practice of maize-fallow or cultivation of maize followed by vegetable (~30% of the areas). It is expected that, with the certification of organic products, the income and livelihood of the farmers will improve further over the years. While Mr. Jrill Makroh's model supplied 95.1%, 82.0%, and 96.0% of the total N, P2O5, and K2O, respectively, needed by the system, Mrs. Skola Kurbah's model supplied 76.0%, 68.6%, and 85.5% of the total N, P2O5, and K2O, respectively.DiscussionThus, IOFS models should be promoted among hill farmers so that they can efficiently recycle farm resources and increase their productivity, net returns, and livelihood while reducing their dependence on external farm inputs

International lower limb collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures

Trauma remains a major cause of mortality and disability across the world1, with a higher burden in developing nations2. Open lower extremity injuries are devastating events from a physical3, mental health4, and socioeconomic5 standpoint. The potential sequelae, including risk of chronic infection and amputation, can lead to delayed recovery and major disability6. This international study aimed to describe global disparities, timely intervention, guideline-directed care, and economic aspects of open lower limb injuries

Broad-Band Activatable White-Opsin

The authors would like to thank C. Cote and K. Dhakal (UTA) for help during initiation of the project. SM would like to thank K. Deisseroth (Stanford University) for ChR2 and C1V1 plasmids, and J. Lin (UCSD) for the ReaChR construct.Currently, the use of optogenetic sensitization of retinal cells combined with activation/inhibition has the potential to be an alternative to retinal implants that would require electrodes inside every single neuron for high visual resolution. However, clinical translation of optogenetic activation for restoration of vision suffers from the drawback that the narrow spectral sensitivity of an opsin requires active stimulation by a blue laser or a light emitting diode with much higher intensities than ambient light. In order to allow an ambient light-based stimulation paradigm, we report the development of a ‘white-opsin’ that has broad spectral excitability in the visible spectrum. The cells sensitized with white-opsin showed excitability at an order of magnitude higher with white light compared to using only narrow-band light components. Further, cells sensitized with white-opsin produced a photocurrent that was five times higher than Channelrhodopsin-2 under similar photo-excitation conditions. The use of fast white-opsin may allow opsin-sensitized neurons in a degenerated retina to exhibit a higher sensitivity to ambient white light. This property, therefore, significantly lowers the activation threshold in contrast to conventional approaches that use intense narrow-band opsins and light to activate cellular stimulation.Yeshttp://www.plosone.org/static/editorial#pee

Surgeons opinions of legal practice in bile duct injury following cholecystectomy

Introduction Litigation for bile duct injury (BDI) following laparoscopic cholecystectomy (LC) places financial strain on the health service, causes significant patient morbidity and adversely affects both the patient and the surgeon. Claimants argue that the injury itself is evidence of negligence. Methods A questionnaire addressing the views on BDI causation was sent to 273 members of the AUGIS working in the National Health Service, UK. A grounded theory was used. Response themes and responses were compared between groups of surgeons. Results Of 117 respondents, 45 % experienced BDI and 22% had medicolegal experience. 47% of respondents identified factors outside the surgeons control as being relevant to BDI. Those that had experienced BDI from their own surgery were less likely to identify surgeon/systems errors as the primary cause for BDI than those that had not (34% vs 74% p Conclusions A significant number of experienced surgeons indicated that BDI following LC should not be assumed to result from surgeon negligence or institutional failure. This suggests that negligence should not be inferred from the act of BDI alone.</p

Surgeons opinions of legal practice in bile duct injury following cholecystectomy

Introduction Litigation for bile duct injury (BDI) following laparoscopic cholecystectomy (LC) places financial strain on the health service, causes significant patient morbidity and adversely affects both the patient and the surgeon. Claimants argue that the injury itself is evidence of negligence. Methods A questionnaire addressing the views on BDI causation was sent to 273 members of the AUGIS working in the National Health Service, UK. A grounded theory was used. Response themes and responses were compared between groups of surgeons. Results Of 117 respondents, 45 % experienced BDI and 22% had medicolegal experience. 47% of respondents identified factors outside the surgeons control as being relevant to BDI. Those that had experienced BDI from their own surgery were less likely to identify surgeon/systems errors as the primary cause for BDI than those that had not (34% vs 74% p&lt;0.001). Medicolegal expert surgeons were more likely to report that substandard technique should be presumed (50% vs 19%, p=0.002), however, 25% of medicolegal experts indicated that not all BDIs caused by their own surgery could have been avoided. Conclusions A significant number of experienced surgeons indicated that BDI following LC should not be assumed to result from surgeon negligence or institutional failure. This suggests that negligence should not be inferred from the act of BDI alone.</p