Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study

In India, cardiovascular disease (CVD), with hypertension as its foremost risk factor, has the highest prevalence rate of non-communicable diseases (NCDs) and a rising mortality. Previous research has found a clustering of behavioural and social risks pertaining to NCDs, though the latter are infrequently addressed in public health interventions in India. This paper reaches toward the development of a social intervention to address social determinants of NCD relating to hypertension and diabetes. We used Theory of Change (ToC) as a theoretical approach to programme design. Mixed methods were used, including qualitative interviews with community members (n = 20), Accredited Social Health Activists (n = 6) and health professionals (n = 8), and a stakeholder workshop (n = 5 participants). The recruitment of participants from one local area in Kerala enabled us to map service provision and gain a holistic understanding of how to utilise the existing workforce to target social risk factors. The findings suggest that social interventions need to focus on ensuring health behaviour information reaches all parts of the community, and that those with more social risk factors are identified and supported to engage with treatment. Further research is required to test the resulting intervention model

Youth futures and a masculine development ethos in the regional story of Uttarakhand

Research on the Uttarakhand region, which became a new state in 2000, has focused largely on agrarian livelihoods, religious rituals, development demands, ecological politics and the role of women in regional social movements. This essay discusses another dimension of the regional imaginary—that of a masculine development ethos. Based on ethnographic research and print media sources, this essay focuses on stories, politics, mobilities and imaginations of young men in the years immediately after the achievement of statehood. Despite increased outmigration of youth in search of employment, many young men expressed the dream of maintaining livelihoods in the familiar towns and rural spaces of Uttarakhand, describing their home region as a source of power and agency. In rallies and in print media, young (mostly upper caste) men expressed their disillusionment with the government and the promises of statehood, arguing that their aspirations for development and employment were left unfulfilled. Gendered stories of the region, told in Hindi in rallies and print media, contained references to local places, people and historical events and were produced through local connections and know-how, fostering a regional youth politics. The article argues that Uttarakhand as a region is shaped by the politics of local actors as well as embodied forms of aspiration, affiliation and mobility.IS

Climatic significance of the marginalization of Scots pine (Pinus sylvestris L.) c. 2500 BC at White Moss, south Cheshire, UK

Subfossil wood from White Moss, south Cheshire, has become the focus of palaeoenvironmental research employing not only conventional coring, pollen analysis, radiocarbon dating and dendrochronology on pine and oak, but also the exhumation of in situ peat areas and dendroecology of the pine ring-width records. Initial dendrochronological research at the site yielded five pine chronologies dating from 3520 to 2462 cal. BC. These and other data indicate three episodes of pine colonization of the mire in the period between 3643 and 1740 cal. BC. Comparison of the pollen and spore records suggest that pine became marginalized at the site c. 2500 cal. BC after successive episodes of increased wetness, and this may represent a staged response to climatic deterioration. Two oak chronologies were dated by reference to the Belfast and to English oak master chronologies to 3228-2898 BC and 2190-1891 BC, respectively, showing the possible co-existence of pine and oak on the mire for part of the time. Further dendrochronological work on subfossil pine at the site resulted in a chronology (WM4) that was cross-matched with pine from elsewhere in England, and subsequently dated absolutely to 2881-2559 BC. Detailed dendroecological information, such as fire episodes and periods of environmental stress indicated in the tree-ring records, have been assigned, precisely and accurately, to calendar years in prehistory. The detailed data show the potential for both dendroecological and wider palaeoclimatic and palaeoenvironmental information that may become available from prehistoric bog-pine chronologies, which might then permit precise correlation and comparisons of proxy-climate data between sites

Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation Previously published in the Digital Urology Journal

Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution. Materials and Methods: Retrospective review was performed of 30 patients (55 ureters) with vesicoureteral reflux who underwent either the Cohen (intravesical) crosstrigonal procedure or the extravesical (detrusorrhaphy) approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG). Inclusion criteria was the presence of primary vesicoureteral reflux. Exclusion criteria were patients who had undergone a previous repair and patients in whom results of neither the renal ultrasound nor the VCUG were available. Results: There were no significant cases of obstruction or wound infection with either approach. Two patients who underwent the extravesical approach had persistent reflux on VCUG three months postoperatively, but both resolved by fifteen months. Average length of stay was only 3.00 ± 1.33 days for the extravesical approach, compared to 5.36 ± 1.75 days for the intravesical approach ( P = .0003 ). Conclusions: Given that by fifteen months success rates were the same with either approach, the extravesical approach is comparable to the intravesical technique and is a viable option in terms of outcome and economics given the shorter length of hospital stay

Obituaries: Co - Cu Folder

151 pages of subject files containing and related to Obituaries: Co - C

Human oocyte-derived sperm chemoattractant is a hydrophobic molecule associated with a carrier protein

Objective: To characterize the nature of the human oocyte-derived chemoattractant. Design: Laboratory in vitro study. Setting: Academic research institute. Patient(s): Ten healthy sperm donors. Oocyte-conditioned media from women undergoing IVF treatment because of male factor infertility. Intervention(s): Sperm samples were processed by the migration-sedimentation technique. Oocyte-conditioned media were collected 2-3 hours after oocyte stripping. Main Outcome Measure(s): Sperm chemotaxis was assayed in a m-slide chamber according to the direction of swimming relative to that of the chemical gradient. Result(s): Oocyte-conditioned media treated with proteases did not lose their chemotactic activity; on the contrary, they became more active, with the activity shifted to lower concentrations. When oocyte-conditioned media were subjected to hexane extraction, chemotactic activity was found in both the hydrophobic and aqueous phases. Known mammalian sperm chemoattractants were ruled out as oocyte-derived chemoattractants. Conclusion(s): Our results suggest that the oocyte-derived chemoattractant is a hydrophobic nonpeptide molecule that, in an oocyte-conditioned medium, is associated with a carrier protein that enables its presence in a hydrophilic environment. (Fertil Steril Ò 2014;102: 885-90

Surgical Technique: Arthroscopic Osteoplasty of Anterior Inferior Iliac Spine for Femoroacetabular Impingement

The anterior inferior iliac spine (AIIS) has variable morphology that correlates with hip range of motion. Subspinal impingement is an extracapsular cause for femoroacetabular impingement (FAI) and is clinically significant because it results in decreased range of motion and groin pain with flexion-based activity. In symptomatic patients with AIIS extension to or below the acetabular rim, AIIS decompression is considered part of an FAI corrective procedure. A consistent exposed bony area on the anterior and inferomedial aspect of the AIIS serves as a “safe zone” of resection allowing for decompression with preservation of the origin of the rectus femoris tendon. This surgical note describes a technique for AIIS decompression. The goal for low AIIS osteoplasty is to resect the AIIS to 2 burr widths (using a 5.5-mm burr) above the acetabular rim, achieving an 11-mm clearance, creating a type I AIIS. The resultant flat anterior acetabular surface between the most anteroinferior prominent point of the AIIS and the acetabular rim allows for free movement of the hip joint without impingement. Careful execution of AIIS decompression can alleviate clinical symptoms of FAI and restore function to the hip joint

Mifepristone-misoprostol combination treatment for early pregnancy loss after embryo transfer: a case series

Objective: Evidence strongly supports the use of mifepristone-misoprostol combination treatment for early pregnancy loss (EPL) among pregnancies conceived without assisted reproductive technologies. No literature exists, however, regarding the efficacy of this treatment in the medical management of EPL among pregnancies after in vitro fertilization and embryo transfer (IVF-ET). These patients differ as some use exogenous hormonal supplementation to provide pregnancy support. Thus, the management for EPL may differ between unassisted conceptions and those after ET. Mifepristone, a progesterone receptor antagonist, may demonstrate an altered treatment effect when used with misoprostol to manage EPL in assisted reproductive technologie-conceived pregnancies. Objective: To describe our institution’s experience using mifepristone-misoprostol to manage EPL after in vitro fertilization with embryo transfer IVF-ET. Design: Retrospective case series Setting: Single academic institution from 2020 to 2022. Patients(s): Nine patients with ultrasound confirmed EPL after IVF-ET. Intervention(s): All 9 patients underwent in vitro fertilization followed by fresh or frozen embryo transfer. All 9 received 200 mg of mifepristone 24 hours before 800 μg of misoprostol. Main Outcome Measurement(s): Incomplete abortion, need for surgical management, number of days to negative serum human chorionic gonadotropin (hCG). Result(s): Of the 9 subjects included, one had a programmed frozen embryo transfer cycle, 6 had modified natural frozen embryo transfer cycles, and 2 underwent fresh ET. Eight subjects had successful expulsion of tissue with one dose of treatment, and one required uterine aspiration. No subjects required additional dosing of misoprostol. The mean number of days elapsed from mifepristone treatment to tissue expulsion was 4.89 ± 11.30 days and the mean days to negative-range serum hCG was 36.89 ± 18.59 days. At the initial ultrasound, all pregnancies had one gestational sac seen; 5/9 had a yolk sac; only 3 had fetal cardiac activity. The mean gestational age at the time of EPL diagnosis was 55.22 ± 8.77 days, with the majority (8/9) having completed 7 weeks gestation. Conclusion(s): Mifepristone-misoprostol combination treatment appears to be a reasonable option for those with EPL after IVF-ET. Future, larger-scale studies are needed comparing combination treatment with misoprostol only among various ET protocols

Endoscopic Repair of Proximal Hamstring Tear With Double-Row Suture Bridge Construct

Hamstring strains account for 25% to 30% of all muscle strains and are an exceedingly common injury in the athletic population. Although proximal hamstring avulsion injuries occur less commonly than strains at the myotendinous junction, they are more severe and debilitating. Proximal hamstring avulsions do not respond well to conservative treatment and are more likely to require surgical intervention. Surgical repair of proximal hamstring avulsions is indicated when the injury fails to respond to conservative treatment, in cases of osseous avulsion with retraction, and in cases of tearing of all 3 hamstring tendons. Endoscopic repair of proximal hamstring avulsions is a promising technique to repair these injuries while reducing morbidity. We describe our technique for endoscopic proximal hamstring repair, which uses a double-row suture bridge construct to reattach the tendons to the ischial tuberosity

Characterizations of Capsule Closure in Hip Arthroscopy Are Infrequently and Incompletely Reported: A Systematic Review

Purpose: To review the recent literature to provide an updated characterization of capsule closure techniques in hip arthroscopy and to determine if the characteristics of closure impacted clinical outcomes. Methods: In keeping with the Preferred Reporting in Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic review was performed with the following eligibility criteria: patients over 18 years of age who underwent primary hip arthroscopy with reporting of patient reported outcome measures or revision/failure, and a sufficiently detailed description of capsule closure. The GRADE framework evaluated study quality, and ROBINS-I evaluated the risk of bias. Results: Across 18 studies (N = 3277) an interportal capsulotomy was reported in 12 studies (1972/3277) cases, and a T-type capsulotomy was reported in six studies (1305/3277) cases). Six studies reported using #2 suture. Nonabsorbable suture was reported in six studies, and absorbable suture in six studies. The rate of failure was 10.5% across five studies (N = 1133) and the rate of revision was 4.4% across 13 studies (N = 2957). Conclusions: Capsule closure is commonly performed with #2 high strength suture—the T-type using two to three sutures in the vertical limb and two to three in the transverse limb, and the interportal type using two to three sutures. Compared to earlier reports, there is a trend for increased utilization of T-type capsulotomy. Although there is a growing body of investigations into the efficacy of routine capsule closure following hip arthroscopy, our results demonstrate infrequent and inconsistent reporting of capsule closure characteristics. Level of Evidence: Level IV, systematic review of Level I-IV studies