Comparative analysis of the clinical, functional and radiological outcomes of proximal femoral nail alone verses proximal femoral nail along with lateral wall plating in management of unstable intertrochanteric femur fracture, AO/OTA, type 31A2 fractures with deficient lateral wall

Background: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating. Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared. Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B. Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better

The contribution of planetary period oscillations towards circulation and mass loss in Saturn’s magnetosphere

Magnetic reconnection is a process during which magnetic energy is released as kinetic energy. It is considered a crucial driver of energy transport and mass loss within Saturn's magnetosphere. On long-term timescales, is thought to be predominantly driven by the rapid rotation of equatorially mass-loaded flux tubes (i.e., the Vasyliunas cycle), but there is some non-negligible driving from the solar wind as well (i.e., the Dungey cycle). In this study, we investigate an atmospheric driven phenomenon that modulates Saturn's magnetosphere every ∼10.6–10.8 hr, known as planetary period oscillations (PPOs), as an additional driver of magnetic reconnection at Saturn. Using an empirical model of PPO dynamics and Cassini magnetic field and plasma measurements, we find that PPO-driven magnetic reconnection is likely to occur in Saturn's magnetosphere, however, the occurrence of the phenomenon depends on temporally variable characteristics of the PPO systems and spatial asymmetries within Saturn's equatorial magnetosphere. Thus, it is not expected to be an on-going process. On year-long timescales, we find that PPOs are expected to be on par with the Dungey Cycle in driving circulation within Saturn's magnetosphere. However, on ∼1–2 weeks-long timescales, under specific conditions where PPO-driven reconnection is expected to be active, this phenomenon can become more significant than the Vasyliunas cycle, and thus dominate circulation within Saturn's magnetosphere. On year-long timescales, this process is estimated to remove upwards of ∼20% of the mass loaded into the magnetosphere by Enceladus

Constraining the Temporal Variability of Neutral Winds in Saturn's Low‐Latitude Ionosphere Using Magnetic Field Measurements

The Cassini spacecraft completed 22 orbits around Saturn known as the “Grand Finale” over a 5 months interval, during which time the spacecraft traversed the previously unexplored region between Saturn and its equatorial rings near periapsis. The magnetic field observations reveal the presence of temporally variable low‐latitude field‐aligned currents which are thought to be driven by velocity shears in the neutral zonal winds at magnetically conjugate thermospheric latitudes. We consider atmospheric waves as a plausible driver of temporal variability in the low‐latitude thermosphere, and empirically constrain the region in which they perturb the zonal flows to be between ±25° latitude. By investigating an extensive range of hypothetical wind profiles, we present and analyze a timeseries of the modeled velocity shears in thermospheric zonal flows, with direct comparisons to empirically inferred angular velocity shears from the Bϕ observations. We determine the maximum temporal variability in the peak neutral zonal winds over the Grand Finale interval to be ∼350 m/s assuming steady‐state ionospheric Pedersen conductances. We further show that the ionospheric currents measured must be in steady‐state on ∼10 min timescales, and axisymmetric over ∼2 h of local time in the near‐equatorial ionosphere. Our study illustrates the potential to use of magnetospheric datasets to constrain atmospheric variability in the thermosphere region

Digital Chunk Processing with Orthogonal GFDM Doubles Wireless Channel Capacity

A novel physical layer (PHY) transmission technique for increasing the channel capacity of transmission, termed as Orthogonal Generalized Frequency Division Multiplexing (OGFDM), has been proposed, investigated and evaluated in this paper. A combination of the Digital Hilbert Filter (DHF) with Generalized Frequency Division Multiplexing (GFDM) has been shown to double wireless channel capacity for each transmitted frequency sub-carrier at acceptable Bit Error Rate (BER) limits. By making use of the great properties of Hilbert transforms, orthogonality is achieved between the traditionally non-orthogonal GDFM subcarriers improving the BER and wireless channel capacity of the transmission. The OGFDM seems to combine the attributes of GFDM and Orthogonal Frequency Division Multiplexing (OFDM) in one sustainable system. The proposed solution achieves orthogonality between the filters of adjacent frequencies of subcarriers instead of between the frequencies of subcarriers themselves. Also, an OGFDM system model is presented, based on which, the relation between the main filter parameters and the system BER and channel capacity performance is specified in a wireless electrical back-to-back transmission system. Finally, by means of simulations, the impact of applying the proposed advanced filters on the aggregated system performance of the BER and channel capacity is shown in an Additive White Gaussian Noise (AWGN) wireless channel

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Modeling the Temporal Variability in Saturn's Magnetotail Current Sheet From the Cassini F‐ring Orbits

The Cassini spacecraft completed 20 highly repeatable orbits during northern summer at Saturn, known as the F‐ring orbits, of which 18 are considered in this study. The spacecraft traversed Saturn's magnetotail current sheet during each apoapsis pass between 16 and 22 Saturn radii over 2‐day intervals and revealed a highly variable radial magnetic field from orbit to orbit. The solar wind and planetary period oscillations (PPOs) are significant sources of temporal variability in the Saturnian magnetosphere. PPOs refer to dual magnetic perturbation systems, one in each hemisphere, which have been observed to modulate the position and thickness of the magnetotail current sheet with a 10.7‐hr periodicity. Thus, we employ a model which considers dual‐modulation effects of the northern and southern PPO systems, together with a model of variable solar wind forcing on the magnetotail current sheet, to investigate their combined temporal effects on the radial magnetic field in the magnetotail. For all 18 F‐ring orbits considered, the modeled radial fields show excellent overall agreement with the temporal variability in the large‐scale structure of the observed radial fields (root mean square error 1.5 nT for 80% of the orbits). The amplitudes of the northern PPO modulations are well constrained between 0.3 and 0.5 Saturn radii, and they exceed the southern modulations by a factor of 1.3. The solar wind forcing is observed to be highly variable from orbit to orbit