Interrogating Erdogan's neo-Ottoman geopolitical imagination

This paper examines the possible emergence of the neo-Ottoman geopolitical order with the Republic of Turkey at its helm under the leadership of President Recep Tayyip Erdogan. The blueprint for this ambitious order is taken from its Ottoman antiquity. Neo-Ottomanism attempts to secure continuity with its Ottoman past by foregrounding Islam as the core theo-cultural framework to achieve the political end of constituting Islamic nations to come under one particular order. To achieve this desired end, Erdogan intensifies his endeavor and employs his tact to forge alliances with Islamic nations and promises them solidarity and mutual prosperity keeping his leadership role intact. To pursue this ambition, he expressed his belligerence against the neighboring nations such as Armenia, Greece, Cyprus, Georgia, Bulgaria, etc., which were once the constituents of the Ottoman empire and preferred interventionist policy to diplomatic cooperation. The symptoms of neo-Ottoman pre-eminence are evident in the nautical territories in the Aegean Sea, the Black Sea, the Sea of Marmara and the Mediterranean Sea. The study employs methods of analysis and scrutiny of the existing literature in the field and the related areas to achieve the objective of what constitutes Erdogan’s neo-Ottoman geopolitical imagination and to conclude as to what are the geopolitical symptoms that validate the possible emergence of the neo-Ottoman political process, and limitations that underpin the process

CHINA’S GEO-ECONOMIC INTEREST IN AFRICA: A SHORT OVERVIEW

The article examines China’s geo-economic interest in Africa. China intends to exercise its leverage over both coastal frontiers for trade and defense and its hinterland for rich mineral, metal, and fossil deposits. Furthermore, the debt trap seems to be one of the methods through which China intended to bargain with Africa to bag as much advantage as it could gain. The question that emerges from this critical engagement with China-Africa relations is to look into how the reality of Africa’s narrative of development is projected both from outside and within and the contradiction embodied in that projection. China used the narrative of development to set its feet on African soil. This paper discusses China’s penetration into Africa by offering interest-free loans and its gradual emergence as a neocolonial power through expanding its network. The method used in the study to establish China’s monopoly and interfering streak in African affairs through BRI is the analysis of available data based on which the objectives and the conclusions are drawn.      &nbsp

Dermo traction as a solution to major skin defects: a prospective study in a tertiary care hospital of South Odisha

Background: Soft tissue loss with exposure of underlying tissue is a challenge to all Orthopedics surgeons. The present prospective study described dermo-traction technique using infant feeding tube or prolene suture as an alternative method for the wound closure.Methods: This prospective study described 30 cases where dermo-traction technique was used for the closure of the wound using infant feeding tube or prolene suture. Study was conducted in Orthopaedics Department of MKCG Medical College, Berhampur from June 2016 to May 2018. Patients requiring skin grafting for their major soft tissue defects or in whom skin grafting or fasciocutaneous flap could not be done were included in study.Results: Out of 30 patients, 2 were lost to follow-up. Average age of study participants was 39.1 years. Male constituted 67.8%. 78.5% of patients had wound in leg, 14.3% in thigh region, rest had on ankle. 82.1% had an open fracture wound, 10.7% had post-operative wound dehiscence and 7.1% soft tissue injury. Average wound healing time was 15.3days with average 5 tightening session of suture. Wounds healed eventually in 26 patients and 2 patients had an infection. Among 26 patients 9 patients had delayed primary and 17 had secondary closure of wound.Conclusions: It can be concluded that gradual closure of the wounds with soft tissue defects can be achieved by applying dermo-traction technique using prolene suture or infant feeding tube with average 15 days of time. So dermo-traction using infant feeding tube or prolene suture is a simple, inexpensive, effective and technically sound alternate solution for closure of wound.

Comparison between conservative and surgical management in postpartum pubic symphysis diastasis: a randomized controlled trial

Background: Pubic symphysis diastasis is a postpartum complication with an incidence of 1:385 to 1:500 births. Typically conservative treatment is performed, operative treatment is also successful alternative method. This study was conducted to assess whether surgery (ORIF) provide early pain relief and improve mobility and quality of life than conservative management does in same patients.Methods: This study is a randomized controlled trial conducted at MKCG Medical College, Berhampur from December 2014 to April 2017. Total eligible 16 postpartum pubic diastasis patients coming to MKCG hospital were randomly assigned to two groups in 1:1 ratio. Group A received surgical and group B conservative management. All were followed up at 3 weeks, 6 weeks, 3 months and upto 6 months in which EQ-5D-3L score and Visual analogue scale were measured for assessing pain and general health outcome in participants. All data were analyzed with SPSS.Results: The mean EQ-5D descriptive index was almost similar in both groups at the time of admission, but declined more rapidly in group A as compared to that in group B. 75% of group A has this index 5 (lowest score) at 6 months whereas none of the group B patients attained it. lower EQ-5D index indicates patients had good mobility and early ambulation, less discomfort, able to do usual activity. There was a significant difference in mean EQ-5D descriptive index and pain VAS score between two groups. Conclusions: This study showed surgical management is more effective than conservative management in postpartum pubic symphysis patients by rapidly improving general health, ameliorating pain and bringing ambulation

A prospective study on surgical management of neglected Montaggia fracture in children without annular ligament repair

Background: Monteggia fracture presenting after 4 weeks of injury termed as neglected monteggia fracture.There are many options for management of this fracture. The present study was planned with objective to assess clinical outcome of patients who were treated with a specific technique of ulnar osteotomy without annular ligament repair.Methods: This prospective study was conducted in Department of Orthopaedics MKCG Medical College and Hospital, Berhampur from July 2015 to April 2018 where 15 patients of neglected monteggia fracture were operated with specific technique of ulnar osteotomy without annular ligament repair. Participants were followed up and at end point they were evaluated for pain, stability, and disturbance of daily and sporting activities. Function was assessed using elbow performance score. Data collected were analyzed in SPSS (version 16.0).Results: Mean age of study participants was 7.3 year and male constituted majority (60%). There were 11 children with Bado type I, 3 with type II and one with type III injury. The mean time from initial injury was 8.8 months. All had limited range of movements of forearm and elbow. All patients had regular follow up for 9 months to 24. In 53.3% flexion arc was improved. The mean flexion arc was increased by 20 degree and pronation-supination arc was reduced by 20 degree.Conclusions: The present study revealed that osteotomy in neglected monteggia fracture brings stability of elbow joint and this surgical management of neglected monteggia fracture without annular ligament reconstruction had good outcome. Annular ligament reconstruction is not always necessary

A comparative study between plating versus titanium elastic nail system in mid-shaft clavicle fracture management

Background: Clavicle fracture is one of most common bony injuries. Despite of high frequency, choice of proper treatment is still a challenge. So a comparative randomized study was planned to compare Plating verses TENS for clavicle fractures management.Methods: Study was conducted in Department of Orthopedics, M.K.C.G Medical College, Berhampur from November 2015 to October 2017.Patients aged from 20-55 years with closed displaced were included in study. Patients were randomized in two groups- One group (25 pateints) treated with TENS and second group (25) with plate. Outcome assessed by pain VAS score, Constant & Murley score, DASH score, cosmetic result, radiological fracture healing time.Results: Mean fracture union time in TENS group was 11.4±2.12 weeks and in plate group 13.4±3.46 weeks (difference was significant p=0.016). Mean pain VAS score in TENS group was 2.56±0.91 and in plating group 3.12±0.8 (p=0.023). Tens group were cosmetically more satisfied (mean score 4.48±0.7) than plate group (mean score 3.8±1.0, p=0.009). Mean DASH and Constant Shoulder Score in TENS group were 1.87±3.4, 9.36±7.04 and plate group 4.8±9.0 and 15.08±9.4 respectively. Both were significant (p=0.039, p=0.000).Conclusions: Our study found that patients treated with TENS showed excellent outcome in 84% cases while 60% in plating group for displaces mid-shaft clavicle fracture. Patients in TENS group better in terms of Constant & Murley score and DASH score than treated with plate

The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019

BACKGROUND: Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. METHODS: Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. FINDINGS: In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. INTERPRETATION: Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. FUNDING: The Bill and Melinda Gates Foundatio

Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background: Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods: Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings: In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005). Interpretation: NCD-related mortality has substantially declined among adolescents in the EU between 1990 and 2019, but the rising trend of YLL attributed to mental disorders and their YLD burden are concerning. Differences by sex, age group, and across EU Member States highlight the importance of preventive interventions and scaling up adolescent-responsive health-care systems, which should prioritise specific needs by sex, age, and location. Funding: Bill & Melinda Gates Foundation

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC

The burden of injury in Central, Eastern, and Western European sub-region : a systematic analysis from the Global Burden of Disease 2019 Study

Background Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. Results In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. Conclusions Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.Peer reviewe