Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier

Dynamic hip screw technique in the management of trochanteric fracture

Background: Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.Methods: Study was conducted in the department of orthopedics, GSL Medical College. Individuals >18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.Results: The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.Conclusions: Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended

Characteristics of a pre-monsoon dryline atmospheric boundary layer over the rain shadow region: A case study

A dryline is the zone of distinct moisture gradient separating warm, moist, and hot, dry air masses. It is usually associated with mesoscale phenomena and plays a significant role in atmospheric boundary layer (ABL) dynamics including initiation of convection/thunderstorms. In the tropical Indian region, these dryline conditions are normally associated with the pre-monsoon season. In the present study, dryline characteristics over a rain shadow region in the Indian subcontinent were investigated utilizing observations and Weather Research and Forecasting (WRF) model from 28 to 30 May 2019. Based upon Wind Profiler Radar and MicroWave Radiometer Profiler measurements, the ABL characteristics were investigated. Interestingly, the ABL height was found to evolve up to 5 km with the horizontal wind vectors oscillating between north-westerly and north-easterly flow. During the intense ABL deepening, stronger downdraft cores were observed in comparison with the updraft cores. The stronger downdrafts entrained free-tropospheric dry air thereby further deepening the ABL. Based upon the entrainment velocity estimates at the ABL top and the variations in potential temperature, the dynamic entrainment fluxes were estimated and further implemented for evaluating two slab models to recreate the ABL growth. With this analysis, we demonstrate the significant contribution of entrainment fluxes on ABL growth during dryline conditions

Completion of Advance Directives Among U.S. Consumers

Current, ongoing national surveys do not include questions about end-of-life (EOL) issues. In particular, population-based data are lacking regarding the factors associated with advance directive completion

Mineral oil and ester based oil/paper insulation decaying assessment by FTIR measurements

Esters based dielectric fluids have been widely researched since 1990’s for application in high voltage insulation applications. Since then, researchers are affirmative towards usage of ester based insulating fluids as a replicated to mineral insulation oils. The operating properties and aging performance of ester oils proved to be potential candidates for high voltage applications. In view of high temperatures and longevity of insulation systems, there also is a need to understand the chemical perspectives along with aging behaviour of ester oils. Accelerated aging of oil/paper insulation associated with mineral oil and synthetic ester with cellulose insulant has been experimentally simulated as per ASTM D 1934 at 115 ℃. Fourier Transform Infrared spectroscopy analysis of oils and cellulose papers is carried out at different aging factors. The compositional changes in oils and cellulose kraft paper with aging have been enumerated. The changes in the absorbance area for appropriate functional groups have been also reported. It is found that, the chemical stability of synthetic esters is superior to that of the mineral oil

Engaging communication experts in a Delphi process to identify patient behaviors that could impact communication in medical encounters.

Abstract Background The communication literature currently focuses primarily on improving physicians' verbal and non-verbal behaviors during the medical interview. The Four Habits Model is a teaching and research framework for physician communication that is based on evidence linking specific communication behaviors with processes and outcomes of care. The Model conceptualizes basic communication tasks as "Habits" and describes the sequence of physician communication behaviors during the clinical encounter associated with improved outcomes. Using the Four Habits Model as a starting point, we asked communication experts to identify the verbal communication behaviors of patients that are important in outpatient encounters. Methods We conducted a 4-round Delphi process with 17 international experts in communication research, medical education, and health care delivery. All rounds were conducted via the internet. In round 1, experts reviewed a list of proposed patient verbal communication behaviors within the Four Habits Model framework. The proposed patient verbal communication behaviors were identified based on a review of the communication literature. The experts could: approve the proposed list; add new behaviors; or modify behaviors. In rounds 2, 3, and 4, they rated each behavior for its fit (agree or disagree) with a particular habit. After each round, we calculated the percent agreement for each behavior and provided these data in the next round. Behaviors receiving more than 70% of experts' votes (either agree or disagree) were considered as achieving consensus. Results Of the 14 originally-proposed patient verbal communication behaviors, the experts modified all but 2, and they added 20 behaviors to the Model in round 1. In round 2, they were presented with 59 behaviors and 14 options to remove specific behaviors for rating. After 3 rounds of rating, the experts retained 22 behaviors. This set included behaviors such as asking questions, expressing preferences, and summarizing information. Conclusion The process identified communication tasks and verbal communication behaviors for patients similar to those outlined for physicians in the Four Habits Model. This represents an important step in building a single model that can be applied to teaching patients and physicians the communication skills associated with improved satisfaction and positive outcomes of care

ANTIBACTERIAL ACTIVITY OF SOME FOLKLORE MEDICINAL PLANTS FROM SOUTH INDIA

Antibacterial activity and phytochemical tests of eight whole plant methanol extracts belonging to family Euphorbiaceae were evaluated. In agar well diffusion assay the diameter of inhibition zones ranged from 3-13 mm. Phyllanthus emblica showed maximum activity of 13 mm. The MIC and MBC observed were 30-140 mcg/ml and 40-160 mcg/ml, respectively. P. piscatorum and P. emblica showed the lowest MIC (30 mcg/ml), P. emblica the lowest MBC (40 mcg/ml) and thus an effective inhibitor of the tested bacteria. Alkaloids, saponins and tannins were detected in 7 out of 8 tested plants

Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters

<p>Abstract</p> <p>Background</p> <p>The communication literature currently focuses primarily on improving physicians' verbal and non-verbal behaviors during the medical interview. The Four Habits Model is a teaching and research framework for physician communication that is based on evidence linking specific communication behaviors with processes and outcomes of care. The Model conceptualizes basic communication tasks as "Habits" and describes the sequence of physician communication behaviors during the clinical encounter associated with improved outcomes. Using the Four Habits Model as a starting point, we asked communication experts to identify the verbal communication behaviors of patients that are important in outpatient encounters.</p> <p>Methods</p> <p>We conducted a 4-round Delphi process with 17 international experts in communication research, medical education, and health care delivery. All rounds were conducted via the internet. In round 1, experts reviewed a list of proposed patient verbal communication behaviors within the Four Habits Model framework. The proposed patient verbal communication behaviors were identified based on a review of the communication literature. The experts could: approve the proposed list; add new behaviors; or modify behaviors. In rounds 2, 3, and 4, they rated each behavior for its fit (agree or disagree) with a particular habit. After each round, we calculated the percent agreement for each behavior and provided these data in the next round. Behaviors receiving more than 70% of experts' votes (either agree or disagree) were considered as achieving consensus.</p> <p>Results</p> <p>Of the 14 originally-proposed patient verbal communication behaviors, the experts modified all but 2, and they added 20 behaviors to the Model in round 1. In round 2, they were presented with 59 behaviors and 14 options to remove specific behaviors for rating. After 3 rounds of rating, the experts retained 22 behaviors. This set included behaviors such as asking questions, expressing preferences, and summarizing information.</p> <p>Conclusion</p> <p>The process identified communication tasks and verbal communication behaviors for patients similar to those outlined for physicians in the Four Habits Model. This represents an important step in building a single model that can be applied to teaching patients and physicians the communication skills associated with improved satisfaction and positive outcomes of care.</p