Cause, pattern and outcome of fractures occurring in the pediatric population of rural tertiary health care center of Nepal.

Introduction: Pediatric trauma is a significant burden to health care worldwide. In Karnali province, most of the cases present late. The aim of this study is to determine demographic characteristics, cause, pattern, treatment and outcome of pediatric fractures in tertiary health care center in Jumla. Method: This is a retrospective study done in patients younger than 16 years who presented to our hospital between January 2016 to December 2017. We analyzed demographic data, injury characteristics, fracture pattern, time of presentation, treatment modalities and outcome. Results: There were total of 1028 patients out of which 60% were males. Mean duration of presentation to hospital was 4.8 days. Most common mechanism of injury was fall from height. 85.60 % were managed conservatively and 14.40% were managed operatively. Postoperative outcome was good in 71 % of the cases, fair in 28% and poor in 1% cases. Forearm fracture was the most common presentation, accounting for 358 cases (34.82%) followed by Supracondylar humerus fracture accounting 23.34%. Conclusion: Pediatric fractures constitute a huge proportion of cases in our hospital. As pediatric bones unite readily, the treatment outcome is good in most of the cases even after conservative management and after delayed presentation. Keywords: pediatric fractures, conservative management, supracondylar fractures, delayed presentation

Clinical profile and outcome of neonates admitted to the Neonatal Care Unit in a rural teaching Hospital

Objectives: Neonatal morbidity and mortality rates reflect efficiency of health services of a country. This study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit. Methods: The study was conducted in Neonatal Unit of Karnali Academy of Health Sciences, Jumla for a period of one year from 1st May 2017 to 30th April 2018. Data of all admitted patients were reviewed and analyzed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Diagnosis was made on clinical examination, radiological findings and laboratory investigations. Data were analyzed using SPSS version 20. Results: Out of 153 neonates admitted during the study period, 2 were excluded because of deficient record. Full-term neonates were 122(80.7%) while preterm were 29 (19.3%). Low birth weight (LBW) babies were 32 (21.18%).Neonatal sepsis 91 (60.26%) was the most common cause of hospital admissions followed by meconium aspiration syndrome 21(13.9%) and prematurity 10(6.62%). Out of 151 newborns, 112 babies (74.1%) were discharged after improvement, 15(9.93%) left against medical advice, 13(8.6%) babies were referred to higher centers for intensive care and there were 9 (5.9%) mortalities and 2(1.3%) got absconded. Conclusion: The majority of neonatal morbidity is due to sepsis, prematurity and respiratory causes. All these causes are preventable to some extent and, can be effectively treated in order to reduce morbidity and mortality. Keywords: New Born, Mortality, Admission, Sepsi

Integration of decision support systems to improve decision support performance

Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes

Local is not always better: the impact of climate information on values, behavior and policy support

In the current research, we experimentally examined the effect of providing local or global information about the impacts of climate change on individuals’ perceived importance of climate change and on their willingness to take action to address it, including policy support. We examined these relationships in the context of individuals’ general value orientations. Our findings, from 99 US residents, suggest that different kinds of climate information (local, global, or none) interact with values vis-à-vis our dependent variables. Specifically, while self-transcendent values predict perceived importance and pro-environmental behavior across all three information conditions, the effect on policy support is less clear. Furthermore, we detected a “reactance effect” where individuals with self-enhancing values who read local information thought that climate change was less important and were less willing to engage in pro-environmental behavior and support policy than self-enhancing individuals in the other information conditions. These results suggest that policy makers and public communicators may want to be cognizant of their audience’s general value orientation. Local information may not only be ineffective but may also prove counterproductive with individuals whose value orientations are more self-enhancing than self-transcendent

Extensively drug-resistant Acinetobacter baumannii in a Thai hospital: a molecular epidemiologic analysis and identification of bactericidal Polymyxin B-based combinations

BACKGROUND: Limited knowledge of the local molecular epidemiology and the paucity of new effective antibiotics has resulted in an immense challenge in the control and treatment of extensively drug-resistant (XDR) Acinetobacter baumannii infections in Thailand. Antimicrobial combination regimens may be the only feasible treatment option in such cases. We sought to characterize the local molecular epidemiology and assess the bactericidal activity of various antibiotics individually and in combination against XDR A. baumannii in a Thai hospital. METHODS: All XDR A. baumannii isolates from Thammasat University Hospital were collected between October 2010 and May 2011. Susceptibility testing was conducted according to reference broth dilution methods. Pulse-field gel electrophoresis was used to genotype the isolates. Carbapenemase genes were detected using polymerase chain reaction. In vitro testing of clinically-relevant concentrations of imipenem, meropenem, doripenem, rifampicin and tigecycline alone and in combination with polymyxin B was conducted using multiple combination bactericidal testing. RESULTS: Forty-nine polymyxin B-susceptible XDR A. baumannii isolates were identified. bla(OXA-23) and bla(OXA-51) genes were detected in all isolates. Eight clonally related clusters were identified, resulting in the initiation of several infection control measures. Imipenem, meropenem, doripenem, rifampicin, and tigecycline in combination with PB respectively, exhibited bactericidal killing in 100%, 100%, 98.0%, 100% and 87.8% isolates respectively at 24 hours. CONCLUSION: Molecular epidemiologic analysis can aid the early detection of infection outbreak within the institution, resulting in the rapid containment of the outbreak. Imipenem/meropenem/rifampicin in combination with polymyxin B demonstrated consistent bactericidal effect against 49 bla(OXA-23)-harbouring XDR A. baumannii clinical isolates, suggesting a role of combination therapy in the treatment of these infections

Search for Dark Matter and Supersymmetry with a Compressed Mass Spectrum in the Vector Boson Fusion Topology in Proton-Proton Collisions at root s=8 TeV

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Measurement of the WZ production cross section in pp collisions at root s=13 Tev

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Relative Modification of Prompt psi(2S) and J/psi Yields from pp to PbPb Collisions at root(S)(NN)=5.02 TeV

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