Barriers to prosthetic devices at a Tanzanian hospital

Background: Limb amputation, often from road trauma, is common in low-income countries. Providing prosthetic devices for amputees is challenging and limited research exists regarding barriers to prosthesis provision. This study aims to elucidate the Prosthesis Provision Pathway (PPP) and identify barriers of prosthesis accessibility at the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania.Patients and Methods: At MOI, 18 healthcare providers, who included 4 orthopaedic technicians, 4 physical therapists, 4 orthopaedic surgeons, 4 junior doctors, and 2 hospital administrators were interviewed and blinded. Responses from semi-structured interviews were transcribed and common themes were identified. A process map diagramming the prosthesis provision pathway was created to highlight barriers and potential areas of improvement.Results: Six main themes emerged from the interviews: the first is that the prosthetics are expensive both for patients and MOI. Second, there are misperceptions of how prosthesis cost will be distributed. Third, there is inefficient communication between providers. Fourth, improved surgical education is needed to improve amputation outcomes. Fifth, amputees face psychosocial stigma, but prosthetics are becoming more accepted. Lastly, healthcare providers understand that trauma is the most common aetiology for amputation.Conclusions: Potential solutions to solving the prosthetic shortage will involve making prostheses more affordable, integrating the orthopaedic prosthesis workshop earlier in the provision process, improving surgical education and communication between providers, and working to prevent road trauma.Keywords: Prosthesis, Amputee, Access, Barrier, Tanzani

A modelling approach to estimate the transmissibility of SARS-CoV 2 during periods of high, low, and zero case incidence

Against a backdrop of widespread global transmission, a number of countries have successfully brought large outbreaks of COVID-19 under control and maintained near-elimination status. A key element of epidemic response is the tracking of disease transmissibility in near real-time. During major outbreaks, the effective reproduction number can be estimated from a time-series of case, hospitalisation or death counts. In low or zero incidence settings, knowing the potential for the virus to spread is a response priority. Absence of case data means that this potential cannot be estimated directly. We present a semi-mechanistic modelling framework that draws on time-series of both behavioural data and case data (when disease activity is present) to estimate the transmissibility of SARS-CoV-2 from periods of high to low – or zero – case incidence, with a coherent transition in interpretation across the changing epidemiological situations. Of note, during periods of epidemic activity, our analysis recovers the effective reproduction number, while during periods of low – or zero – case incidence, it provides an estimate of transmission risk. This enables tracking and planning of progress towards the control of large outbreaks, maintenance of virus suppression, and monitoring the risk posed by re-introduction of the virus. We demonstrate the value of our methods by reporting on their use throughout 2020 in Australia, where they have become a central component of the national COVID-19 response

Scalar conservation laws with nonconstant coefficients with application to particle size segregation in granular flow

Granular materials will segregate by particle size when subjected to shear, as occurs, for example, in avalanches. The evolution of a bidisperse mixture of particles can be modeled by a nonlinear first order partial differential equation, provided the shear (or velocity) is a known function of position. While avalanche-driven shear is approximately uniform in depth, boundary-driven shear typically creates a shear band with a nonlinear velocity profile. In this paper, we measure a velocity profile from experimental data and solve initial value problems that mimic the segregation observed in the experiment, thereby verifying the value of the continuum model. To simplify the analysis, we consider only one-dimensional configurations, in which a layer of small particles is placed above a layer of large particles within an annular shear cell and is sheared for arbitrarily long times. We fit the measured velocity profile to both an exponential function of depth and a piecewise linear function which separates the shear band from the rest of the material. Each solution of the initial value problem is non-standard, involving curved characteristics in the exponential case, and a material interface with a jump in characteristic speed in the piecewise linear case

Electronic Structures of Quantum Dots and the Ultimate Resolution of Integers

The orbital angular momentum L as an integer can be ultimately factorized as a product of prime numbers. We show here a close relation between the resolution of L and the classification of quantum states of an N-electron 2-dimensional system. In this scheme, the states are in essence classified into different types according to the m(k)-accessibility, namely the ability to get access to symmetric geometric configurations. The m(k)-accessibility is an universal concept underlying all kinds of 2-dimensional systems with a center. Numerical calculations have been performed to reveal the electronic structures of the states of the dots with 9 and 19 electrons,respectively. This paper supports the Laughlin wave finction and the composite fermion model from the aspect of symmetry.Comment: Two figure

An economic appraisal of the effect of tire inflation pressure for alternative tillage systems on a silty clay loam soil

Compacting soil has an adverse effect on soil properties, decreases crop productivity, and subsequently reduces farm income. Low tire inflation pressure (LTP) help in managing soil compaction and protecting the soil environment; however, there is scant economic data available on LTP in US Midwest farming systems. Hence, a 3-year study investigated the effects of LTP, compared to tires inflated to the standard tire inflation pressure systems, on crop yield and farm economy for a typical maize/soybean rotation. The effect of the two tire inflation pressure systems was factorialized with three tillage systems: deep tillage (DT, 450 mm), shallow tillage (ST, 100 mm), and no-till systems. The results showed that LTP systems increased maize (Zea mays) yield by 4.51% (2017) and 2.70% (2018) and soybean (Glycine max) by 3.70% in 2018. Annual earnings for both 200- and 800-ha farms increased for all tillage systems with LTP tires based on a partial budget analysis. The payback periods for LTP tires were very short, ranging from 0.32 years for DT on an 800-ha farm to 1.18 years for ST on a 200-ha farm. The net present value of the higher returns with LTP tires was substantial, especially for the DT system. This study shows a strong economic benefit from investments in LTP tires on silty clay loam soils in the US Midwest

From Climate Change to Pandemics: Decision Science Can Help Scientists Have Impact

Scientific knowledge and advances are a cornerstone of modern society. They improve our understanding of the world we live in and help us navigate global challenges including emerging infectious diseases, climate change and the biodiversity crisis. However, there is a perpetual challenge in translating scientific insight into policy. Many articles explain how to better bridge the gap through improved communication and engagement, but we believe that communication and engagement are only one part of the puzzle. There is a fundamental tension between science and policy because scientific endeavors are rightfully grounded in discovery, but policymakers formulate problems in terms of objectives, actions and outcomes. Decision science provides a solution by framing scientific questions in a way that is beneficial to policy development, facilitating scientists’ contribution to public discussion and policy. At its core, decision science is a field that aims to pinpoint evidence-based management strategies by focussing on those objectives, actions, and outcomes defined through the policy process. The importance of scientific discovery here is in linking actions to outcomes, helping decision-makers determine which actions best meet their objectives. In this paper we explain how problems can be formulated through the structured decisionmaking process. We give our vision for what decision science may grow to be, describing current gaps in methodology and application. By better understanding and engaging with the decision-making processes, scientists can have greater impact and make stronger contributions to important societal problems.Christopher M. Baker, Patricia T. Campbell, Iadine Chades, Angela J. Dean, Susan M. Hester, Matthew H. Holden, James M. McCaw, Jodie McVernon, Robert Moss, Freya M. Shearer, and Hugh P. Possingha

Produtividade da cana-de-açúcar após o cultivo de leguminosas

Estudou-se o efeito do cultivo prévio de leguminosas sobre a produtividade e lucratividade da cana-de-açúcar. Foram determinados a produtividade de biomassa, o acúmulo de nutrientes das leguminosas, a ocorrência natural de fungos micorrízicos arbusculares, bem como o efeito das leguminosas sobre a população de nematoides do gênero Pratylenchus à cana-de-açúcar. O experimento foi desenvolvido em Piracicaba (SP), Brasil, em solo classificado como Argissolo Vermelho-Amarelo distrófico, utilizando-se a cultivar de cana-de-açúcar (Saccharum spp.) IAC87-3396. As avaliações dos efeitos do cultivo prévio das leguminosas foram realizadas durante cinco cortes consecutivos. Os tratamentos consistiram do cultivo prévio das leguminosas: Amendoim (Arachis hypogaea L) - cultivares IAC-Tatu e IAC-Caiapó, crotalária júncea IAC 1 (Crotalaria juncea L) e mucuna preta [Mucuna aterrima (Piper & Tracy) Holland], e um tratamento-testemunha. Adotou-se o delineamento em blocos casualizados com cinco repetições. A leguminosa mais produtiva de biomassa seca (parte aérea+raízes) foi a crotalária júncea IAC 1 (10.264 kg ha-1), seguida da mucuna preta (4.391 kg ha-1) e dos amendoins, IAC-Caiapó (3.177 kg ha-1) e IAC-Tatu (1.965 kg ha-1). O amendoim IAC-Caiapó e a mucuna preta foram as espécies mais infectadas por fungos micorrízicos. O amendoim, independente da cultivar, foi a leguminosa que mais reduziu a infestação de Pratylenchus spp. na cana-de-açúcar. Após cinco cortes da cana-de-açúcar o melhor desempenho foi notado no tratamento com cultivo prévio de crotalária júncea IAC 1, o qual promoveu incrementos de 30% e 35% na produtividade de colmos e de açúcar respectivamente e o melhor desempenho econômico