Settlements Under Changed Structural Loadings

The paper deals with settlement analysis of the foundation systems which currently support the Tower City Center located in Downtown Cleveland, Ohio. The project features the complete renovation of an old retail arcade and conversion of abandoned space in the Old Union Railroad Terminal. The major foundation system consists of a number of closely spaced spread footings bearing at varying elevations. A very small section of the development is supported by deep-seated belled caisson units. These foundations were originally installed during the late 1920\u27s to support the construction of a proposed twenty-five story U-shaped building with a lower structure in the open space. However, due to reduced economic activity after 1929, the project was scaled back, and only one to three story buildings were constructed on these foundations. It was determined that, for the proposed development, the soils at the foundation bearing elevations should be capable of withstanding the expected maximum column loads. Therefore, the primary concern was not the soil\u27s bearing capacity, but the total and differential settlements under the new design structural loading conditions. Theoretical settlements calculated for several key locations were compared with the actual field data developed over a period of eleven months

Effect of iodine impregnated plastic adhesive drapes in preventing surgical site infection post spine surgeries

Background: Surgical Site Infection (SSI) complicates roughly 1-3% of orthopaedic surgeries. This study aimed to assess the effect of iodine impregnated plastic adhesive drapes (PAD) in preventing surgical site infection post spine surgeries. Methods: This non-randomized experimental study was conducted in the Department of Orthopedics, of a tertiary care hospital in Pathankot, Punjab, from January 1, 2022 till July 31, 2022, in which adult patients who underwent elective spine surgeries involving cervical, thoracic and lumbar spine and requiring post-operative care of at least 3 days were included. Every alternate patient received iodine impregnated surgical incise plastic adhesive drape (3M ioban 2) for draping before the skin incision. The patients were followed up on for six months after surgery. Results: It was observed a significantly higher duration of surgery in the PAD group, as compared to those without PAD (140.4±45.6 vs 112.5±36.7 mins, p value <0.05). Furthermore, length of incision was not significantly different between the two patient groups (15.4±6.6 vs 17.3±8.5 cm, p value = 0.71). It was observed that overall infection rate in our study population was 3.85% (n=3). It was found to be 3% in the patients with iodine impregnated PAD and 5% in patients without iodine impregnated PAD, with no significant difference between them (p value = 0.88). Conclusions: We found no data supporting or denying the use of iodine impregnated PAD for lowering the incidence of SSI in patients having elective spine surgery cases

Functional outcome of patients with lumbar intervertebral disc herniation treated by minimally invasive microdiscectomy

Background: The disorder lumbosacral radiculopathy affects the function of one or more lumbosacral nerve roots. The aim of this research is to understand the clinical and epidemiological features of patients diagnosed with disc herniation and treated at our facility using minimally invasive microdisectomy. Methods: From August 2021 to August 2022, we conducted a prospective research in the Department of Orthopedics at a tertiary care hospital in Pathankot. During the study period, all patients over the age of 18 who presented with complaints of leg or back pain, or other neurological symptoms supported by Magnetic Resonance Imaging (MRI) suggestive of disc herniation, were included. All patients were operated using a minimally invasive micro lumbar discectomy method. Results: The majority of patients had less than 100 mL of blood loss (75%) and 72% underwent surgery in less than an hour. Only one patient had an intraoperative cerebrospinal fluid leak and no patient had post-operative infection. It was observed that 81% were admitted for 5 to 8 days. Immediately post-operatively, we observed that 50% had good outcome on MacNab score and 9% had excellent functional outcome. At the final outcome at 6 months, 44% had good functional outcome and 47% had an excellent functional outcome. At the final outcome at 6 months, 44% had good and 50% had excellent functional outcomes. Conclusions: The findings of our study can aid us in budgeting and infrastructure planning for disc herniation patients. Long-term clinical outcomes in these individuals should be the focus of future study

Interlocking nailing for treating comminuted fractures of the shaft of femur

Background: The fracture of the femoral shaft is one of the most frequent fractures seen in orthopaedic practise. The purpose of this study was to evaluate the operative procedure for managing communited fractures of the femoral shaft using interlocking fixation. Methods: This prospective study was conducted in Pathankot, Punjab, with patients who presented to our emergency department as participants. We included all patients over the age of 18 who presented to our emergency department with a comminuted femoral shaft fracture. All patients underwent interlocking nailing. Results: During the study period, 62 patients fulfilled our inclusion and exclusion criteria, 79% of which were males. In the present study, 50% of the patients demonstrated clinical union of the fracture in 12 to 14 weeks, 24% had clinical union in 10 to 12 weeks, while 26% had clinical union in 14 to 16 weeks. Similarly, majority of the patients showed radiological union of the fracture in 16 to 18 weeks (48%). Radiological union occurred in 23% in 14 to 16 weeks and in 29% in 18 to 20 weeks. Majority (77%) of the patients stayed in hospital for 10 to 14 days and the functional outcome as measured by Klemm and Borner criteria was excellent in 63% patients. Infection (5%) and limb length discrepancy less than 5 mm (3%) were the only complications observed in our patient population. Conclusions: Our results show that Interlocking nailing results in good functional outcome with minimal complications

Dynamic hip screw versus proximal femoral nail in the treatment of intertrochanteric fracture of femur

Background: As the elderly population grows, the number of hip fractures continues to increase. This study aims to compare the clinical outcomes of dyanamic hip screw and proximal femoral nail in the fixation of intertrochanteric fracture of femur. Methods: After obtaining approval of the ethics committee, a prospective study was conducted in the department of orthopedics, SKR Hospital, Pathankot from January 2021 till December 2022. Informed consent was taken from patients who fulfilled the inclusion/exclusion criteria and relevant clinical information was collected, including intra and post-operative details. Results: During the study period, 65 patients with intertrochanteric fracture were included in the study, of which 33 were treated with PFN and 32 with DHS. It was observed that 91% of the patients who underwent PFN had blood loss less than 100 ml, while 72% of the patients who had DHS had blood loss between 100-300 ml. Mobilization started on the first postoperative day in 67% of PFN patients while as compared to 13% of DHS patients (p value <0.01). Among late complications, there was one case of implant failure among PFN cases, while there were two cases of non-union, two cases of implant failure and one case of late infection among DHS group of patients. It was observed that 91% of PFN group patients had excellent outcomes, while outcome was excellent in 66% of DHS group patients. Conclusions: Our study showed that PFN is a superior method of osteosynthesis as compared to DHS in the treatment of intertrochanteric fractures

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Seed oil content variation in Jatropha curcas Linn. in different altitudinal ranges and site conditions in

Abstract The present study was conducted to determine the variation in yield and oil content by taking composite sample of six Jatropha trees selected randomly from two cultural site conditions viz. arable (T1), non-arable (T2) and three altitudinal ranges E1 (400-600m) ), E2 (600-800m) and E3 (800-1000 m) in Himachal Pradesh. The oil was extracted from the dried seed using steam distillation method of oil extraction. The highest oil was recovered in T2 E2 (non-arable site with low altitude) various morphological and yield attribute like number of fruits/branches, number of fruits/tree, number of seeds/tree were also studied. Arable site with high altitude (T1E3) recorded the highest value for these parameters

Comparison of on-Treatment Platelet Reactivity Between Triple Antiplatelet Therapy With Cilostazol and Standard Dual Antiplatelet Therapy in Patients Undergoing Coronary Interventions: A Meta-Analysis

Background: The recent literature has shown that triple antiplatelet therapy with cilostazol in addition to the standard dual antiplatelet therapy with aspirin and clopidogrel may reduce platelet reactivity and improve clinical outcomes following percutaneous coronary intervention. The purpose of this meta-analysis is to compare the efficacy of triple antiplatelet therapy and dual antiplatelet therapy in regard to on-treatment platelet reactivity. Methods: Nine studies (n = 2179) comparing on-treatment platelet reactivity between dual antiplatelet therapy (n = 1193) and triple antiplatelet therapy (n = 986) in patients undergoing percutaneous coronary intervention were included. Primary end points were P2Y12 reaction unit (PRU) and platelet reactivity index (PRI). Secondary end points were platelet aggregation with adenosine diphosphate (ADP) 5 and 20 μmol/L and P2Y12% inhibition. Mean difference (MD) and 95% confidence intervals (CI) were computed and 2-sided α error \u3c.05 was considered as a level of significance. Results: Compared to dual antiplatelet therapy, triple antiplatelet therapy had significantly lower maximum platelet aggregation with ADP 5 μmol/L (MD: -14.4, CI: -21.6 to -7.2, P \u3c .001) and 20 mmol/L (MD: -14.9, CI: -22.9 to -6.8, P \u3c .001), significantly lower PRUs (MD: -45, CI: -59.4 to -30.6, P \u3c .001) and PRI (MD: -26, CI: -36.8 to -15.2, P \u3c .001), and significantly higher P2Y12% inhibition (MD: 18.5, CI: 2.3 to 34.6, P = .025). Conclusion: Addition of cilostazol to conventional dual antiplatelet therapy significantly lowers platelet reactivity and may explain a decrease in thromboembolic events following coronary intervention; however, additional studies evaluating clinical outcomes will be helpful to determine the benefit of triple antiplatelet therapy