An unclassified tibial plateau fracture: Reverse Schatzker type IV.

The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level 1 major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture

Towards Sustainable Municipal Solid Waste Management in Malaysia

This work is part of the SYNERGORS project (“A Systems Approach to Synergistic Utilisation of Secondary Organic Streams”) funded by the UKRI Natural Environment Research Council (NE/R012938/1) through the UKRI/NERC Industrial Innovation Fellowship Programme (2018-2021). This project was led by Dr Kok Siew Ng at University of Oxford. Website: https://eng.ox.ac.uk/synergorsProject summary report: https://eng.ox.ac.uk/media/10670/synergors-final-report.pdfEXECUTIVE SUMMARY: The increasing amount of municipal solid waste (MSW) generation and the lack of strategic improvements on solid waste management in Malaysia require urgently the attention of the government and the public.It has been estimated that 1.17 kg/capita/day of MSW is generated in Malaysia, 65% of which is household solid waste that has doubled over the past 20 years due to population growth and urbanisation. Without a sufficient waste treatment and recycling infrastructure in place, most of the MSW is destined to continue to be landfilled. Not only it can cause pollution and health hazards, MSW is also one of the major sources of global methane emissions accounting for 11%. As methane is the second largest contributor of global greenhouse gas emissions after carbon dioxide, it is critical that Malaysia develops systemic sound solid waste management as part of its climate actions guided by the Paris agreement. Also, by treating waste as resource, the recent shift in the government strategy to move towards the circular economy should be aligned with SDG 12 targets (Responsible Consumption and Production). Although the quantity of recyclable waste collected tripled between 2018 and 2021, the officially reported recycling rate of 31.5% in 2021 remains questionable as the recycling infrastructure in Malaysia is not yet well established. This points to the significant efforts Malaysia needs to make to move towards a sustainable waste management regime, and to achieve its ambition for reaching a recycling target of 40% by 2025. Malaysia started implementing a plan for moving towards sustainable waste management in the early 1990s. However, the recycling programmes were not well received by the public at that time, and it was only in 2001, that policy goals for sustainable waste management have been included in the regulatory landscape through the 8th Malaysia Plan (2001-2005). In 2005, the National Strategic Plan for Solid Waste Management was developed to guide solid waste policy planning and resource allocation. Two years after, the Solid Waste and Public Cleansing Management Act 2007 (Act 672) was created that came into enforcement in September 2011 in six out of the thirteen states (Perlis, Kedah, Pahang, Negeri Sembilan, Melaka, Johor) and two out of the three federal territories (i.e. Kuala Lumpur and Putrajaya). This partial adoption of the Act has created inconsistency in waste management and planning as well as incomplete waste data gathering. This,has led to ineffective waste management practices, that, in turn, resulted in long-term environmental, economic and social consequences. Even though sustainable waste management goals continue to be included in the recent 12th Malaysia Plan (2021-2025), the lack of public awareness on the importance of source separation of waste and recycling prevents progress in this field. The infrastructure for waste collection and treatment is also insufficient to serve the needs. All these factors have created significant barriers for Malaysia to realise sustainable waste management.UK Natural Environment Research Council (NE/R012938/1

Sect and House in Syria: History, Architecture, and Bayt Amongst the Druze in Jaramana

This paper explores the connections between the architecture and materiality of houses and the social idiom of bayt (house, family). The ethnographic exploration is located in the Druze village of Jaramana, on the outskirts of the Syrian capital Damascus. It traces the histories, genealogies, and politics of two families, bayt Abud-Haddad and bayt Ouward, through their houses. By exploring the two families and the architecture of their houses, this paper provides a detailed ethnographic account of historical change in modern Syria, internal diversity, and stratification within the intimate social fabric of the Druze neighbourhood at a time of war, and contributes a relational approach to the anthropological understanding of houses

Extreme sensitivity of the spin-splitting and 0.7 anomaly to confining potential in one-dimensional nanoelectronic devices

Quantum point contacts (QPCs) have shown promise as nanoscale spin-selective components for spintronic applications and are of fundamental interest in the study of electron many-body effects such as the 0.7 x 2e^2/h anomaly. We report on the dependence of the 1D Lande g-factor g* and 0.7 anomaly on electron density and confinement in QPCs with two different top-gate architectures. We obtain g* values up to 2.8 for the lowest 1D subband, significantly exceeding previous in-plane g-factor values in AlGaAs/GaAs QPCs, and approaching that in InGaAs/InP QPCs. We show that g* is highly sensitive to confinement potential, particularly for the lowest 1D subband. This suggests careful management of the QPC's confinement potential may enable the high g* desirable for spintronic applications without resorting to narrow-gap materials such as InAs or InSb. The 0.7 anomaly and zero-bias peak are also highly sensitive to confining potential, explaining the conflicting density dependencies of the 0.7 anomaly in the literature.Comment: 23 pages, 7 figure

Preconditioning of Cardiosphere-Derived Cells With Hypoxia or Prolyl-4-Hydroxylase Inhibitors Increases Stemness and Decreases Reliance on Oxidative Metabolism

Cardiosphere-derived cells (CDCs), which can be isolated from heart explants, are a promising candidate cell source for infarcted myocardium regeneration. However, current protocols used to expand CDCs require at least 1 month in vitro to obtain sufficient cells for transplantation. We report that CDC culture can be optimized by preconditioning the cells under hypoxia (2% oxygen), which may reflect the physiological oxygen level of the stem cell niche. Under hypoxia, the CDC proliferation rate increased by 1.4-fold, generating 6 × 10(6) CDCs with higher expression of cardiac stem cell and pluripotency gene markers compared to normoxia. Furthermore, telomerase (TERT), cytokines/ligands involved in stem cell trafficking (SDF/CXCR-4), erythropoiesis (EPO), and angiogenesis (VEGF) were increased under hypoxia. Hypoxic preconditioning was mimicked by treatment with two types of hypoxia-inducible factor (HIF) prolyl-4-hydroxylase inhibitors (PHDIs): dimethyloxaloylglycine (DMOG) and 2-(1-chloro-4-hydroxyisoquinoline-3-carboxamido) acetic acid (BIC). Despite the difference in specificity, both PHDIs significantly increased c-Kit expression and activated HIF, EPO, and CXCR-4. Furthermore, treatment with PHDIs for 24 h increased cell proliferation. Notably, all hypoxic and PHDI-preconditioned CDCs had decreased oxygen consumption and increased glycolytic metabolism. In conclusion, cells cultured under hypoxia could have potentially enhanced therapeutic potential, which can be mimicked, in part, by PHDIs

Scoping review : intergenerational resource transfer and possible enabling factors

We explore the intergenerational pattern of resource transfer and possible associated factors. A scoping review was conducted of quantitative, peer-reviewed, English-language studies related to intergenerational transfer or interaction. We searched AgeLine, PsycINFO, Social Work Abstracts, and Sociological Abstracts for articles published between Jane 2008 and December 2018. Seventy-five studies from 25 countries met the inclusion criteria. The scoping review categorised resource transfers into three types: financial, instrumental, and emotional support. Using an intergenerational solidarity framework, factors associated with intergenerational transfer were placed in four categories: (1) demographic factors (e.g., age, gender, marital status, education, and ethno-cultural background); (2) needs and opportunities factors, including health, financial resources, and employment status; (3) family structures, namely, family composition, family relationship, and earlier family events; and (4) cultural-contextual structures, including state policies and social norms. Those factors were connected to the direction of resource transfer between generations. Downward transfers from senior to junior generations occur more frequently than upward transfers in many developed countries. Women dominate instrumental transfers, perhaps influenced by traditional gender roles. Overall, the pattern of resource transfer between generations is shown, and the impact of social norms and social policy on intergenerational transfers is highlighted. Policymakers should recognise the complicated interplay of each factor with different cultural contexts. The findings could inform policies that strengthen intergenerational solidarity and support.</jats:p

MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer

Purpose: The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. Methods: This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and “category of guideline” (i.e., “recommendation”, “suggestion” or “no guideline possible”). Results: Twelve generic suggestions (level of evidence – 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. Conclusions: This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management