Evaluation of effectiveness of Ponseti's method in the clubfoot management under 1-year children: a prospective study

Background: Congenital talipes equino Varus is common congenital orthopedic foot deformity in children characterized by hindfootequinus, hind foot varus, midfoot cavus, and forefoot adduction deformities. There is a necessity to analyze the number of casts employed in the treatment, compliance of bracing, relapse pattern and percentages of surgical referral under 1 year of age for clear understanding and better practice to achieve successful outcomes. This study aimed to judge the effectiveness of Ponseti in the treatment of clubfoot under 1-year old children.  Methods: The patients were selected in the OPD and evaluated for virgin idiopathic clubfoot under 1-year age. Serial casting done weekly by Ponseti method after assessing Pirani and Demeglio score before every cast.Results: In our study all 29 clubfeet that were treated by Ponseti method showed complete correction. Minimum cast being 5 and maximum being 10 casts. Corrected feet were supple, plantigrade and painless of which 1 foot had relapse<3weeks due to ill-fitting shoes. Which was subsequently corrected with repeat tenotomy and cast application.Conclusions: The Ponseti method is a safe, effective, cheap and reproducible method for correction of CTEV which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot under 1-year age. For successful outcome and to prevent relapse, this technique must be applied strictly in accordance to the protocol and parents must be taught the importance of full compliance with bracing. Our series has a short follow up. Longer follow-up is needed for further evaluation of effectiveness of Ponseti method.

Arthroscopic repair of rotator cuff tears: analysis and functional outcome

Background: Rotator cuff injuries are common injuries occurring around the shoulder with an incidence ranging from 5 to 39%. Rotator cuff tears can be either partial thickness or full thickness. If remains untreated, may lead to persistent shoulder pain, functional limitation and decreased quality of life. In the present study, we assess the functional outcome following arthroscopic repair of rotator cuff tears. We also assess the various parameters affecting the functional outcome following repair.Methods: 15 patients with rotator cuff tears were subjected to this study. Preoperative evaluation of the American Shoulder and Elbow Surgeons (ASES) shoulder score and University of California and Los Angeles (UCLA) shoulder score was done. Arthroscopic rotator cuff repair using single row repair with suture anchors was done. The patients were followed up at 6 weeks, 3 months and 6 months where ASES score and UCLA score were assessed.Results: Of the 15 patients, 14 had supraspinatus tear, 2 patients had infraspinatus tear and 2 patients had subscapularis tear. According to UCLA scoring system 22% patients had excellent, 43% patients had good results, 23% patients had fair results and 12% patients had poor results. ASES score also showed progressive improvement at subsequent follow ups at 3 and 6 months.Conclusions: From our present study we conclude that arthroscopic rotator cuff repair is a good modality showing excellent functional outcome with less morbidity, minimal postoperative pain, better cosmesis and early resumption of daily routine activities.

Demographic profile and functional outcome following fixation of malleolar fractures in adults

Background: Malleolus are important structures which forms part of ankle mortise and provide stability to it. This article underlines the current demographic profile of patients sustaining malleolar fractures in adults. It also discusses the modalities of treatment and functional outcomes following open reduction and internal fixation of these fractures as well as the improvement in functional outcome following early mobilization.Methods: 30 patients sustaining malleolar fractures who attended the Department of Orthopedics were included in the study. The patients were operated as and when the soft tissue condition permitted and were followed up in outpatient department at 6 weeks, 3 months and 6 months where functional outcome based on Baird and Jackson scoring system was assessed.Results: In this study, the average age of patients was 43.8 years with a male preponderance. Supination-external rotation was the most common mechanism of injury following a slip or twisting injury. According to Baird and Jackson scoring system 20% patients had excellent, 50% patients had good results, 20% patients had fair results and 10% patients had poor results.Conclusions: 70% patients had excellent to good results following fixation of malleolar fractures. Early mobilization was started in 5 patients with 80% patients showing excellent results. Open reduction and Internal fixation proved to be an excellent procedure leading to union in all cases, less complication and early resumption of routine activities.

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review.

BACKGROUND: Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. METHODS: Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. RESULTS: One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). CONCLUSION: Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation

Recovering global supply chains from supply interruptions: the role of sourcing strategy

Problem definition: Fast recovery from sourcing interruptions is a key objective for global supply chains and for business continuity professionals. In this paper, we study the impact of different supply chain strategies—supplier diversification and the use of long-term relationships—on the ability of a supply chain to recover from sourcing interruptions. Academic/Practical relevance: Improving supply chains’ recovery ability has been an important focus area for both practitioners and academics. Collectively, available anecdotal evidence and theoretical analyses provide ambiguous recommendations driven by competing effects of different sourcing strategies. Our paper provides the first rigorous and large-scale empirical evidence relating the use of different supply chain strategies to the ability of a supply chain to recover from supply-interruptions. Methodology: We develop a compound estimator of a supply-chain’s recovery rate that can be constructed using limited available data (only the time series of firms’ actual sourcing behaviour). Using more than two and half million import manifests, we extract firms’ maritime sourcing transactions and we use this data to estimate recovery rates of different firm-category supply chains of publicly traded US firms. Results: We find that supplier diversification is associated with slower recovery from sourcing interruptions, while the use of long-term relationships is associated with faster recovery. A one standard deviation decrease in the former is associated with a 16% faster recovery, and a like increase in the latter is associated with a 20% faster recovery. Managerial implications: Our paper brings important empirical evidence to the hitherto theoretical debate on the impact of sourcing strategies on faster recovery in supply chains. We therefore provide actionable advice on supply chain design for faster recovery

Hospital Variation in Survival Trends for In‐hospital Cardiac Arrest

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139094/1/jah3561.pd

Retrospective cohort study of hospital variation in airway management during in-hospital cardiac arrest and the association with patient survival: insights from Get With The Guidelines-Resuscitation

Abstract Importance The optimal approach to airway management during in-hospital cardiac arrest is unknown. Objective To describe hospital-level variation in endotracheal intubation during cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and the association between hospital use of endotracheal intubation and arrest survival. Design, setting, participants Retrospective cohort study of adult patients suffering in-hospital cardiac arrest at Get With The Guidelines-Resuscitation participating hospitals between January, 2000, and December, 2016. Hospitals were categorized into quartiles based on the proportion of in-hospital cardiac arrest patients managed with endotracheal intubation during CPR. Risk-adjusted mixed models with random intercepts were created to assess the association between hospital quartile of in-hospital arrests managed with endotracheal intubation during CPR and survival to hospital discharge. Exposure Hospital rate of endotracheal intubation during CPR for in-hospital arrest Main outcomes and measures Survival to hospital discharge Results Among 155,252 patients suffering in-hospital cardiac arrest at 656 hospitals, 69.7% of patients received endotracheal intubation during CPR and overall survival to discharge was 24.8%. At the hospital level, the median rate of endotracheal intubation use was 71.2% (interquartile range, 63.6 to 78.1%; range, 26.6 to 100%). We found a strong inverse association between hospital rate of endotracheal intubation and survival to discharge (risk-adjusted odds ratio comparing highest intubation quartile vs. lowest intubation quartile, 0.81; 95% confidence interval (CI), 0.74 to 0.90; p value < .001). This association was modified by the presence of respiratory failure prior to arrest (p for interaction < .001), and stratified analyses demonstrated lower patient survival at hospitals with higher rates of endotracheal intubation was limited to patients without respiratory failure prior to cardiac arrest. Conclusion In a national sample of patients suffering IHCA, the use of endotracheal intubation during CPR varied across hospitals. We found a strong inverse association between hospital use of endotracheal intubation during CPR and survival to discharge, but this association was confined to patients without respiratory failure prior to arrest. Identifying the optimal approach to airway management for in-hospital cardiac arrest may have a significant impact on patient survival.https://deepblue.lib.umich.edu/bitstream/2027.42/149130/1/13054_2019_Article_2426.pd

The Effect of Hybrid Photovoltaic Thermal Device Operating Conditions on Intrinsic Layer Thickness Optimization of Hydrogenated Amorphous Silicon Solar Cells

Historically, the design of hybrid solar photovoltaic thermal (PVT) systems has focused on cooling crystalline silicon (c-Si)-based photovoltaic (PV) devices to avoid temperature-related losses. This approach neglects the associated performance losses in the thermal system and leads to a decrease in the overall exergy of the system. Consequently, this paper explores the use of hydrogenated amorphous silicon (a-Si:H) as an absorber material for PVT in an effort to maintain higher and more favourable operating temperatures for the thermal system. Amorphous silicon not only has a smaller temperature coefficient than c-Si, but also can display improved PV performance over extended periods of higher temperatures by annealing out defect states from the Staebler-Wronski effect. In order to determine the potential improvements in a-Si:H PV performance associated with increased thicknesses of the i-layers made possible by higher operating temperatures, a-Si:H PV cells were tested under 1 sun illumination (AM1.5) at temperatures of 25oC (STC), 50oC (representative PV operating conditions), and 90 oC (representative PVT operating conditions). PV cells with an i-layer thicknesses of 420, 630 and 840 nm were evaluated at each temperature. Results show that operating a-Si:H-based PV at 90 oC, with thicker i-layers than the cells currently used in commercial production, provided a greater power output compared to the thinner cells operating at either PV or PVT operating temperatures. These results indicate that incorporating a-Si:H as the absorber material in a PVT system can improve the thermal performance, while simultaneously improving the electrical performance of a-Si:H-based PV