Achieving hip fracture surgery within 36 hours: an investigation of risk factors to surgical delay and recommendations for practice

BACKGROUND: The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. MATERIALS AND METHODS: Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. RESULTS: A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ (2) (1, N = 512) = 0.10, p = 0.757]. CONCLUSIONS: Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable. LEVEL OF EVIDENCE: III

UJI EFEKTIFITAS POLY4 SIRIUS SEBAGAI SUMBER KMgS TERHADAP pH TANAH DAN PRODUKTIVITAS JAGUNG (Zea Mays L.) DI PROBOLINGGO JAWA TIMUR

Penelitian Uji Efektifitas Poly4 Sirius sebagai sumber KMgS terhadap pH tanah dan produktivitas jagung dilaksanakan di Kebun Percobaan Balai Penelitian Tanaman Kacang dan Umbi, KP. Muneng, Kab. Probolinggo, Jawa Timur. Waktu penelitian Juli-November 2018. Percobaan menggunakan Rancangan Acak Kelompok diulang empat  kali, terdiri dari 12 kombinasi takaran pemberian pupuk urea, Poly4,  SP 36, Kieserite dan NPK, menggunakan jarak tanam 70 cm x 20 cm dengan menggunakan varietas Bisi 18, dimana setiap unit perlakuan ditanam 8 baris tanam dengan panjang baris 6 m. Hasil penelitian menunjukkan bahwa pupuk majemuk Poly4 sebagai salah satu sumber K memiliki kualitas yang sama dengan pupuk KCl, di mana penggunaan pupuk Poly4 dengan takaran 257 kg/ha (setara 36 kg K2O/ha) yang dikombinasikan dengan pupuk NP (urea takaran 413 kg/ha dan pupuk SP36 250 kg/ha) memberikan hasil 13,3 t/ha yang tidak berbeda nyata dengan pemupukan  NP yang dikombinasikan dengan pupuk KCl 100 kg/ha dengan hasil 12,6 t/ha. Pupuk Poly4 selain mengandung hara K yang berdampak positif terhadap pertumbuhan diameter juga mengandung hara Mg berdampak positif terhadap peningkatan kandungan klorofil daun jagun

Relationship Between Surfactant and Population of Heterotrophic Bacteria in Estuary of Dumai River Dumai City Riau Province

This research was conducted on April 2017. Sampling was conducted in estuary of Dumai River, Dumai City, Riau Province. A study aims to determine the relationship between concentration of surfactant and population of heterotrophic bacteria in the estuary waters of Dumai River Dumai City Riau Province. Sampling was done at 6 sampling points (stations). The analysis of surfactant concentration was conducted at the Chemical Laboratory of the Sea and the total analysis of heterotrophic bacteria at the Marine Microbiology Laboratory of Department of Marine Science Faculty of Fisheries and Marine University of Riau, Pekanbaru. The results showed that the highest concentration of surfactant was found at Station 5 (0.8538 mg / l) and the lowest at Station 1 (0.2025 mg / l). Then, the logarithm of the highest average total colony was found at Station 1 (6.18 cells / ml) while the lowest at Station 5 (5.66 cells / ml). The correlation concentration models of surfactant with the total colony using regression was negative correlation Y = 6.3745 - 0.7882 (X), R2 = 0.8622, r = 0.9285 showed that the value of surfactant concentration (X) increased by 1 unit will decrease the total of colony (Y) was 0,7882 cells/ml, with the effect of surfactant to bacteria equal 85% and the level of closeness of the relationship was 93%

Modelling of land use and land cover changes and prediction using CA-Markov and Random Forest

We used the Cellular Automata Markov (CA-Markov) integrated technique to study land use and land cover (LULC) changes in the Cholistan and Thal deserts in Punjab, Pakistan. We plotted the distribution of the LULC throughout the desert terrain for the years 1990, 2006 and 2022. The Random Forest methodology was utilized to classify the data obtained from Landsat 5 (TM), Landsat 7 (ETM+) and Landsat 8 (OLI/TIRS), as well as ancillary data. The LULC maps generated using this method have an overall accuracy of more than 87%. CA-Markov was utilized to forecast changes in land usage in 2022, and changes were projected for 2038 by extending the patterns seen in 2022. A CA-Markov-Chain was developed for simulating long-term landscape changes at 16-year time steps from 2022 to 2038. Analysis of urban sprawl was carried out by using the Random Forest (RF). Through the CA-Markov Chain analysis, we can expect that high density and low-density residential areas will grow from 8.12 to 12.26 km2 and from 18.10 to 28.45 km2 in 2022 and 2038, as inferred from the changes occurred from 1990 to 2022. The LULC projected for 2038 showed that there would be increased urbanization of the terrain, with probable development in the croplands westward and northward, as well as growth in residential centers. The findings can potentially assist management operations geared towards the conservation of wildlife and the eco-system in the region. This study can also be a reference for other studies that try to project changes in arid are as undergoing land-use changes comparable to those in this study

Reliability of Community Health Worker Collected Data for Planning and Policy in a Peri-Urban Area of Kisumu, Kenya

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question “What is the reliability of data collected at the Community level by Community health workers?”. The methods which we use to find an reliable answer to this question is “Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability”. Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive

Perceptions about data-informed decisions: an assessment of information-use in high HIV-prevalence settings in South Africa

BACKGROUND: Information-use is an integral component of a routine health information system and essential to influence policy-making, program actions and research. Despite an increased amount of routine data collected, planning and resource-allocation decisions made by health managers for managing HIV programs are often not based on data. This study investigated the use of information, and barriers to using routine data for monitoring the prevention of mother-to-child transmission of HIV (PMTCT) programs in two high HIV-prevalence districts in South Africa. METHODS: We undertook an observational study using a multi-method approach, including an inventory of facility records and reports. The performance of routine information systems management (PRISM) diagnostic ‘Use of Information’ tool was used to assess the PMTCT information system for evidence of data use in 57 health facilities in two districts. Twenty-two in-depth interviews were conducted with key informants to investigate barriers to information use in decision-making. Participants were purposively selected based on their positions and experience with either producing PMTCT data and/or using data for management purposes. We computed descriptive statistics and used a general inductive approach to analyze the qualitative data. RESULTS: Despite the availability of mechanisms and processes to facilitate information-use in about two-thirds of the facilities, evidence of information-use (i.e., indication of some form of information-use in available RHIS reports) was demonstrated in 53% of the facilities. Information was inadequately used at district and facility levels to inform decisions and planning, but was selectively used for reporting and monitoring program outputs at the provincial level. The inadequate use of information stemmed from organizational issues such as the lack of a culture of information-use, lack of trust in the data, and the inability of program and facility managers to analyze, interpret and use information. CONCLCUSIONS: Managers’ inability to use information implied that decisions for program implementation and improving service delivery were not always based on data. This lack of data use could influence the delivery of health care services negatively. Facility and program managers should be provided with opportunities for capacity development as well as practice-based, in-service training, and be supported to use information for planning, management and decision-making

Assessing the perceptions of a biostatistics and epidemiology module: Views of Year 2 medical students from a Malaysian university. A cross-sectional survey

Background In the era of evidence based medicine, biostatistics and epidemiology are considered as the main elements aiding the health professional to design a research study, understand the literature, and make decisions about patient care. The aim of the study is to explore students' perception about this subject because it plays an important role in determining educational outcome. Methods Data were collected from a self-administered questionnaire distributed among 164 Year 2 medical students. The 5-point Likert scale anchored by Strongly disagree = 1 and Strongly agree = 5 included 36 questions in four domains designed to assess the perception of a biostatistics and epidemiology module amongst students. Results 138 students with ages ranging from 20 to 24 years (Mean = 20.7; SD = 0.62) returned their responses to the questionnaire. This was a response rate of 84.14%. Of the 138 students, 80.7% realized the relevance of the subject to real health issues at the end of the module, while 89.8% believed the module focused on interpretation more than calculation. More than three quarters (78.1%) agreed that lack of practicing exercises was the cause for declining interest in the subject, while only 26.1% believed that lectures were not interesting. Another three quarters (75.4%) believed that there were too many lectures for one day of teaching activities, while 84.6% recommended practical sessions for designing research and data collection. Conclusions This study found that students perceived the relevance of biostatistics and epidemiology to real health issues. The major cause of poor interest in the subject was attributed to the short duration of the course, lack of practicing exercises, and the need for practical data collection sessions. Emphasis should be given to early introduction of projects for data collection and analysis

The HIV-1 Nef protein binds argonaute-2 and functions as a viral suppressor of RNA interference

The HIV-1 accessory protein Nef is an important virulence factor. It associates with cellular membranes and modulates the endocytic machinery and signaling pathways. Nef also increases the proliferation of multivesicular bodies (MVBs), which are sites for virus assembly and budding in macrophages. The RNA interference (RNAi) pathway proteins Ago2 and GW182 localize to MVBs, suggesting these to be sites for assembly and turnover of the miRNA-induced silencing complex (miRISC). While RNAi affects HIV replication, it is not clear if the virus encodes a suppressor activity to overcome this innate host response. Here we show that Nef colocalizes with MVBs and binds Ago2 through two highly conserved Glycine-Tryptophan (GW) motifs, mutations in which abolish Nef binding to Ago2 and reduce virus yield and infectivity. Nef also inhibits the slicing activity of Ago2 and disturbs the sorting of GW182 into exosomes resulting in the suppression of miRNA-induced silencing. Thus, besides its other activities, the HIV-1 Nef protein is also proposed to function as a viral suppressor of RNAi (VSR)