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Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.

Background: Nursing deficits are growing, and healthcare providers in developed countries must address the challenges of ethically building a sustainable workforce without a continued excessive reliance on overseas recruitment. To secure this, a focus on long-term retention of international recruits is paramount. Objective: To explore the migration motivations and experiences of initial integration for internationally recruited nurses within the healthcare system (England). Design: A mixed methods survey. Setting(s) and participants: 655 internationally recruited nurses who had recently commenced work in England completed the survey. Methods: qualitative and quantitative data was gathered to explore internationally recruited nurses’ demographics and professional backgrounds, migration motivations, application processes, arrival and settlement and initial experiences of integration into the workforce alongside their support and future aspirations. Results: The quantitative results revealed a population of international nurses that were highly educated and vastly experienced, with career development and desires to improve quality of life being the primary motivations for migration. Participants indicated a perception of being well supported during initial application and arrival stage, however, did experience some degree of challenge during workplace integration involving fluctuating levels of support and appointments into positions that did not match their years of experience and previous qualifications. This data was reinforced further detailed by the qualitative feedback that illuminated the difficulties nurses can face during initial arrival and integration and the apparent impact on mental well-being. Conclusion: This paper, contextualised with an international literature base verifying the experiences of internationally recruited nurses, argues that it is the consistent responsibility of employers in developed countries to protect the experiences of international recruits. This can be done by investing in solutions as a key retention strategy.

Background: International nurses (migrant nurses who are recruited to work in different countries) make essential contributions to global health and care workforces that are experiencing domestic nurse shortages. Global recruitment and migration is increasing, and with growing dependency on international nurses, health and care employers must understand their lived experiences if they want to support acculturation and subsequent retention. Aim: This paper reports a systematic review of qualitative literature on the experiences of international nurses working overseas. The aim is to explore the lived experiences of international nurses working and living in different countries globally. We argue their experiences shape socialisation and contribute to longer term retention of this fundamental nursing workforce. Method: A systematic literature search was carried out in Medline, CINAHL, PsychInfo, PubMed and Web of Science for global research publications from 2010 to 2020. Research studies conducted in Australia, Canada, New Zealand, the United Kingdom and the United States were identified, quality appraised and subjected to data extraction/analysis. Findings: The findings of twenty seven papers were synthesised into six themes: (1) individual and organisational preparedness, (2) communication and the art of language, (3) principles and practices of nursing, (4) social and cultural reality, (5) equality, diversity and inclusion, and (6) facilitators of integration and adaptation. Discussion: Whilst experiences are multifaceted and complex, factors shaping acculturation of international nurses were transferable across various countries. Individual motivations for migration should be recognised, and short term, transitional and long term needs must be identified to support development needs and ongoing career progression. Cultural integration and language barriers should be sensitively managed to enable effective acculturation. Culturally sensitive leadership is also key to ensuring zero tolerance of inappropriate racist and discriminatory behaviours. Conclusion: Health and care employers offer tangible benefits for international nurse workforces and in culturally compassionate and professional sociocultural environments, international nurses can thrive. However, to effectively retain this workforce in the longer term, significant improvement is required across a number of areas. Tweetable abstract: This new systematic review paper explores the factors that can support acculturation and retention of internationally-recruited nurses globally.

Similar to most wetlands, the Florida Everglades landscape was altered to promote agriculture and human settlement, significantly altering the natural hydrologic regime. Once former agricultural land located within Everglades National Park (ENP), the Hole-in-the-Donut (HID) wetland restoration program became the first mitigation bank project in Florida. The HID program utilized a restoration technique of complete soil removal to effectively eradicate an invasive plant species. This research investigated the effects of the vegetation and soil removal on the hydrologic conditions of the HID, specifically evapotranspiration and water chemistry. Annual evapotranspiration rates were determined for the region using remotely sensed data and compared to the acres restored over a 15-year period. Groundwater and surface waters were collected from both inside the HID and from adjacent areas within ENP for major cations and anions and total nutrient concentrations. Evapotranspiration rates were found to decrease from a mean of 1083.4 mm year−1 in the year 2000 to 891.6 mm year−1 in 2014 as the restored area increased to 4893 acres. Concentrations of ions and nutrients were lower in groundwater and surface water within the restored areas compared to adjacent areas. We conclude that the lack of soil cover (along with reduced evapotranspiration rates) contributed to the lower ion and nutrient concentrations in the surface water and groundwater within the HID.

Plants are in a constant evolutionary arms race with their pathogens. At the molecular level, the plant nucleotide-binding leucine-rich repeat receptors (NLRs) family has coevolved with rapidly evolving pathogen effectors. While many NLRs utilize variable leucine-rich repeats (LRRs) to detect effectors, some have gained integrated domains (IDs) that may be involved in receptor activation or downstream signaling. The major objectives of this project were to identify NLR genes in wheat (Triticum aestivum L.) and assess IDs associated with immune signaling (e.g., kinase and transcription factor domains). We identified 2,151 NLR-like genes in wheat, of which 1,298 formed 547 gene clusters. Among the non-toll/interleukin-1 receptor NLR (non-TNL)-like genes, 1,552 encode LRRs, 802 are coiled-coil (CC) domain-encoding (CC-NBS-LRR or CNL) genes, and three encode resistance to powdery mildew 8 (RPW8) domains (RPW8-NBS-LRR or RNL). The expansion of the NLR gene family in wheat is attributable to its origin by recent polyploidy events. Gene clusters were likely formed by tandem duplications, and wheat NLR phylogenetic relationships were similar to those in barley and Aegilops. We also identified wheat NLR-ID fusion proteins as candidates for NLR functional diversification, often as kinase and transcription factor domains. Comparative analyses of the IDs revealed evolutionary conservation of more than 80% amino acid sequence similarity. Homology assessment indicates that these domains originated as functional non-NLR-encoding genes that were incorporated into NLR-encoding genes through duplication events. We also found that many of the NLR-ID genes encode alternative transcripts that include or exclude IDs, a phenomenon that seems to be conserved among species. To verify this, we have analyzed the alternative transcripts that include or exclude an ID of an NLR-ID from another monocotyledon species, rice (Oryza sativa). This indicates that plants employ alternative splicing to regulate IDs, possibly using them as baits, decoys, and functional signaling components. Genomic and expression data support the hypothesis that wheat uses alternative splicing to include and exclude IDs from NLR proteins.

Presents the construction of lines of transgenic mice containing the human A gamma globin gene linked to the locus control region. Experimental methods; Findings and discussion.