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Background Inadequate health human resources is a key challenge to advancing child survival in Ghana. Nurses are an essential human resource to target because they represent the largest portion of the health workforce. Building on lessons learned from our pilot pediatric nurse training project and World Health Organization guidelines for transforming and scaling up health professional education, this project aimed to; train 500 pediatric nurse specialists through a one-year training program; develop and integrate a critical mass of pediatric nursing faculty and establish a national standardized pediatric nursing curriculum. This study aimed to evaluate the effectiveness of a national pediatric nurse training program in Ghana at the end of 4 years, including eight cohorts with 330 graduates. Methods This was a mixed-method evaluation with surveys, focus groups and a pre-test/post-test design. Before and after surveys were used to measure knowledge and confidence at baseline and graduation. Objective Structured Clinical Examinations (OSCE) were used to measure clinical skills at baseline, graduation, and 14 months follow-up. At the end of every module, surveys were used to measure students’ satisfaction. Focus groups at graduation qualitatively measured program outcomes. Repeat focus groups and surveys at 14 months after graduation captured the graduates’ career progress, experiences reintegrating into the health system and long-term program outcomes. Results Overall, the graduates completed the program with significantly increased knowledge, confidence, and clinical skills. They also had increased job satisfaction and were able to apply what they learned to their jobs, including leadership skills and gender-sensitive care. Data from 14-month follow-up OSCEs showed that all graduates remained competent in communication, physical assessment, and emergency care, although some obtained a lower mark compared to their performance at graduation. This finding is linked with the observation that the amount of mentorship, support from leadership and equipment that the graduates accessed from their respective facilities varied. Conclusions Mixed-methods evaluations demonstrated significant increases in knowledge confidence and skills by completing the program and maintenance of skills more than 1 year after graduation. Findings have implications for those working on the design, implementation, and evaluation of nursing education interventions in low- and middle-income countries.

A new class of highly efficient blue emitters consisting of phenanthroimidazole–carbazole hybrid disc-shaped molecules with two Schiff base units have been designed and well characterized. All the prepared materials exhibited a columnar hexagonal phase (Colh) over a broad temperature range and a stabilized mesophase at room temperature with good thermal stability. Their electrochemical, thermal and photophysical behavior was extensively evaluated using cyclic voltammetry (CV), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), polarized optical microscopy (POM) and UV-visible spectrophotometry. The synthesized compounds exhibited blue-light emission in the solid thin film as well as in the solution state. The number of alkoxy side chains (–OR) substituted at terminal positions inbuilt with Schiff base groups on the phenanthroimidazole-substituted carbazole core showed an influence on the thermal behavior and stability of the mesophase. These types of materials are promising due to their wide range of columnar hexagonal phases, self-assembly and blue-light emission in solution as well as solid state.

Patients with end-stage single compartment osteoarthritis benefit from the less invasive unicompartmental knee arthroplasty (UKA). With increasing financial restraints, some healthcare services have set specific BMI cut-offs when determining patient eligibility for knee arthroplasty due to perceived obesity-related complications. The aim of this systematic review is to determine the effect obesity has on outcomes following UKA, and thus elucidate whether obesity should be a contraindication for UKA. A PRISMA systematic review was conducted using five databases (MEDLINE, EMBASE, Cochrane, PubMed and Web of Science) to identify all clinical studies that examined the effect of obesity on outcomes following UKA. Quantitative meta-analysis was carried out using RevMan 5.3 software. Quality assessment was carried out using the Critical Appraisal Skills Programme (CASP) checklist. Thirty studies, including a total of 80 798 patients were analysed. The mean follow- up duration was 5.42 years. Subgroup meta-analyses showed no statistically significant difference following UKA between patients cohorts with and without obesity in overall complication rates (95% CI, P = 0.52), infection rates (95% CI, P = 0.81), and revision surgeries (95% CI, P = 0.06). When further analysing complications, no differences were identified in minor (95% CI, P = 0.23) and major complications (95% CI, P = 0.68), or venous thromboembolism rates (95% CI, P = 0.06). When further analysing revision surgeries, no differences were identified for revisions specifically for infection (95% CI, P = 0.71) or aseptic loosening (95% CI, P = 0.75). This meta-analysis shows that obesity does not result in poorer post-operative outcomes following UKA and should not be considered a contraindication for UKA. Future studies, including long-term follow-up RCTs and registry-level analyses, should examine factors associated with obesity and consider stratifying obesity to better delineate any potential differences in outcomes.

This paper reports the first fluorescent supramolecular columnar liquid crystals derived from chalcone-biphenyl amine-functionalized on the lower rim of calixarene core with a good temperature range. The structural characterization and possible conformation of these supramolecular materials were studied by FT-IR, 1H NMR, 13C NMR and HRMS spectroscopic techniques. The photophysical and electrochemical properties were investigated by UV-visible spectrophotometry and cyclic voltammetry, respectively. All the synthesized materials (7a–7d) showed blue-light emission in solution, as well as in thin films, with good quantum yields. The number of peripheral alkoxy side chains substituted on the terminal position affected the thermal durability and stability of the calixarene derivatives. These supramolecules showed columnar self-assembly and stabilized mesophase with good thermal stability. The application of these chalcone ester-based supramolecular columnar liquid crystalline materials was tested by fabricating efficient blue organic light-emitting diodes (OLEDs) with either neat or doped materials.

Anterior cruciate ligament (ACL) reconstruction has been a successful treatment for ACL rupture. However ongoing rotational instability can be an issue. Several surgical techniques have been recommended to overcome this including lateral extra-articular tenodesis (LET) and more recently anterolateral ligament reconstruction (ALLR).To compare the clinical outcomes following ACL reconstruction (ACLR) alone or ACLR with either LET or ALLR.A systematic review was conducted by means of four databases (MEDLINE, EMBASE, Cochrane and Clinical.Trials.Gov), and thePooled meta-analyses illustrated that ACLR with additional LET or ALLR results in improved pivot shift test scores, compared to isolated ACLR. There was no statistically significant difference in International Knee Documentation Committee (IKDC) clinical scores with addition of either LET or ALLR. ACL re-rupture rates were compared between LET and ALLR techniques. There was a statistically significant difference between techniques, with a 1.14% rupture rate in ACLR +ALLR, and 4.03% rupture rate in ACLR + LET. Isolated ACLR re-rupture rates were 12.59%, significantly higher than when augmented with either ALLR or LET (This meta-analysis has found that use of either LET or ALLR in addition to ACLR results in improved mechanical outcomes suggesting surgeons should consider augmenting ACLR with an extra-articular procedure in patients with rotatory instability. Furthermore, both anterolateral extra articular procedures in addition to ACLR lead to reduced ACL re-rupture rates compared to isolated ACLR. Moreover, ALLR results in reduced ACL re-rupture rates, compared to LET. More research is needed to compare the two respective extra-articular procedures.

The prevalence of Vitamin D deciency in India ranges from 50% to 94% in different age groups. Primary objective of the study was to determine the prevalence of vitamin D deciency among adults with nonspecic complaints of musculoskeletal pain/tiredness/weakness with no other symptoms or medical comorbidities. The normal reference range of our laboratory for serum 25(OH)D level is 30–100 ng/ml. Out of the entire cohort of 400 patients, only 12% (n=48) had sufcient serum vitamin D levels (>30 ng/mL) .T he mean± S.D. value of serum vitamin D for the study population was 20.61 ±11.67 (median =20; range= 2.4-124). More than half of the study sample (n=222; 55.5%) analyzed had decient serum Vit D levels (≤20 ng/ml) and almost a third of the sample (n=130; 32.5%) had insufcient serum Vit D levels (21-30 ng/ml). This study also documented statistically signicant results between serum vitamin D levels in patients with different sunlight exposure (p=0.032). This study conrms a high prevalence of vitamin D deciency in people with diffuse musculoskeletal pain in apparently healthy urban Indians and advocates the supplementation of vitamin D in such patient population.

Neurogenic bladder dysfunction is one of prominent impairments following Spinal Cord Injury (SCI) and is seen in 90% of patients.This study has been undertaken to correlate the effect of anticholinergic drug (oxybutynin) on urodynamic parameters in neurogenic bladder of SCI patients.This is a hospital based non randomized prospective interventional study.After initial baseline urodynamic study,patients with detrusor areflexia were excluded from the study group and thirty patients showing detrusor overactivity and detrusor sphincter dyssynergia were treated with oral oxybutynin 5 mg for 7 days followed by repeat urodynamic evaluation thereafter.Our study concluded that mean bladder compliance improved from 6.114 to 17.95 ml/cmH2O after intervention and mean bladder capacity also increased after intervention (229.7ml) from (165.3ml) and changes were statistically significant.Antimuscarinic (Oxybutynin) is an effective drug in management of neurogenic bladder in SCI patients increases bladder compliance and capacity and results are objectively achieved within seven days

Cost-utility analysis (CUA) studies are becoming increasingly important due to the need to reduce healthcare spending, especially in the field of trauma and orthopaedics. There is an increasing need for trauma and orthopaedic surgeons to understand these economic evaluations to ensure informed cost-effective decisions can be made to benefit the patient and funding body. This review discusses the fundamental principles required to understand CUA studies in the literature, including a discussion of the different methods employed to assess the health outcomes associated with different management options and the various approaches used to calculate the costs involved. Different types of model design may be used to conduct a CUA which can be broadly categorized into real-life clinical studies and computer-simulated modelling. We discuss the main types of study designs used within each category. We also cover the different types of sensitivity analysis used to quantify uncertainty in these studies and the commonly employed instruments used to assess the quality of CUAs. Finally, we discuss some of the important limitations of CUAs that need to be considered. This review outlines the main concepts required to understand the CUA literature and provides a basic framework for their future conduct. Cite this article: EFORT Open Rev 2021;6:305-315. DOI: 10.1302/2058-5241.6.200115

Context: Tumour budding score (TBS) implies poor prognosis in colorectal cancer (CRC). A higher score is associated with a higher rate of lymph node metastasis. Therefore, it influences the treatment modality in Stage 2 and pT1 CRC. The International Tumour Budding consensus conference (ITBCC) proposed use of x20 objective for scoring which is not frequently available in Indian Laboratories. Tata Memorial Centre (TMC) has proposed score groups for x40 objective which could be more feasible for reporting in India. Aims: To establish the significance of reporting tumour budding routinely in CRC and assess the reproducibility of TMC proposed score groups for x40 objective. Methods: 4 Hematoxylin and Eosin stained sections from the tumour were studied in 32 CRC cases. TBS was defined as the single worst field with highest number of Tumour buds using the x40 objective and scored as low=0 to 1, intermediate=2 to 4 and high= more than equal to 5. TBS was compared with nodal metastasis. Results: TBS was low in 23 cases, intermediate in 6 cases and high in 3 cases. All 3 cases with high TBS showed nodal metastasis with 2 cases (66%) having nodal stage N2b. All 6 cases with intermediate TBS score also showed nodal metastasis. Of the 23 low TBS cases, 7 showed nodal metastasis with 5 cases having nodal stage N1a. Conclusions: TBS using x40 objective is a reproducible method and is associated with higher risk of lymph node metastasis. It should be incorporated in routine reporting of all CRC cases.

Despite the introduction and use of latex-free gloves, natural rubber latex hypersensitivity is still an issue in hospital medicine both for patients and healthcare professionals. Clear understanding of the groups at risk as well as perioperative assessment and management is key to reducing complications and improving safety. In this literature review, we cover the perioperative management of patients with latex hypersensitivity, as well as the implications for healthcare professionals. We also review the cost analyses of latex hypersensitivity in the healthcare system and the evidence available.

We show that kidney exchange markets suffer from market failures whose remedy could increase transplants by 30 to 63 percent. First, we document that the market is fragmented and inefficient; most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals only partly internalize their patients’ benefits from exchange, and current platforms suboptimally reward hospitals for submitting patients and donors. Third, we calibrate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires either a mandate or a combination of new mechanisms and reimbursement reforms. (JEL D24, D47, I11)

Geological and geochemical characteristics of the litho units exposed in and around Kalalikhera area of Pur-Banera belt have confirmed the presence of felsic volcanic rock unit named Kalalikhera felsic volcanic, with characteristic features such as (i) abundance of lapilli composed of polygonal quartz and feldspar and (ii) presence of relict bipyramidal quartz. These volcanics are associated with thin bands of chert. Geochemically, the volcanics are found to be of rhyolitic composition. Development of garnet porphyroblasts along with preferred orientation of the silicate minerals of rhyolite indicates a low to medium grade metamorphism and deformation of the units. Monazite geochemistry of the volcanics indicated towards the metamorphic origin of monazites, with REE pattern show steep fractionation trend from La to Lu. The in-situ chemical age of 2192 ± 57 Ma recorded from xenotime is interpreted as indicative of the opening of the Aravalli basin with the onset of rifting leading to the formation of Kalalikhera volcanics. The estimated ages of 1784 ± 92, 1351 ± 45 and 1026 ± 57 Ma from monazite analyses are interpreted as different metamorphic events associated with (i) closure of the basin and the onset of Aravalli orogeny, (ii) further imprints of Delhi orogeny, and (iii) with late Grenvillian age imprints.

Osteoarthritis (OA) is a degenerative disorder associated with cartilage loss and is a leading cause of disability around the world. In old age, the capacity of cartilage to regenerate is diminished. With an aging population, the burden of OA is set to rise. Currently, there is no definitive treatment for OA. However, cell-based therapies derived from adipose tissue are promising. A PRISMA systematic review was conducted employing four databases (MEDLINE, EMBASE, Cochrane, Web of Science) to identify all clinical studies that utilized adipose tissue derived mesenchymal stem cells (AMSCs) or stromal vascular fraction (SVF) for the treatment of knee OA. Eighteen studies were included, which met the inclusion criteria. Meta-analyses were conducted on fourteen of these studies, which all documented WOMAC scores after the administration of AMSCs. Pooled analysis revealed that cell-based treatments definitively improve WOMAC scores, post treatment. These improvements increased with time. The studies in this meta-analysis have established the safety and efficacy of both AMSC therapy and SVF therapy for knee OA in old adults and show that they reduce pain and improve knee function in symptomatic knee OA suggesting that they may be effective therapies to improve mobility in an aging population.

Calls for eliminating prioritization for SARS-CoV-2 vaccines are growing amid concerns that prioritization reduces vaccination speed. We use an SEIR model to study the effects of vaccination distribution on public health, comparing prioritization policy and speed under mitigation measures that are either eased during the vaccine rollout or sustained through the end of the pandemic period. NASEM's recommended prioritization results in fewer deaths than no prioritization, but does not minimize total deaths. If mitigation measures are eased, abandoning NASEM will result in about 134,000 more deaths at 30 million vaccinations per month. Vaccination speed must be at least 53% higher under no prioritization to avoid increasing deaths. With sustained mitigation, discarding NASEM prioritization will result in 42,000 more deaths, requiring only a 26% increase in speed to hold deaths constant. Therefore, abandoning NASEM's prioritization to increase vaccination speed without substantially increasing deaths may require sustained mitigation.

Calls for eliminating prioritization for SARS-CoV-2 vaccines are growing amid concerns that prioritization reduces vaccination speed. We use an SEIR model to study the effects of vaccination distribution on public health, comparing prioritization policy and speed under mitigation measures that are either eased during the vaccine rollout or sustained through the end of the pandemic period. NASEM’s recommended prioritization results in fewer deaths than no prioritization, but does not minimize total deaths. If mitigation measures are eased, abandoning NASEM will result in about 134,000 more deaths at 30 million vaccinations per month. Vaccination speed must be at least 53% higher under no prioritization to avoid increasing deaths. With sustained mitigation, discarding NASEM prioritization will result in 42,000 more deaths, requiring only a 26% increase in speed to hold deaths constant. Therefore, abandoning NASEM’s prioritization to increase vaccination speed without substantially increasing deaths may require sustained mitigation.

Firefighting is a challenging job, and it comes with a risk of loss of life. With some technical advancements, this risk can be reduced. This paper explains the making of a firefighting robot with the help of flame sensors and Arduino UNO microcontroller board. The robot is made to detect and extinguish the fire. A detailed explanation of components used for making the firefighting robot has been provided. Closed loop control diagram and flow chart are provided for better understanding of principle and control process of firefighting robot, respectively. Every action of the robot has been explained using Proteus 8 Professional simulation environment. Finally, the step by step process of hardware connections has been provided.

BACKGROUND Healthcare services are facing economic constraints globally with an increasingly elderly population, and greater burdens of osteoarthritis. Because of the chronic nature of osteoarthritis and the costs associated with surgery, arthroplasty is seen as potentially cost saving. There have been no systematic reviews conducted on cost effectiveness analysis (CEA) studies of total hip arthroplasty (THA) in the management of osteoarthritis. The aim of this systematic review was to evaluate CEAs conducted on THA for osteoarthritis to determine if THA is a cost-effective intervention. MATERIALS AND METHODS A systematic review was conducted using five databases to identify all clinical CEAs of THA for osteoarthritis conducted after 1 January 1997. Twenty-eight studies were identified that met the inclusion criteria. The Quality of Health Economic Analysis (QHES) checklist was employed to assess the quality of the studies. RESULTS The average QHES score was 86 indicating high quality studies. All studies reviewed concluded that THA was a cost-effective intervention. In younger patients, cementless THA and ceramic on polyethylene implants were found to be most cost effective. Hybrid THA and metal on polyethylene implants had the greatest cost utility in older patients. In patients with acetabular defects, cemented cup with impaction bone grafting was most cost effective, while dual mobility THA was most cost effective in patients with high risk of dislocation. CONCLUSION We have shown that THA is a cost-effective treatment for hip osteoarthritis. These findings should be implemented into clinical practice to improve cost utility in health services across the world.

While the mechanism design paradigm emphasizes notions of efficiency based on agent preferences, policymakers often focus on alternative objectives. School districts emphasize educational achievement, and transplantation communities focus on patient survival. It is unclear whether choice-based mechanisms perform well when assessed based on these outcomes. This paper evaluates the assignment mechanism for allocating deceased donor kidneys on the basis of patient life-years from transplantion (LYFT). We examine the role of choice in increasing LYFT and compare equilibrium assignments to benchmarks that remove choice. Our model combines choices and outcomes in order to study how selection induced in the mechanism affects LYFT. We show how to identify and estimate the model using quasi-experimental variation resulting from the mechanism. The estimates suggest that the design in use selects patients with better post-transplant survival prospects and matches them well, resulting in an average LYFT of 8.78, which is 0.92 years more than a random assignment. However, the aggregate LYFT can be increased to 13.84. Realizing the majority of the gains requires transplanting relatively healthy patients, who would have longer life expectancies even without a transplant. Therefore, a policymaker faces a dilemma between transplanting patients who are sicker and those for whom life will be extended the longest.

Waitlists are often used to ration scarce resources, but the trade-offs in designing these mechanisms depend on agents' preferences. We study equilibrium allocations under alternative designs for the deceased donor kidney waitlist. We model the decision to accept an organ or wait for a preferable one as an optimal stopping problem and estimate preferences using administrative data from the New York City area. Our estimates show that while some kidney types are desirable for all patients, there is substantial match-specific heterogeneity in values. We then develop methods to evaluate alternative mechanisms, comparing their effects on patient welfare to an equivalent change in donor supply. Past reforms to the kidney waitlist primarily resulted in redistribution, with similar welfare and organ discard rates to the benchmark first-come, first-served mechanism. These mechanisms and other commonly studied theoretical benchmarks remain far from optimal. We design a mechanism that increases patient welfare by the equivalent of an 18.2% increase in donor supply., National Science Foundation (U.S.) (Grant SES‐1729090, SES‐1254768), National Institutes of Health (U.S.) (Grant R21‐DK113626), Alfred P. Sloan Foundation (Grant FG‐2019‐11484)

We improve the upper bound on the superbridge index $sb[K]$ of a knot type $[K]$ in terms of the bridge index $b[K]$ from $sb[K] \leq 5b -3$ to $sb[K]\leq 3b[k] - 1$., 12pages, 4 figures

Purpose The purpose of this paper is to propose a practical framework for community participation in post-disaster resettlement. Design/methodology/approach The proposed framework has been tested in two model villages (MVs) of Punjab, Pakistan. Primary data were collected through household surveys, focus group discussions and expert interviews. A survey with 67 households was conducted for obtaining qualitative data regarding community participation in post-disaster resettlement. Findings The first MV (Ittehad MV) was resettled by the local NGO, and the second (Basti Meera Mullan) by the provincial government. Results indicate that community participation significantly varied in selected MVs. NGOs have achieved positive realizations due to effective community involvement in resettlement efforts, whereas the governmental approach lacked in proactive community participation. Practical implications This framework can be used for other disasters, by refining and incorporating disaster relevant components. This research will be highly useful for disaster managers, private developers and NGOs engaged in resettling disaster-affected population. Social implications The proposed framework can help disaster-affected communities to resettle according to their terms. This can only be attained if affected communities will proactively participate in resettlement planning process. Originality/value This original framework is exclusively designed to attain sustainability for post-disaster settlement through community participation.

Kidney exchange platforms serve patients who need a kidney transplant and who have a willing, but incompatible, donor. These platforms match patients and donors to produce transplants. This paper documents operational details of the three largest platforms in the United States. It then uses the framework developed in Agarwal et al. (2017) to examine how practical details influence platform productivity. The results show that reducing frictions in accepting proposed matches, frequent matching, and encouraging altruistic donors are important ways in which a platform can increase its productivity.

Many scarce public resources are allocated through wait lists that use priorities for individual agents. A new priority system for allocating deceased donor kidneys was adopted in 2014. This redesign was guided by simulations that held decision-rules fixed. We synthesize recent theoretical results to show that the welfare effects of a mechanism depend on the interaction between dynamic incentives and heterogeneity in preferences. We show evidence suggesting that patient decisions on the deceased donor kidney wait list respond to dynamic incentives. Therefore, an empirical approach to dynamic mechanism design is an essential complement to mechanism design theory in dynamic environments.

Background: Diabetes mellitus (DM) is recognised as an important risk factor for tuberculosis (TB). India has high-TB burden, along with rising DM prevalence. Aim: This study was conducted to document the co-existence of DM and TB in persons with established TB and difference in clinical presentation. Type of Study: This was a cross-sectional, descriptive observational study conducted at selected directly observed treatment (DOT) centre in Gwalior North-Central India. Materials and Methods: A total of 550 patients of confirmed diagnosis of TB and on treatment were recruited. The study participants were screened for DM and diagnoses were made on the basis of the World Health Organization criteria. Clinical parameters were compared between persons with DM and those without DM. Results: DM/TB comorbidity was noted in 85 persons, and these made up 15.4% of the study population. Mean age was higher in DM patients with TB (43.4 ± 15.4 vs. 33.1 ± 16.2 years, P = 0.000); the mean duration of symptoms of TB with DM was more (124 ± 16.4 vs. 107.49 ± 10.3 days). Majority of the patients (63.5% dysglycaemic and 43.6% normoglycaemic TB patients) were presented with a cough with or without expectoration and significantly found more in dysglycaemic TB patients (odds ratio = 2.2, P = 0.007). The frequency of reporting symptoms was higher among dysglycaemic TB patients as compared to normoglycaemic TB patients. This difference in both groups was found to be statistically significant (P < 0.05) for pleural effusion, fever, shortness of breath, chronic abdominal pain, fatigue/weakness and in other non-specific symptoms. Conclusions: Given the substantial burden of DM and TB co-morbidity, this study makes a contribution for re-echo the need to raise awareness on screening for DM in persons with TB.