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Purpose: Fracture stability is important in choosing the optimal treatment for pediatric femoral fractures, although there is no consensus for characterizing a fracture as “stable” or “unstable.” The authors sought to measure interobserver and intraobserver reliability in classifying femoral fracture stability and examined the relationship between fracture ratio and perceived fracture stability and morphology. Methods: Fracture ratios were calculated from anteroposterior and lateral radiographs from 65 children aged 5 to 12 years, who were treated for femoral shaft fractures at a level 1 pediatric trauma center. Deidentified radiographs were placed into a PowerPoint presentation in random order and were shown to six fellowship-trained pediatric orthopaedic surgeons at two time points, 4 months apart. Raters classified stability as “stable/unstable” and morphology as “spiral/oblique/transverse.” Cohen and Fleiss kappa (k) values were calculated to determine intraobserver and interobserver reliability. Generalized linear modeling was used to compare FR to rater fracture stability and morphology. Results: The mean k for fracture stability for all raters was 0.68 (strong intraobserver agreement). The k for fracture stability during Round 1 was 0.53 (67.7% interobserver agreement, moderate). The k for fracture stability during Round 2 was 0.68 (75.4% interobserver agreement, strong). The mean k for fracture morphology for all raters was 0.79 (strong intraobserver agreement). The k for fracture morphology during Round 1 was 0.38 (15.4% agreement, fair). The k for fracture morphology during Round 2 was 0.46 (24.6% agreement, moderate). The average anteroposterior ratio in stable fractures was 1.32 compared with 1.78 in unstable fractures (P < 0.001). The average lateral ratio in stable fractures was 1.34 compared with 2.10 in unstable fractures (P < 0.001). Average anteroposterior and lateral ratios were highest in spiral fractures and lowest in transverse fractures (P < 0.003). Conclusions: Raters demonstrated strong intraobserver and interobserver agreement in classifying radiographic femoral fracture stability. Anteroposterior and lateral fracture ratios were significantly higher in unstable fractures.

BACKGROUND The pain control efficacy, postoperative opioid requirements, and costs among patients undergoing major shoulder surgery using different perioperative analgesia modalities have been topics of active debate. Several studies have compared periarticular injection (PAI) to interscalene block (ISB) in shoulder arthroplasty, but there is a paucity of data comparing them in arthroscopic rotator cuff repair. METHODS Patients aged 18-80 years with full-thickness rotator cuff tears and undergoing primary arthroscopic rotator cuff repair at 2 different shoulder centers were screened and subsequently randomized to receive either periarticular injection (PAI) of liposomal bupivacaine mixed with 0.25% bupivacaine (n = 41) or single-shot interscalene nerve block (ISB) (n = 36). Visual analog scale (VAS) pain scores, oral morphine equivalent (OME) use, Single Assessment Numerical Evaluation (SANE) scores, and costs were collected. Differences with P

Pandemic disease always poses one of the greatest security threats to national security. It is widely discussed as a non-traditional threat candidate to national security (NDU, CACI, The Asymmetric Threat Symposium, 2008, p. 31). Indeed, the COVID-19 has not only unleashed havoc on developing nation but also provided a vital national security lesson exposing weaknesses in their capabilities to protect citizens. For example, Nepal has lost more than 2000 lives of its people and about 271,000 have severely suffered this viral infection, and the deaths with this pandemic in the US and UK are even higher. And the trend of causalities has increasingly been continuing along with an alarming rate of infection. Meanwhile, a new deadly variant of corona virus is swiftly spreading across the globe including Nepal. This study employs the qualitative research framework and data have been employed from secondary sources. The research philosophy adopted is interpretivism where the researcher has included his viewpoints to available data in presenting ideas. The article explores causes and multi-dimensional effects, critical nexus between COVID-19 and National Security in support to the argument that the nature, scope, novelty and complexity of COVID-19 pandemic demands an Integrated National Security Strategy for an effective application of all the instruments of national power, including Nepali Army, public and private sector to respond successfully. This paper also spotlights the crucial role of Nepali Army in containing pandemics that proffers to reappraisal of such a vital security body’s strategies and doctrines, taking the current corona virus in serious consideration.

Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery. Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity. Results: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity. Conclusion: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.

Fasting guidelines for pediatric procedural sedation have historically been controversial. Recent literature suggests that there is no difference in adverse events regardless of fasting status.The goal of this study was to examine adverse outcomes and departmental efficiency when fasting guidelines are not considered during pediatric emergency department (PED) sedation for orthopedic interventions.Retrospective chart review identified 2674 patients who presented to a level I PED and required procedural sedation for orthopedic injuries between February 2011 and July 2018. This was a level III, retrospective cohort study. Patients were categorized into the following groups: already within American Society of Anesthesiologists (ASA) fasting guidelines on presentation to the PED (n = 671 [25%]), had procedural sedation not within the ASA guidelines (n = 555 [21%]), and had procedural sedation after fasting in the PED to meet ASA guidelines (n = 1448 [54%]). Primary outcomes were length of stay, time from admission to start of sedation, length of sedation, time from end of sedation to discharge, and adverse events.There was a significant difference in the length of stay and time from admission to sedation-both approximately 80 min longer in those with procedural sedation after fasting in the PED to meet ASA guidelines (p 0.001). There was no significant difference among groups in length of sedation or time to discharge after sedation. Adverse events were uncommon, with only 55 total adverse events (0.02%). Vomiting during the recovery phase was the most common (n = 17 [0.006%]). Other notable adverse events included nine hypoxic events (0.003%) and five seizures (0.002%). There was no significant difference in adverse events among the groups.Length of stay in the PED was significantly longer if ASA fasting guidelines were followed for children requiring sedation for orthopedic procedures. This is a substantial delay in a busy PED where beds and resources are at a premium. Although providing similar care with equivalent outcomes, the value of spending less time in the PED is evident. Overall, adverse events related to sedation are rare and not related to fasting guidelines.

Of late, hybrid warfare has emerged as a widely contested but practically tested war strategy anticipated in the future. This paper revolves around strategies to deter, mitigate and counter hybrid threats to national security in the context of Nepal. Prevailing geopolitical and geostrategic environments exhibit that different actors, including state and non-state hybrid strategies pose a clear challenge to Nepal's national security interests. Hence, there is a need for a national security strategy to counter hybrid threats which demands fresh thinking, expanding the traditional enemy-centric threat assessment and response. But the general understanding of hybrid warfare is underdeveloped because hybrid means are ambiguous and complex, such as unorthodox, unpredictable and constantly changing. Ultimately, developing and implementing effective national security policy, ensuring political stability, zero tolerance policy on corruption, good governance, economic and resources development, trusted law enforcement, effective stakeholders including security and intelligence system, building resilience are the best ways to prevent a hybrid war before it erupts. This article argues that Nepali Army, as a key responder, too needs to have an updated military doctrine and strategy on its role in countering it.

Localization problem has gained a significant attention in the field of wireless sensor networks in order to support location-based services or information such as supporting geographic routing protocols, tracking events, targets, and providing security protection techniques. A number of variants of DV-Hop-based localization algorithms have been proposed and their performance is measured in terms of localization error. In all these algorithms, while determining the location of a non-anchor node, all the anchor nodes are taken into consideration. However, if only the anchors close to the node are considered, it will be possible to reduce the localization error significantly. This paper explores the effect of the close anchors in the performance of the DV-Hop-based localization algorithms and an improvement is proposed by considering only the closest anchors. The simulation results show that considering closest anchors for estimation of the location reduces localization error significantly as compared to considering all the anchors.

This work deals with the theoretical study on the molecular structure of two well known natural products: dalbergin (DLBG) and methyldalbergin (MDLBG). DLBG and MDLBG, a type of neoflavonoids, have a variety of biological activities: anti-osteoporotic, tumor-specific cytotoxicity, antibacterial, antioxidant actions, antiulcergenic and anti-inflammatory. Computational study on molecular properties of title molecules is presented using density functional theory (DFT) with B3LYP functional and 6-311++G(d,p) and LanL2DZ basis set. Molecular electrostatic potential surface (MEPS) and electronic reactivity descriptors were used to understand the role of interactions involved in affecting the chemical reactivity of both molecules. Natural bond orbital (NBO) analysis predicted the stability of molecules due to charge delocalization and hyper conjugative interactions. Natural bond orbital studies were performed to investigate the intramolecular charge transfer that results in molecular stability, and π → π* transition. Molecular docking studies show that the title molecules exhibit an antiosteoporotic and antibacterial activity.

In the present study, a combined theoretical and experimental approach is used to study the structure and properties of 4-methoxydalbergione (MD). The optimized geometry was calculated by B3LYP method using 6–311++G(d,p) basis set. Three conformers of MD (MD I, MD II and MD III) have been found by potential energy surface scan. The FT-Raman and FT-IR spectra were recorded in the solid phase, and interpreted in terms of potential energy distribution analysis. Good consistency is found between the calculated results and observed spectra. The detailed interpretation of electron delocalization from filled lone pair orbitals to unfilled antibonding molecular orbitals of most interacting molecular orbitals of the molecule has been done by natural bond orbital (NBO) analysis. HOMO-LUMO energy gap shows that chemical reactivity of MD II is higher than MD I and MD III. Molecular electrostatic potential (MEP) surface has also been predicted with the help of density functional theory. Global and local reactivity descriptors are used to study the chemical reactivity of the molecule. Chemical reactivity parameters show that MD II is softer and chemically more reactive than MD I and MD III. Topological parameters at bond critical points (BCP) have been evaluated by ‘Quantum theory of atoms in molecules’ (QTAIM). The docking studies revealed that the active sites C=O of MD showed best binding energies of −5.17, −5.43, −4.31,-4.77, −5.86 and −4.77for 5O3L, 1HTM, 3UV5, 5I1Q, 1MU7 and 1QZQ respectively, which are bacterial proteins of Escherichia coli.