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Purpose: This study sought to establish the prevalence and morphological characteristics of lumbosacral transitional vertebrae (LSTV) in the South African population and its correlation with South African's population affinities. Methods: A retrospective review was performed of 3096 consecutive thoracic-abdominal-pelvic radiographs at two large public hospitals in South Africa. Categorisation of LSTV was classified according to Castellvi et al. (1984): Types II, III, and IV with unilateral (A) or bilateral (B) subtypes present. The three largest South African population groups (participant self-identified), namely Black African, Coloured and White population affinities were equally sampled, comprising 1032 radiographs for each population affinity. Results: The overall prevalence of LSTV was 10 % (N = 308 of 3096). Prevalence by classification/type was 67.9 %, 27.6 % and 4.5 % for II, III, and IV, respectively. The most prevalent subtype was Type IIA (41.9 %), Type IIB (26 %), Type IIIB (21.8 %), and Type IV (5.8 %), respectively. Prevalence by frequency of side was bilateral (47.7 %), left (26.6 %), right (21.1 %), while 4.5 % could not be sided (Type IV morphology). The sex distribution was 53.9 % (166/308) female and 46.1 % (142/308) male. Prevalence by population affinity was 10.5 %, 9.3 % and 9.9 % for the Black African, Coloured and White population affinities, respectively. Analyses of all groups found that the Black African and Coloured populations demonstrated two statistically significant results: greater affinity for the prevalence of sacralisation (95 % CI: 0.396–4.33, p = 0.008), and sacralisation amongst males (95 %, CI: 0.42–3.36, p = 0.010). Conclusion: This study was the first dedicated study of LSTV prevalence in a South African population. There was no significant difference in the prevalence of LSTV between the three largest population groups. Statistically, sacralisation was observed in greater proportions in the Black African and Coloured populations, particularly among males.

The main objective of every Small and Medium Enterprise is to develop the ability to generate profits permanently over time; However, the Covid-19 pandemic significantly affected the global economy, generating an average reduction of 27% in global production and consumption, as well as a reduction in the use of labor, either due to reduced wages or reduction in working hours, which has had an impact on the increase in poverty. It is in this context that SMEs, with the aim of continuing to operate, implemented a strategy to reinvent themselves, which has been based on the greater use of the Internet and digital platforms with the aim of energizing their market or changing their line of business. , will thus develop activities in other areas or new services that did not exist before the moment of this reinvention. In this context, electronic commerce increased in a first stage, promoting the need to develop the so-called ‘last mile’ processes, which is provided most of the time by light logistics companies; However, the lack of agile and rapid implementation methodologies that facilitate the identification and selection of digital technologies appropriate to the processes of SMEs has caused the growth rate of e-commerce sales to decrease, which affects consumption and poverty reduction. Therefore, the objectives of this research are to provide a methodology that allows improving the strategic planning of the organization, adapting the strategy to changes in the environment in an agile and rapid manner, and identifying the resources and actions required that contribute to increasing the productivity through the Digital Canvas Model and Digital Transformation in logistics SMEs in the short term.

The objective of the work was to enhance the competitiveness of e-commerce and to mitigate the disadvantages associated with it, such as the untimely delivery of purchased products. This was to be achieved through the implementation of a proposed methodology in the processes related to the ‘Last Mile’, leveraging Big Data and Lean Logistics to boost the productivity of light logistics SMEs (small and medium-sized enterprises). To identify the conditions impacting the distribution processes, a study was conducted on a population of 750 S MEs, utilizing a sample of 255 companies through stratified probabilistic sampling. The research spanned the years 2022 and 2023. The methodology advocated in this study combines Lean Logistics and Big Data to enhance the supply chain's efficiency and profitability for SMEs engaged in light logistics, amidst the post-pandemic landscape and the conflict between Ukraine and Russia. This methodology was structured into three stages: firstly, the organization of the customer shipment database; secondly, the cleaning of this database to pinpoint records scheduled for distribution; and thirdly, the assignment of delivery rates and probabilities using historical delivery outcomes. The findings suggested that the integration of Lean Logistics and Big Data offers a viable solution for improving the supply chain efficiency and profitability for light logistics SMEs during the post-pandemic period and amidst the Ukraine-Russia conflict. This research's originality is underscored by its novel approach of merging Lean Logistics and Big Data to fortify the supply chain efficiency and profitability for SMEs in light logistics, a synergy not previously identified in existing literature.

Abstract Background This study aimed at determining the effectiveness of an innovative approach using interprofessional simulation scenarios (IPSS) in improving knowledge, attitude, and practice (KAP) of hospital-acquired infection control (HAIC) among health professionals. Methods The interventional study was conducted in a teaching hospital in Malaysia. Purposive sampling was used to recruit participants from surgical, intensive care, and other units. Thirty-six health professionals in the experimental and forty in the control group completed the study. All subjects participated in an interactive lecture and demonstrated four IPSS on HAIC i.e. (i) taking blood specimen (ii) bedsore dressing (iii) collecting sputum for acid-fast bacilli and (iv) intermittent bladder catheterization. Each team consisted of a doctor and a nurse. A self-administered questionnaire on KAP on HAIC was completed by respondents during the pre-, immediately and, post-intervention. An independent t-test was conducted to measure the significance between the experimental and control group. Results The mean scores for KAP among the experimental group increased following the intervention. Significant differences in scores were seen between the two groups post-intervention (p

This research article focuses on the ergonomic design of the workstations for the plastics industry plant to reduce the postural load that improves the workers’ productivity and the operators’ absenteeism due to musculoskeletal disorders. This article develops an innovative solution to deal with one of the main problems of the plastic industry, namely, the high rate of worker absenteeism generated by musculoskeletal disorders due to the high postural load at the stations of work in this industry. The research is divided into four stages, namely the Determination of the objectives through the analysis of the problem and its root causes, the Redesign of the work methodologies in the productive area, the Improvement in the activities and tools used in the production chain, and Evaluations of the different impacts that the proposal entails. A proposed model validated with the Delmia V5 software and evaluation methods such as RULA, REBA, and OCRA, made possible a reduction in the level of risk of 50% and 66.7% in the different jobs analyzed and obtained 42,929 PEN in savings per year in respect to the total costs generated by the absenteeism presented. The result of the new workstations satisfies the ergonomic aspects and the needs of the workers. The study focuses on an analysis of risk levels that occurred in each of the high-density bag production activities, where non-conformity was found regarding the high risks presented, those leading causes with inappropriate postures by the staff, non-optimal working conditions, and absence of ergonomic furniture. This research serves as the basis for future lines of research and other companies with similar characteristics to implement the model.

After acute myocardial infarction, patients are at increased risk for adverse outcomes, including heart failure and death. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown promising cardiovascular benefits, but their efficacy in patients after myocardial infarction is not well established. This study aimed to evaluate the efficacy of SGLT2i in preventing cardiovascular outcomes in patients after myocardial infarction through a systematic review and meta-analysis. We conducted a comprehensive literature search of PubMed, Cochrane, EMBASE, and Web of Science for randomized controlled trials (RCTs) and retrospective and prospective studies evaluating SGLT2i in patients after myocardial infarction. The primary outcomes were major adverse cardiovascular events (MACEs) and all-cause mortality. Secondary outcomes included cardiovascular mortality, recurrent myocardial infarction, revascularization, and rehospitalization. Data were pooled using a random-effects model, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The meta-analysis included eight studies (three RCTs and five observational studies) with a follow-up duration ranging from 4 to 24 months. SGLT2i were associated with a significantly lower risk of MACE (RR: 0.71, 95% CI: 0.52-0.97, p = 0.03) and rehospitalization (RR: 0.64, 95% CI: 0.51-0.82, p<0.01) compared to controls. Although not statistically significant, the risk of all-cause mortality (RR: 0.79, 95% CI: 0.53-1.18, p = 0.25) and cardiovascular mortality was lower in the SGLT2i group. This meta-analysis suggests that SGLT2i may improve cardiovascular outcomes in patients after myocardial infarction, particularly by reducing the risk of MACEs and rehospitalization. However, larger trials with high-risk populations are needed to confirm these findings and elucidate the underlying mechanisms., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nall et al.)

Background: NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission., Method: A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken., Results: We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis., Conclusion: By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources., (© 2024 John Wiley & Sons Ltd.)

Acute kidney injury (AKI) frequently occurs in hospitalized individuals with liver cirrhosis and represents a significant risk factor for early in-hospital mortality, holding crucial clinical and prognostic importance. The objective of this meta-analysis was to assess the risk factors associated with AKI in hospitalized individuals with cirrhosis. This systematic review and meta-analysis was conducted in concordance with guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two independent researchers systematically searched major databases, including MEDLINE/PubMed, Web of Science, and EMBASE, from January 2015 until December 2023. A total of 14 studies were included in this meta-analysis, of which six were prospective, and the remaining were retrospective. Of the 9,659 cirrhosis patients in the 14 included studies, 3,968 had developed AKI with a pooled incidence of 41% (95% confidence interval = 34-47%). Our findings showed that a high Model for End-Stage Liver Disease (MELD) score, infection, high Child-Pugh-Turcotte stage score, high serum creatinine, high serum bilirubin, and low serum albumin were significantly associated with high incidence of AKI in liver cirrhosis patients. The results emphasize the importance of vigilant monitoring in cirrhosis patients to detect any indications of AKI, followed by meticulous and attentive management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nall et al.)

Background and Method: A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019., Results: There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self-harm in particular attended more sessions than those with anxiety., Conclusions: Addressing why these associations occur may improve mental health care in young persons., (© 2022 Association for Child and Adolescent Mental Health.)

Importance: US primary care practitioners (PCPs) are the largest clinical workforce, but few provide addiction care. Primary care is a practical place to expand addiction services, including buprenorphine and harm reduction kits, yet the clinical outcomes and health care sector costs are unknown., Objective: To estimate the long-term clinical outcomes, costs, and cost-effectiveness of integrated buprenorphine and harm reduction kits in primary care for people who inject opioids., Design, Setting, and Participants: In this modeling study, the Reducing Infections Related to Drug Use Cost-Effectiveness (REDUCE) microsimulation model, which tracks serious injection-related infections, overdose, hospitalization, and death, was used to examine the following treatment strategies: (1) PCP services with external referral to addiction care (status quo), (2) PCP services plus onsite buprenorphine prescribing with referral to offsite harm reduction kits (BUP), and (3) PCP services plus onsite buprenorphine prescribing and harm reduction kits (BUP plus HR). Model inputs were derived from clinical trials and observational cohorts, and costs were discounted annually at 3%. The cost-effectiveness was evaluated over a lifetime from the modified health care sector perspective, and sensitivity analyses were performed to address uncertainty. Model simulation began January 1, 2021, and ran for the entire lifetime of the cohort., Main Outcomes and Measures: Life-years (LYs), hospitalizations, mortality from sequelae (overdose, severe skin and soft tissue infections, and endocarditis), costs, and incremental cost-effectiveness ratios (ICERs)., Results: The simulated cohort included 2.25 million people and reflected the age and gender of US persons who inject opioids. Status quo resulted in 6.56 discounted LYs at a discounted cost of $203 500 per person (95% credible interval, $203 000-$222 000). Each strategy extended discounted life expectancy: BUP by 0.16 years and BUP plus HR by 0.17 years. Compared with status quo, BUP plus HR reduced sequelae-related mortality by 33%. The mean discounted lifetime cost per person of BUP and BUP plus HR were more than that of the status quo strategy. The dominating strategy was BUP plus HR. Compared with status quo, BUP plus HR was cost-effective (ICER, $34 400 per LY). During a 5-year time horizon, BUP plus HR cost an individual PCP practice approximately $13 000., Conclusions and Relevance: This modeling study of integrated addiction service in primary care found improved clinical outcomes and modestly increased costs. The integration of addiction service into primary care practices should be a health care system priority.

Breast cancer risk assessment is in the process of refinement, largely due to the potential for pharmacologic risk reduction. In the 1970s, benign tissue changes were assigned relative risk (RR) values. The 1980s witnessed the introduction of mathematical models for calculating risk. Genetic counseling and testing appeared in the 1990s. Now in 2002, we are witnessing efforts to improve risk assessment by actively searching for cellular 'atypia' through nipple aspirate fluid (NAF), ductal lavage, and random fine needle aspiration (FNA). One deficiency plagues any approach to predicting breast cancer based on historical risk factors--exclusion of the 70% majority of women who develop breast cancer without any identifiable risk factors. Realizing that the long-term goal of breast cancer risk assessment should be tissue and/or serum-based strategies, the authors introduce the Oklahoma Breast Cancer Project, a tissue bank designed to augment research devoted to molecular biologic markers of risk.