Virgin coconut oil - its methods of extraction, properties and clinical usage: a review

Abstract

Virgin coconut oil (VCO) is a processed edible oil, which is removed from the mature coconuts. It is a colourless water insoluble liquid and obtained by the hot and cold extraction processes. The nutritional components of VCO are mainly contributed to by lauric acid, its primary content. VCO has shown its anticancer, antimicrobial, analgesic, antipyretic and antiinflammatory properties. Because of these medicinal properties, VCO has gained the wider attention among the medical field. Most evidently VCO has shown its potential antioxidant property, because of its phenolic compounds and medium chain fatty acids. It is one of the beneficial compounds used to prevent and treat the oxidative stress induced neurological disorders like stress, depression and Alzheimer's disease. Dietary supplementation of VCO is easy and economical and safer in daily life among all age groups. It is also beneficial for the cardiovascular, respiratory, dermatological, reproductive and bone health. It can also be applied to the skin as a moisturizer in the paediatric age group. Hence, exploration of antioxidant property as well as other beneficial effects of VCO in various health conditions will be valuable.

Automated and Optimized Neurosurgery Scheduling System Improves Resident Satisfaction

BACKGROUND AND OBJECTIVES

Neurosurgery residency involves a complex structure with multiple hospitals, services, and clinic days, leading to challenges in creating equitable call schedules. Manually prepared scheduling systems are prone to biases, error, and perceived unfairness. To address these issues, we developed an automated scheduling system (Automated Optimization of Neurosurgery Scheduling System [AONSS]) to reduce biases, accommodate resident requests, and optimize call variation, ultimately enhancing the educational experience by promoting diverse junior-senior-attending relationships.

METHODS

AONSS was developed and tailored to the University of Florida program, with inaugural use in 2021-2022 and mandatory implementation in the 2022-2023 academic year. 2019-2021 academic years were used as control. Residents were surveyed using Google Forms before and after implementation to assess its impact. Outcome measures included call and pairing variations, duty hours, as well as subjective factors such as satisfaction, fairness, and perceived biases.

RESULTS

Twenty-six residents (28%-39% female/year) were included in the study. AONSS was used for 6/13 blocks during the 2021-2022 academic year and 13/13 blocks for the 2022-2023 academic year. Overall call variation reduced by 70%. All other objective secondary measures have improved with AONSS. Weekly and monthly duty hours were reduced and less varied. Satisfaction scores improved from 21% reporting being somewhat satisfied or very satisfied to 90%. Fairness scores improved from 43% reporting being somewhat fair or very fair to 95%. Perception of gender bias decreased from 29% to 0%. No resident felt there was racial bias in either system.

CONCLUSION

Our newly developed automated scheduling system effectively reduces variation among calls in a complex neurosurgery residency, which, in return, was found to increase residents' satisfaction with their schedule, improve their perception of fairness with the schedule, and has completely removed the perception of sexual bias in a program that has a large percentage of females. In addition, it was found to be associated with decreased duty hours.

Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Quasi-dynamic breathing model of the lung incorporating viscoelasticity of the lung tissue

We advanced a novel model to calculate viscoelastic lung compliance and airflow resistance in presence of mucus, accounting for the quasi-linear viscoelastic stress-strain response of the parenchyma (alveoli) tissue. We adapted a continuum-based numerical modeling approach for the lung, integrating the fluid mechanics of the airflow within individual generations of the bronchi and alveoli. The model accounts for elasticity of the deformable bronchioles, resistance to airflow due to the presence of mucus within the bronchioles, and subsequent mucus flow. Simulated quasi-dynamic inhalation and expiration cycles were used to characterize the net compliance and resistance of the lung, considering the rheology of the mucus and viscoelastic properties of the parenchyma tissue. The structure and material properties of the lung were identified to have an important contribution to the lung compliance and airflow resistance. The secondary objective of this work was to assess whether a higher frequency and smaller volume of harmonic air flow rate compared to a normal ventilator breathing cycle enhanced mucus outflow. Results predict, lower mucus viscosity and higher excitation frequency of breathing are favorable for the flow of mucus up the bronchi tree, towards the trachea.

Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis

BACKGROUND

Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s.

METHODS

We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy.

RESULTS

Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy.

CONCLUSIONS

R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.

Nanostructured nickel doped zinc oxide material suitable for magnetic, supercapacitor applications and theoretical investigation

This Paper describes the synthesis of nickel doped ZnO is planned by chemical co-precipitation techniques. The prepared nanostructured nickel doped zinc oxide samples were analyzed by thermogravimetric differential thermal analysis (TG/DTA), X-ray diffraction (XRD), Fourier transform infra red (FTIR), field emission scanning electron microscopy (FESEM), high resolution transmission electron microscopy (HRTEM), electron paramagnetic resonance (EPR), and cyclic voltametry (CV). Nanostructure nickel doped ZnO materials have developed as promising for the basis of its broad range of employing in diverse areas. The attractive properties of nickel doped ZnO materials are highly demanded in high-energy potential applications. The nickel doped zinc oxide materials are hexagonal wurtzite arrangement is confirmed by XRD. The morphological -features of FE-SEM show nickel doped zinc oxide NPs are the structure of spherical type with agglomeration. The calculated particle size 11 nm is confirmed by HR-TEM. EPR spectra of nickel doped zinc oxide nanoparticles are ferromagnetic nature. Further, CV studies of Ni doped ZnO materials of the specific capacitance value is 133 Fg^-1 at the scan rate 10 mVs^-1 it is suitable for super capacitor application. The quantum chemical calculations were done by using DFT techniques through B3LYP/LANL2DZ level of basis set.

Music therapy for preterm neonates in the neonatal intensive care unit: An overview of systematic reviews

AIM

To summarise the quantity and quality of evidence for using music therapy for preterm infants in the neonatal intensive care unit (NICU).

METHODS

We performed an overview of evidence for the effectiveness and safety of MT for preterm infants in the NICU. We performed a random-effects meta-analysis of data from studies that fit the definition of MT.

RESULTS

We identified 12 eligible systematic reviews and the methodological quality by AMSTAR-2 ranged from moderate to critically low. We identified 14 eligible randomised trials and 7 observational studies where the intervention fits the definition of MT. Meta-analysis of the RCTs showed that MT significantly decreases heart rate, mean difference (MD) (95% CI), -3.21 [-5.22, -1.19], respiratory rate, MD -2.93 [-5.65, -0.22], and maternal anxiety, MD -17.50 [-20.10, -14.90], and increases feeding volume, MD 29.59 [12.79, 46.38]. Long-term neurodevelopmental or safety outcomes were not reported. GRADE assessment of outcomes ranged from low to very low, downgraded for high risk of bias in the included studies, inconsistency and imprecision.

CONCLUSION

Low to very low certainty evidence suggests that MT in preterm infants improves short-term physiological parameters, feeding and maternal anxiety but safety and long-term outcomes were not reported.

424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses

Aim

Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role.

Method

A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected.

Results

Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future.

Conclusions

Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.

Nonepileptic, Stereotypical, and Intermittent Symptoms After Subdural Hematoma Evacuation

Transient neurological deficits can occur in the setting of subdural hemorrhages with subsequent unremarkable electrodiagnostic and radiological evaluation. This scenario is rare and can be difficult for physicians to interpret. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization, which may present clinically as nonepileptic, stereotypical, and intermittent symptoms (NESIS). In these instances, patients are often misdiagnosed as epileptics and committed to long-term antiseizure drugs. We present a 51-year-old patient developing acute global aphasia following the evacuation of a subdural hematoma, with no significant findings on laboratory, microbiological, electrodiagnostic, or radiological evaluation. The patient experienced spontaneous improvement and returned to baseline in the subsequent weeks. Increased awareness of NESIS as a cortical spreading depolarization phenomenon can improve patient care and prevent both unnecessary, extended medical evaluations and therapeutic trials.

Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial

AIMS

The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial.

MATERIALS AND METHODS

Paclitaxel at 80 mg/m² on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916).

RESULTS

In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2).

CONCLUSION

Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.

A microfluidic flow analyzer with integrated lensed optical fibers

Rapid optical interrogation of flowing cells or particles is a powerful tool in the field of biomedical diagnostics. Determination of size and composition of fast-flowing cells, with diameters in the range of 2- 15 μ m , often require complex open-space optics and expensive high-speed cameras. In this work, a method to overcome these challenges by using a hydrodynamic flow-based microfluidic platform coupled with on-chip integrated fiber optics is reported. The lab-scale portable device developed uses a combination of on-chip lensed and non-lensed optical fibers for precision illumination. The narrow light beam produced by the lensed fiber ( f = 150 μ m ) enables precise optical analysis with high sensitivity. A planar arrangement of optical fibers at various angles facilitates multi-parametric analysis from a single point of interrogation. As proof of concept, the laboratory-scale portable bench-top prototype is used to measure fluorescence signals from CD4 immunostained cells and human blood samples. The performance of microfluidic flow analyzer is also compared to the conventional Guava® easyCyte 8HT flow cytometer.

Craniopharyngiomas in children - experience of consecutive 152 operated cases

Context

Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors.

Objective

This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases.

Design

This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest.

Subjects and Methods

152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease.

Results

Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%).

Conclusions

Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.

Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?

Carpal height ratio and ulnar variance on plain X-ray were measured and compared to the width/height ratio of the lunate as measured on a computed tomography (CT) scan in 50 patients with Kienböck's disease. Width/height ratio of the lunate was also measured in a series of 50 controls. No correlation between ulnar variance and fractures was found. Conversely, the correlation between carpal height ratio on X-ray and width/height ratio on a CT scan was statistically significant. Similarly, the correlation between ulnar variance and width/height ratio was statistically significant. We have concluded that width/height ratio while correlating with carpal height is a better measure of lunate collapse. It also appeared that lunate collapse precedes carpal collapse, specifically most if not all lunates have collapsed prior to reduction in carpal height ratio. Finally, while we are unable to conclude the level at which the width/height ratio of lunate becomes unreconstructable, it does appear that in all Litchman stage 3b and most if not all of 3a the shape of the lunate has altered significantly.

Effects of Pyruvic Acid, Succinic Acid, and Oregano Essential Oil on Salmonella, Natural Microflora, and Quality of Raw Ground Chicken

ObjectivesThe growing stringency of regulations related to pathogens in raw poultry and increasing consumer demand for more natural food ingredients makes it imperative to explore alternative antimicrobial agents. The aim of this study was to assess the anti-Salmonella effect of combinations of succinate or pyruvic acid with oregano essential oil in raw ground chicken. Additionally, their effect on natural microflora and quality of ground chicken over simulated retail display was evaluated.Materials and MethodsNalidixic acid (NA) adapted Salmonella Typhimurium was inoculated on skin-on broiler breast meat pieces. The antimicrobial treatments given to meat were 2 and 3% pyruvic acid (PA) or monosodium succinate (SA) in combination with 0.5% essential oil (EO). Agar at the concentration of 0.05% was added to water used to prepare antimicrobial solutions to disperse the essential oil. Mode of antimicrobial treatment was 30 s dip. The meat was then ground and evaluated for pathogen reduction. Data were analyzed using 1-way ANOVA. Surviving Salmonella were recovered on XLT-4 with 50 ppm NA. Non-inoculated meat was similarly treated with antimicrobial dip and ground. Ground chicken was packaged in foam trays with PVC overwrap, and evaluated for mesophilic aerobic plate count (APC), psychrotrophic count (PC), pH, instrumental color (CIE L*, a*, and b*), and expressible moisture over 8 d of simulated retail display.A factorial design was assigned to the experiment with antimicrobial treatments and display days as the fixed effect factors. Data were analyzed using a mixed general linear model that considered replicates as a random effect in addition to the mentioned fixed effects. All trials were conducted in three replicates.ResultsMaximum reduction obtained in Salmonella counts from ground chicken was 1.52 log CFU/g and 0.98 log CFU/g, resulting from 3% SA + 0.5% EO, and 3% PA + 0.5% EO, respectively. Three percent SA + 0.5% EO treatment resulted in ground chicken with approximately 1.2 log CFU/g lower APC on Day 8 that was significantly lower (P < 0.05) than all other treatments. This treatment also resulted in less pH variation over the entire shelf life duration and lighter color of ground meat on Day 8.ConclusionThese results indicate that combination of monosodium succinate and oregano essential oil provides effective reduction of Salmonella and improved raw quality of ground chicken. This antimicrobial combination can be employed as a clean label ingredient for raw chicken applications.

Effects of Drying, Lactic Acid, and an Antimicrobial Marinade on the Survival of Generic Escherichia coli on Biltong

ObjectivesThe objective of the experiment was to evaluate the effects of drying, lactic acid spray, and a certain marinade application on the survival of generic Escherichia coli on biltong.Materials and MethodsFrozen eyes of round (IMPS #171C) were obtained from a local beef purveyor. The eyes of round were thawed (at 4°C), trimmed of extra fat and connective tissues, and cut into strips (L × W × T; 6 in × 2 in × 0.75 in). The experiment was divided into 2 groups and replicated once. Experiment 1 was further sub-grouped into 3 treatments: (1) negative control (NC), (2) negative control for dip treatment (NCD), and (3) inoculated group (I). Experiment 2 was sub-grouped into 6 treatments: (1) negative control (NC), (2) negative control for dip treatment (NCD), (3) positive inoculated control (PIC), and inoculated treatments (4) marinated (M), (5) 2% lactic acid spray (LA), and (6) marinated and lactic acid spray (MLA). For both experiments 1 and 2, 12 strips of biltong were randomly selected for each treatment (n = 36 for experiment 1; n = 72 for experiment 2). The inoculated samples were dipped for 30 s in a cocktail (5-log) of 4 different strains of nalidixic adapted Escherichia coli (beef isolates) and allowed 2 h for attachment at 4°C. The lactic acid was sprayed to each side of the respective biltong and allowed a 10-min resting period. Marinade was applied to respective treatment groups by dipping, rubbing, and incubating overnight (at 4°C). All samples were kept in a smokehouse in a controlled environment with drying cycle at 78°F and 60% relative humidity. Experiment 1 was incubated in the smokehouse for a total of 12 d and experiment 2 was incubated for 9 d total. Samples from each treatment group were removed on Days 0, 2, 5, 7, 9, and 12 (experiment 1 only) for microbiological sampling and analysis. Samples were homogenized, serially diluted, enumerated on TSA plus 200 ppm nalidixic acid, and incubated at 35°C for 18–24 h. Colonies were counted after 24 h and colony counts were transformed into log10 CFU for reporting.ResultsThe data for experiment 2 showed that the treatments LA, M, MLA, and PIC were able to achieve a 2.5–3 log10 CFU reduction after 9 d of drying. The M and MLA treatments exhibited a 2–3 log10 CFU reduction after 2 d of drying as compared with LA and PIC that showed a similar reduction in microbial counts after 9 d of incubation. The NC and NCD treatment groups resulted in no microbial growth from Day 0 till Day 9 of incubation. The data for experiment 1 showed that there was a 1 log10 CFU reduction of E. coli in treatment group I. The NC and NCD groups did not show microbial growth from Day 0 till Day 9 of incubation. The water activity decreased overtime to 0.722 for experiment 1 and 0.711 for experiment 2. Overall, the M and the MLA samples appeared to have the greatest and quickest killing effect on generic E. coli.ConclusionResults from these experiments suggest that the combination of drying with a lactic acid spray and marinade application causes a decrease in the E. coli population on Biltong during incubation for 9 or 12 d. While the results show that there may be a small decrease from drying alone, the greatest decreasing effect appears to be the combination of the drying, lactic acid, and marinade. Future work will include additional replicates and experiments with pathogens such as E. coli O157:H7.

Anti-Salmonella Effects of Pyruvic and Succinic Acid in Combination with Oregano Essential Oil

ObjectivesEffective decontamination approaches will aid in improving safety of poultry products and help processors comply with pathogen performance standards. Increasing consumer demand for clean label and more natural ingredients presents a scope to explore alternative decontamination approaches for meat and food contact surfaces. This study aimed to evaluate the antimicrobial efficacy of combinations of pyruvic acid (PA), succinic acid (SA), and oregano essential oil (EO) against Salmonella Typhimurium in suspensions, cells inoculated on raw chicken, and cells attached to steel.Materials and MethodsMinimum bactericidal concentration (MBC) assays were conducted in Mueller-Hinton broth (5 mL). Bacterial cells were added to broth suspensions of antimicrobial agents or their combinations. A contact time not exceeding 10 s was provided. Surviving bacteria were recovered on tryptic soy agar (TSA). Bacterial inactivation was confirmed by enrichment in D/E broth. Experiment involved completely randomized design with each concentration of organic acid and essential oil being considered as one level. Data were analyzed using 1-way ANOVA. Aqueous solutions of PA, SA, EO, and the mixtures of PA+EO and SA+EO were prepared using 0.05% agar to suspend the essential oil. Skin-on raw chicken breast meat pieces (2.5 cu cm) were used as a substrate to inoculate nalidixic acid (NA) adapted Salmonella cells. Pieces were treated with antimicrobial agents for 30 s by dipping, and surviving Salmonella were recovered using D/E broth on XLT-4 agar with 50 ppm NA. Four different experiments with variable acid and essential oil concentrations were performed and data were analyzed using 1-way ANOVA. Each experiment included an inoculated untreated control. Stainless steel coupons (2 × 5 cm) were used as a substrate for Salmonella attachment. Cells were allowed to grow and attach on coupons submerged in tryptic soy broth for 24 h. Coupons were rinsed to remove planktonic cells. Attached cells remaining on the coupon were dip treated with antimicrobial agents for 5 min. Surviving cells were recovered on TSA. For antimicrobial treatments leading to no cell recovery, additional experiments were performed. The recovery broth was enriched in tryptic soy broth and streaked on TSA to confirm inactivation. Three different experiments were conducted while including their respective inoculated and untreated controls and analyzed using 1-way ANOVA. All experiments were conducted in three replicates.ResultsMBC for was found to be PA (0.5%), SA(3%), EO (0.04%), PA+EO (0.25 + 0.02%), SA+EO (0.25 + 0.02%), respectively. 1% PA + 0.08% EO combination produced the maximum reduction (1.42 ± 0.11 log CFU/cm2) followed by 6% SA + 0.08% EO (1.02 ± 0.08 log CFU/cm2) in Salmonella populations on raw chicken. More than 6 log CFU/coupon of attached Salmonella were inactivated by mixtures of 0.25% PA + 0.02% EO and 1.5% SA + 0.02% EO.ConclusionThe combinations of PA+EO and SA+EO both exhibited strong anti-Salmonella activity in cell suspensions, on cells attached to stainless steel, and were effective in reducing Salmonella populations on raw chicken. Therefore, these antimicrobial combinations merit further research for raw poultry, meat, and other sanitation applications.

Firework-related blast injury to the hand and treatment algorithm

Firework injuries, which most commonly affect hands, are increasing in frequency and severity. We present a pictorial case of a devastating hand injury following a firework explosion in a young male patient. The blast resulted in splaying of the hand with multiple fractures, neurovascular compromise and soft tissue loss. Reconstruction involved a third-ray amputation, fracture fixation, nerve and soft tissue repair resulting in an adequate hand with near-normal appearance. Firework-related hand injuries pose a significant surgical challenge due to the combination of burn and blast forces that can compromise the function of intact vessels and nerves making salvage and reconstruction particularly difficult. Here, we propose a treatment algorithm based on current literature. Our case demonstrates, what initially appeared to be an unsalvageable injury can be reconstructed to produce a functional hand if appropriate surgical measures are taken.

Epilepsy outcome following resection of low-grade brain tumors in children

OBJECTIVE

The indication for and timing of surgery for epilepsy associated with low-grade mixed neuronal-glial tumors may be controversial. The purpose of this study was to evaluate the effect of resection and associated variables on epilepsy and on progression-free survival (PFS).

METHODS

A retrospective chart review of patients treated between 1992 and 2016 was conducted to identify individuals with epilepsy and low-grade gliomas or neuronal-glial tumors who underwent resective surgery. Data analyzed included age at epilepsy onset, age at surgery, extent of resection, use of electrocorticography, the number of antiepileptic drugs (AEDs) before and after surgery, the presence of dysplasia, Engel class, histological findings, and PFS. The institutional review board protocol was specifically approved to conduct this study.

RESULTS

A total of 107 patients were identified. The median follow-up was 4.9 years. The most common pathology was dysembryoplastic neuroepithelial tumor (36.4%), followed by ganglioglioma (31.8%). Eighty-four percent of patients had Engel class I outcomes following surgery. Gross-total resection was associated with a higher likelihood of an Engel class I outcome (90%) as compared to subtotal resection (58%) (p = 0.0005). Surgery reduced the AED burden, with 40% of patients requiring no AEDs after surgery (p < 0.0001). Children with neurodevelopmental comorbidities (n = 5) uniformly did not experience seizure improvement following resection (0% vs 83% overall; p < 0.0001). Electrocorticography was used in 33% of cases and did not significantly increase class I outcomes. PFS was 90% at 5 years. Eleven percent of tumors recurred, with subtotal resection more likely to result in recurrence (hazard ratio 5.3, p = 0.02). Histological subtype showed no significant impact on recurrence.

CONCLUSIONS

Gross-total resection was strongly associated with Engel class I outcome and longer PFS. Further studies are needed to elucidate the suitable time for surgery and to identify factors associated with oncological transformation.

Exploring light confinement in laser-processed LYSO:Ce for photon counting CT application

With the goal of developing a low-cost scintillator-based photon counting detector (PCD) with high dose efficiency suitable for CT, the light transport characteristics in LYSO:Ce detectors containing laser induced optical barriers (LIOB) are simulated. Light confinement and light collection efficiencies (LCE) are studied for a variety of optical barrier patterns and properties (refractive index (RI) and barrier/crystal interface roughness). Up to 80% confinement is achievable with a simple pixel pattern with one barrier wall separating each pixel coupled one-to-one to a photodetector (PD) pixel. Confinement is heavily dependent on barrier properties, and rough interfaces and higher RI results in increased cross-talk. Three approaches to enhance performance beyond the basic pattern are explored: (1) Multiple barrier walls separating each crystal pixel. (2) Introduction of long and short range confinement by having multiple crystal pixels per PD pixel. (3) Combination of LIOB and laser ablation (LA). (1) Is effective for rough interfaces where confinement can be increased by up to 24% for double compared to single walls. (2) Results in high confinement in the pixel centered on the PD pixel, but lower confinement closer to the PD edge. This feature may be explored to achieve spatial resolution beyond the PD pixel size using light sharing based positioning algorithms. (3) Can increase confinement for smooth interfaces using a smooth ablation in the bottom part of the crystal. A general trend across all configurations is a trade-off between light confinement and LCE. The LCE attainable is found comparable to that for mechanically pixelated arrays. While the confinement achievable with LIOB is always lower compared to a mechanically pixelated array, the former may offer a high level of flexibility in terms of detector design. This, in combination with the possibility to fabricate sub-mm pixels in a cost-effective manner, makes LIOB a promising technology for scintillator-based PCDs.

The role of national rural health mission in reducing infant mortality rate in India

Purpose

The purpose of this paper is to assess the role of National Rural Health Mission (NRHM) in reducing Infant Mortality in India. The study will help the government in deciding its future course of action regarding the infant mortality rate (IMR) reduction in India.

Design/methodology/approach

This paper adopts the interrupted time series analysis (ITSA) approach with a control group to study the role of NRHM in reducing the IMR in India. The authors examined infant mortality in rural areas of India for the level and trend change before and after the implementation of NRHM. The authors then applied a suitable ARMA model to estimate the coefficients of the regression model. From the estimated results, the study predicts the counterfactuals for both the rural IMR and urban IMR and plots the results.

Findings

The study found the evidence supporting the hypotheses that the NRHM has led to a reduction in the difference between urban IMR and rural IMR. The research shows that the rural IMR declined at steeper rates in the post-NRHM period (2005–2015).

Originality/value

None of the existing studies analyses the impact of a social scheme like NRHM on the reduction of IMR in India by applying the ITSA. The study is unique as it estimates the counterfactuals and plots the results which show the impact of NRHM on reducing IMR.

Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

INTRODUCTION

Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication.

MATERIALS AND METHODS

Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery.

RESULTS

Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25-95.5) for QuickDASH and 70.4 (range 33-92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0-43.2) and 17.2 (range 0-44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01).

CONCLUSIONS

The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna-carpal impaction.

Constraining Fission Yields Using Machine Learning

Having accurate measurements of fission observables is important for a variety of applications, ranging from energy to non-proliferation, defense to astrophysics. Because not all of these data can be measured, it is necessary to be able to accurately calculate these observables as well. In this work, we exploit Monte Carlo and machine learning techniques to reproduce mass and kinetic energy yields, for phenomenological models and in a model-free way. We begin with the spontaneous fission of 252Cf, where there is abundant experimental data, to validate our approach, with the ultimate goal of creating a global yield model in order to predict quantities where data are not currently available.

An instrumented glove for monitoring hand function

The measurement of hand kinematics is important for the assessment and rehabilitation of the paralysed hand. The traditional method of hand function assessment uses a mechanical or electronic goniometer placed across the joint of interest to measure the range of joint movement. Mechanical goniometers are imprecise and lack the ability to provide a dynamic measurement; electronic goniometers are expensive and cumbersome to use during therapy. An alternative to the goniometric based assessment is to use inertial motion sensors to monitor the hand movement-these can be incorporated in a glove. In this paper, we present the design of an instrumented glove equipped with Magnetic, Angular Rate and Gravity (MARG) sensors for the objective evaluation of hand function. The instrumented glove presented in this paper is designed to assess the range of movement of the hand and also monitor the hand function during the course of hand rehabilitation. Static and dynamic calibrations were performed for the Euler angles calculated from the MARG sensors. The results are also presented for physiological flexion/extension of the wrist (relative roll), flexion/extension of elbow (relative pitch), and internal rotation/external rotation (relative yaw). The static calibration results gave mean absolute errors of 4.1° for roll, 4.0° for pitch, and 4.6° for yaw. From the dynamic calibration, the speed of response to a step change gave a convergence time of 0.4 s; sinusoidally oscillating movement gave good tracking at 0.2 Hz but exhibits overshoot errors at higher frequencies which were tested to be 1 Hz. We present the results of the calibration of the instrumented glove (one sensor pair measuring one joint angle) measuring anatomical joint angles-mean absolute errors during static calibration: 6.3° for a relative roll (wrist flexion/extension), 5.0° for relative pitch (elbow flexion/extension), and 4.5° for relative yaw (shoulder internal rotation/external rotation). The experimental results from the instrumented glove are promising, and it can be used as an alternative to the traditional goniometer based hand function assessments.

An instrumented object for hand exercise and assessment using a pneumatic pressure sensor

Measurement of grip force is important for both exercise training and assessment of the hand during physical rehabilitation. The standard method uses a grip dynamometer which measures the force between the fingers and opposing thumb. The primary limitation of the grip dynamometer is the restriction of measurement to cylindrical grasps. Any deformation of the hand due to muscular or skeletal disease makes the grip dynamometer difficult or impossible to use. An alternative to the grip dynamometer is a sealed pneumatic object that can be gripped by the hand. Measurement of the internal pressure in the object can be related to the grip force. In this paper, we analyze such a pneumatic pressure sensing object for hand grip assessment and also describe an easy fabrication of the grip sensor. The instrumented object presented in this paper is designed to assess both the maximal voluntary grip forces and continuous grip force to monitor control of hand function during exercise under instruction from a therapist. Potential uses of such a pneumatic pressure sensing object for hand grip are in physical rehabilitation of patients following paralysing illnesses like stroke and spinal cord injury.