A Systems Map of the Challenges of Climate Communication.

Over the past sixty years, scientists have been warning about climate change and its impacts on human health, but evidence suggests that many may not be heeding these concerns. This raises the question of whether new communication approaches are needed to overcome the unique challenges of communicating what people can do to slow or reverse climate change. To better elucidate the challenges of communicating about the links between human activity, climate change and its effects, and identify potential solutions, we developed a systems map of the factors and processes involved based on systems mapping sessions with climate change and communication experts. The systems map revealed 27 communication challenges such as "Limited information on how individual actions contribute to collective human activity," "Limited information on how present activity leads to long-term effects," and "Difficult to represent and communicate complex relationships." The systems map also revealed several themes among the identified challenges that exist in communicating about climate change, including a lack of available data and integrated databases, climate change disciplines working in silos, a need for a lexicon that is easily understood by the public, and the need for new communication strategies to describe processes that take time to manifest.

Cage Augmentation of the Retained Acetabular Shell with a Dual Mobility Cup using the Double Socket Technique.

Introduction: Prevention of dislocation after total hip arthroplasty (THA) remains a topic of debate. There are various surgical options to manage hip instability such as large femoral heads, and constrained liners, although the best option to tackle this is still controversial. In revision scenarios with previous well-fixed acetabulum shells, the cementation of polyethylene liners or the cementation of dual mobility (DM) into a well-fixed acetabulum shell (Double Socket Technique) has been documented before.Here, we report a case of re-revision THA, where we have used the Double Socket Technique of retaining the previous well-fixed acetabular shell with the cementation of the DM cup along with an anti-protrusio cage inside the socket. To the best of our knowledge, this is the first such a case to be reported worldwide. Case Report: A 54-year-old male who underwent THA in 1990 and an acetabulum cup revision in 2003 presented to us with right hip pain. Radiographs showed Paprosky Type 3A femoral bone loss and polyethylene wear. Intraoperatively after removing the polyethylene liner, the acetabulum shell was found to be well fixed and therefore retained. To increase stability, an anti-protrusio cage was inserted over it and a DM cup was cemented onto it (double socket). The femoral stem was revised using Wagner stem and encerclage wires and a hook plate was used to stabilize the osteotomy site. Conclusion: This technique is a reliable option and helps shorten the surgical time and reduce the bone loss that can occur in extracting a well-fixed acetabulum shell. The use of a DM cup decreases the chances of instability compared to the cementation of polyethylene liners and decreases the high failure rate associated with the use of cementation of constrained liners. The addition of an anti-protrusio cage in addition to the Double Socket Technique increases the stability of the construct.

Role of Mentzer Index for Differential Diagnosis of Iron Deficiency Anaemia and Beta Thalassemia Trait.

BACKGROUND: The most common differential diagnoses of microcytic hypochromic anaemia are iron deficiency anaemia and beta thalassemia. Globally, thalassemia affects approximately 4.4 out of every 10,000 live births whereas iron deficiency anaemia comprises half of all anaemia worldwide as per world health organization. The definitive diagnosis of beta thalassemia trait and iron deficiency anaemia requires haemoglobin analysis and iron studies respectively, which are not possible to perform in all suspected cases especially in resource limited settings. The study aims to evaluate the reliability of mentzer index in differentiating beta thalassemia trait from iron deficiency anaemia. METHODS: This was a cross sectional, observational study done on 59 patients each of beta thalassemia trait and iron deficiency anaemia from August 2019 to July 2020. Patients who were found to be having iron deficiency anaemia diagnosed by iron studies and beta thalassemia trait diagnosed by Hb electrophoresis were enrolled in the study using simple random sampling technique. RESULTS: Mentzer index correctly identified 95.76% of overall patients. Area under receiver operating characteristic curve was 0.993 (95% CI, 0.985-1.002, p<0.001). For beta thalassemia trait, mentzer index showed a sensitivity of 93.2%, specificity of 98.3%, positive predictive value of 98.2%, negative predictive value of 93.5%; while for iron deficiency anaemia, sensitivity of 98.3%, specificity of 93.2%, positive predictive value of 93.5% and negative predictive value of 98.2%. Youden's index was 91.5. CONCLUSIONS: The findings of the present study make mentzer index a reliable screening method, especially in a resource poor setting, like Nepal. Further confirmation by gold standard tests is recommended.

TFNA Implant Failure with Helical Blade Cut-out.

INTRODUCTION: Trochanteric femoral nail-advanced (TFNA) was introduced in the market with better nail design, better alloy (titanium molybdenum) and both sliding and static locking options of the helical blade. Although, it was devised to overcome the shortcomings of roximal Femoral Nail Anti-rotation (PFNA), it still can have complications, if the principles of fracture management are not met. Here, we report a case of a TFNA implant failure with helical blade cut-out in an elderly osteoporotic patient treated for inter-trochanteric femur fracture. To the best of our knowledge, this is the first report of helical blade cut-out wit TFNA nail in world literature. CASE REPORT: An 83-year-old female patient was treated with a TFNA nail for inter-trochanteric femur fracture (AO 31A2.1). An acceptable reduction and stable fixation were achieved. The position of the helical blade in the head was in the optimal position with a tip apex distance (TAD) of 29 mm. The patient presented to us 6 weeks later with implant failure with helical blade cut out after a history of fall. Cemented bipolar hemiarthroplasty with calcar reconstruction using a mesh was done. The patient was clinically asymptomatic and was walking full weight-bearing till her last follow-up at 14 months. CONCLUSION: We can associate the failure seen in our case with an increased TAD of 29 mm, osteoporotic bone and a neutral to negative variance. Helical blade cut-out was seen as the blade was locked onto the nail with insufficient hold onto the osteoporotic head fragment which collapsed into varus, leading to cut-out. This case report emphasizes the importance of TAD, valgus reduction, and positive variance in avoiding implant failures, even with a newer implant like TFNA which was developed to improvise onto the shortcomings of PFNA nail.

The feasibility of a three-dimensional charting interface for general dentistry.

BACKGROUND: Most current paper- and computer-based formats for patient documentation use a two-dimensional dental chart, a design that originated almost 150 years ago in the United States. No studies have investigated the inclusion of a three-dimensional (3-D) charting interface in a general dental record. METHODS: A multidisciplinary research team with expertise in human-computer interaction, dental informatics and computer science conducted a 14-week project to develop and evaluate a proof of concept for a 3-D dental record. Through several iterations of paper- and computer-based prototypes, the project produced a high-fidelity (hi-fi) prototype that was evaluated by two dentists and two dental students. RESULTS: The project implemented a prototypical patient record built around a 3-D model of a patient's maxillofacial structures. Novel features include automatic retrieval of images and radiographs; a flexible view of teeth, soft tissue and bone; access to historical patient data through a timeline; and the ability to focus on a single tooth. CONCLUSIONS: Users tests demonstrated acceptance for the basic design of the prototype, but also identified several challenges in developing intuitive, easy-to-use navigation methods and hi-fi representations in a 3-D record. CLINICAL IMPLICATIONS: Test participants in this project accepted the preliminary design of a 3-D dental record. Significant further research must be conducted before the concept can be applied and evaluated in clinical practice.