Attaining a British consensus statement on managing idiopathic congenital talipes equinovarus (CTEV) through a Delphi process: a study protocol.

INTRODUCTION: Idiopathic congenital talipes equinovarus (CTEV) is the most common congenital limb deformity. Non-operative intervention using the Ponseti method has shown to be superior to soft tissue release and has become the gold standard for first-line treatment. However, numerous deviations from the Ponseti protocol are still reported following incomplete correction or deformity relapse. Significant variation in treatment protocols and management is evident in the literature. Reducing geographical treatment variation has been identified as one of The James Lind Alliance priorities in children's orthopaedics. For this reason, the British Society of Children's Orthopaedic Surgery (BSCOS) commissioned a consensus document to form a benchmark for practitioners and ensure consistent high quality care for children with CTEV. METHODS AND ANALYSIS: The consensus will follow an established Delphi approach aiming at gaining an agreement on the items to be included in the consensus statement for the management of primary idiopathic CTEV up to walking age. The process will include the following steps: (1) establishing a steering group, (2) steering group meetings, (3) a two-round Delphi survey aimed at BSCOS members, (4) final consensus meeting and (5) dissemination of the consensus statement. Degree of agreement for each item will be predetermined. Descriptive statistics will be used for analysis of the Delphi survey results. ETHICS AND DISSEMINATION: No patient involvement is required for this project. Informed consent will be assumed from participants taking part in the Delphi survey. Study findings will be published in an open access journal and presented at relevant national and international conferences. Charities and associations will be engaged to promote awareness of the consensus statement.

Novel Electromagnetic Sensors Embedded in Reinforced Concrete Beams for Crack Detection.

This paper investigates the possibility of applying novel microwave sensors for crack detection in reinforced concrete structures. Initially, a microstrip patch antenna with a split ring resonator (SRR) structure was designed, simulated and fabricated. To evaluate the sensor's performance, a series of structural tests were carried out and the sensor responses were monitored. Four reinforced concrete (RC) beam specimens, designed according to the European Standards, were tested under three-point bending. The load was applied incrementally to the beams and the static responses were monitored via the use of a load cell, displacement transducers and crack width gauges (Demec studs). In parallel, signal readings from the microwave sensors, which were employed prior to the casting of the concrete and located along the neutral axis at the mid-span of the beam, were recorded at various load increments. The microwave measurements were analysed and compared with those from crack width gauges. A strong linear relationship between the crack propagation and the electromagnetic signal across the full captured spectrum was found, demonstrating the technique's capability and its potential for further research, offering a reliable, low-cost option for structural health monitoring (SHM).

An analyses of the status of landfill classification systems in developing countries: Sub Saharan Africa landfill experiences.

Municipal solid waste (MSW) management remains a challenge in developing countries due to increasing waste generation, high costs associated with waste management and the structure of the containment systems implemented. This study analyses the classification of landfilling systems by using documented cases reported mainly in publications in waste management in relation to non-engineered landfilling systems/approved dumpsites in Sub Saharan African (SSA) countries from 2000 to 2018. The work identifies an existing system for the classification of landfill sites and utilises this system to determine the situation of landfill sites in SSA countries. Each article was categorised according to the main landfilling management practice reported: Uncontrolled dumping, semi controlled facility, medium controlled facility, medium/high-engineered facility or high state-of the-art facility. Findings suggested that 80% of the documented cases of landfill sites assessed in SSA countries were classified as level 0 or 1. The structure of the containment and controlled regime were identified by the focus group discussion participants as important predictors of possible strengths, weaknesses, opportunities and threats for the landfill sites considered. The study represents the first identifiable and comprehensive academic evaluation of landfill site classification based on site operations reported in the available peer reviewed literature. The information provides insight on the status of landfill sites in SSA countries with respect to the landfilling management practice and a baseline for alternative corrective measures.

Surgical Outcomes of Single-Level Bilateral Selective Dorsal Rhizotomy for Spastic Diplegia in 150 Consecutive Patients.

OBJECTIVES: Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. METHODS: Demographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records. RESULTS: Preoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months. CONCLUSIONS: SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.

Assessing combined sewer overflows with long lead time for better surface water management.

During high-intensity rainfall events, the capacity of combined sewer overflows (CSOs) can exceed resulting in discharge of untreated stormwater and wastewater directly into receiving rivers. These discharges can result in high concentrations of microbial pathogens, biochemical oxygen demand, suspended solids, and other pollutants in the receiving waters. The frequency and severity of the CSO discharge are strongly influenced by climatic factors governing the occurrence of urban stormwater runoff, particularly the amount and intensity of the rainfall. This study attempts to assess the impact of climate change (change in rainfall amount and frequency) on CSO under the high (A1FI) and low (B1) Special Report on Emissions Scenarios of the greenhouse concentration derived from three global circulation models in the north west of England at the end of the twenty-first century.

Profile of medical waste management in two healthcare facilities in Lagos, Nigeria: a case study.

Proper management and safe disposal of medical waste (MW) is vital in the reduction of infection or illness through contact with discarded material and in the prevention of environmental contamination in hospital facilities. The management practices for MW in selected healthcare facilities in Lagos, Nigeria were assessed. The cross-sectional study involved the use of questionnaires, in-depth interviews, focused group discussions and participant observation strategies. It also involved the collection, segregation, identification and weighing of waste types from wards and units in the representative facilities in Lagos, Nigeria, for qualitative and quantitative analysis of the MW streams. The findings indicated that the selected Nigerian healthcare facilities were lacking in the adoption of sound MW management (MWM) practices. The average MW ranged from 0.01 kg/bed/day to 3.98 kg/bed/day. Moreover, about 30% of the domestic waste from the healthcare facilities consisted of MW due to inappropriate co-disposal practices. Multiple linear regression was applied to predict the volume of waste generated giving a correlation coefficient (R(2)) value of 0.99 confirming a good fit of the data. This study revealed that the current MWM practices and strategies in Lagos are weak, and suggests an urgent need for review to achieve vital reversals in the current trends.

SOME CONSEQUENCES OF SEXUAL DIMORPHISM: FEEDING IN MALE AND FEMALE FIDDLER CRABS, UCA PUGNAX (SMITH).

1. There were no differences in the respiratory rates of male and female Uca pugnax of comparable sizes. 2. The amount of salt marsh sediment ingested by starved male and female crabs was similar. 3. The number and weight of fecal pellets produced by male and female crabs were similar, as was the organic matter content. 4. The above suggests that there are minimal differences in food demands and digestive efficiencies between the sexes, yet the enlarged claw of the fiddler crabs cannot be used for feeding. This requires some compensatory mechanism in male crabs. 5. Male fiddlers do show about half the feeding motions per unit time compared to females, but they compensate by feeding about twice as long. This is corroborated by field observations. 6. Further compensation, if needed, could be achieved by the slightly larger holding surface of the feeding claw in males, perhaps allowing the grasping of larger fragments of marsh sediment.