Management of "Long" Nerve Gaps.

Long-gap nerve injuries offer unique physiological and logistical treatment challenges to the reconstructive surgeon. Options include nerve autograft, processed nerve allograft, nerve transfers, and tendon transfers. This review provides an evidence-framed discussion regarding the pros and cons of these diverse approaches.

Severe vascular complications after derotational osteotomy of the tibia salvaged with free functional latissimus dorsi muscle transfer. A case report.

We present a case study of a 26-year-old male who sustained severe vascular and neurogenic injury during derotational osteotomy of the tibia. Directly postoperatively he complained of a drop foot, but 3 days later presented with an ischemic compartment syndrome of the anterior and lateral compartments. After debridement the osteotomy and metalware were exposed and the patient had a drop foot. Here we report how we salvaged his lower limb with a free functional latissimus dorsi muscle transfer that reconstructed soft tissues and restored ankle dorsiflexion.

The effect of cash transfers on health in high-income countries: A scoping review.

High-income countries use cash transfer programs to mitigate poverty, in part to improve the health of low-income populations and potentially reduce their use of public health care. This review synthesizes evidence from studies that employed experimental or quasi-experimental designs to evaluate the effect of cash transfer interventions on health outcomes or health care utilization in high-income countries. We excluded interventions if they required prior contributions for eligibility, substituted cash transfers for in-kind services, or were contingent on specific health behaviours, and excluded studies published before 1970. We searched 14 academic databases on May 13, 2022 and April 18, 2023, identifying 20,978 unique records. After screening, 164 studies were included. These studies covered interventions in 14 countries, with the largest share from the United States. The most common health outcomes examined were fertility, birth weight, self-rated health, tobacco use, and depression. We classified studies into seven intervention categories and eight health outcome domains, and identified where systematic reviews may be possible. We found relatively few studies examining health care utilization as an outcome and identify this as a knowledge gap. We categorized effects as beneficial or harmful, except for fertility and health care utilization where effects were categorized as increase or decrease. With insufficient consistency of outcomes for meta-analysis, we employed a vote count and sign test to assess the presence of any effect. Across the six relevant health domains, 98 of 130 studies (.75; 95% CI: .67, .82) reported a beneficial median effect, significantly different from the null value of 50% (p = .000). Of 37 studies examining fertility, 23 showed increases (.62; 95% CI: .46, .76) in fertility, which did not clear our threshold for statistical significance using conservative assumptions (p = .094). However, a larger share of studies reported increased fertility for child/family benefits (.69, n = 26) than for employment-related cash transfers (.44, n = 9). Results for health care utilization were evenly distributed (5 increase, 4 inconsistent, 6 decrease), but these are difficult to interpret as outcomes include both preventive and acute care. Our study provides replicable methods to enable future meta-analyses.

Latissimus dorsi tendon transfer versus open complete repair for symptomatic massive rotator cuff tear.

BACKGROUND: Symptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT. METHODS: Cases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset. RESULTS: The functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05). CONCLUSIONS: LDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).

Measuring income inequality via percentile relativities.

The adage "the rich are getting richer" refers to increasingly skewed and heavily-tailed income distributions. For such distributions, the mean is not the best measure of the center, but the classical indices of income inequality, including the celebrated Gini index, are mean based. In view of this, it has been proposed in the literature to incorporate the median into the definition of the Gini index. In the present paper we make a further step in this direction and, to acknowledge the possibility of differing viewpoints, investigate three median-based indices of inequality. These indices overcome past limitations, such as: (1) they do not rely on the mean as the center of, or a reference point for, income distributions, which are skewed, and are getting even more heavily skewed; (2) they are suitable for populations of any degree of tail heaviness, and income distributions are becoming increasingly such; and (3) they are unchanged by, and even discourage, transfers among the rich persons, but they encourage transfers from the rich to the poor, as well as among the poor to alleviate their hardship. We study these indices analytically and numerically using various income distribution models. Real-world applications are showcased using capital incomes from 2001 and 2018 surveys from fifteen European countries.

Hospital transfers for evaluation and treatment of hand infections: Are all transfers necessary?

Background: Hand infections represent a common hand condition in the emergency department and one that frequently requires a hand specialist. The purpose of our study is to analyze hospital transfers for hand infections with a primary outcome being potential clinically avoidable transfers and to identify areas for improvement in the care of hand infections. Methods: Retrospective review of The Texas Healthcare Information Collection Database from 2015 to 2019. We analyzed all transfers for hand infections. Statistical analyses included: Transfer diagnosis, surgical interventions, length of stay (LOS), the day of the week that the transfer was initiated and whether or not the transfer or centralization was necessary or potentially avoidable. Results: A total of 3489 patients were transferred from one hospital to another for the management of a hand infection. 1628 (46.6 â€‹%) underwent at least one surgical intervention and 1861 (53.3 â€‹%) were treated non-operatively. Patients undergoing operative interventions had a lower LOS compared to those non-operatively. Transfers admitted during the weekend had decreased average LOS relative to non-weekend transfers, but a 94.7 â€‹% increased odds of receiving a relevant surgical intervention during the hospital admission. Nearly all patients were transferred to urban region hospitals. Of total, 1194 (34.22 â€‹%) were considered potentially avoidable centralizations, which we defined as transfer that resulted in no surgical intervention and discharge to home within 72 â€‹h. Conclusions: Although the reason for centralization was unknown, our analysis showed a high number of transfers that could have been potentially avoidable. We propose the development of specific guidelines, and perhaps the use of remote consultations for areas where hand specialist are not reliably available to help optimize the care of patient with hand infections.

Health effects of introducing an unconditional child benefit in Poland: Evidence from a difference in differences analysis.

The association between income and health is well-documented, yet the impact of unconditional child benefits on health in high-income countries remains unclear. This study evaluates the health effects of a generous unconditional child transfer introduced in Poland in 2016. We employed a difference-in-differences methodology using 2010-2019 data from the European Union Statistics on Income and Living Conditions (EU-SILC). Our analysis compared health outcomes between parents eligible for the child benefit and a control group of childless individuals and parents of ineligible children. The introduction of the child benefit was associated with a 2.7 percentage point increase in reporting very good self-perceived health among beneficiaries. The improvement was more significant among the lower-income half, and there was a notable decrease in unmet medical and dental needs by 1.4 percentage points. The policy significantly improved health outcomes, suggesting the potential of unconditional cash transfers to enhance health in high-income countries, particularly for economically disadvantaged groups.

Drug company methodologies used for reporting in the UK pharmaceutical industry payment transparency database between 2015 and 2019: A content analysis.

Pharmaceutical companies spend hundreds of millions of pounds on marketing/R&D-related payments annually to healthcare organisations and healthcare professionals. UK pharmaceutical industry self-regulatory bodies require member companies who sign up to their code of conduct to publish details of their payments. They are also required to publish the methodologies underlying these payments, namely methodological notes. This study aimed to analyse UK pharmaceutical companies' methodological notes and their adherence to the Association of the British Pharmaceutical Industry code of conduct and other relevant guidance. We conducted a content analysis of methodological notes for the years 2015, 2017 and 2019 and assessed companies' adherence to self-regulatory bodies' requirements and recommendations for methodology disclosure. Overall, 90 companies made payment disclosures in all three years, publishing 269 methodological notes. We found gaps in adherence to self-regulatory requirements. Only 3 (3.3 %) companies provided clear information for all self-regulatory body recommendations and regulations in all of their notes. Companies also varied in their approaches to important areas. For example, of the 244 notes with clear information on VAT management, 36.1 % (N = 88) included VAT, 30.3 % (N = 74) excluded VAT, and 33.6 % (N = 82) had multiple rules for VAT. There was evidence of widespread non-adherence to self-regulatory requirements. This suggests flaws with self-regulation and a need for greater enforcement of rules or consideration of a publicly mandated disclosure system.

Characterization of the complete mitogenome of Tiarella polyphylla, commonly known as Asian foamflower: insights into the multi-chromosomes structure and DNA transfers.

BACKGROUND: Tiarella polyphylla D. Don has been traditionally used to cure asthma and skin eruptions. However, the sequence and the structure of the mitogenome of T. polyphylla remained elusive, limiting the genomic and evolution analysis based on the mitogenome. RESULTS: Using a combination of Illumina and Nanopore sequencing reads, we de novo assembled the complete mitogenome of T. polyphylla. In addition to unveiling the major configuration of the T. polyphylla mitogenome was three circular chromosomes with lengths of 430,435 bp, 126,943 bp, and 55,269 bp, we revealed five (R01-R05) and one (R06) repetitive sequence could mediate the intra- and inter-chromosomal recombination, respectively. Furthermore, we identified 208 short and 25 long tandem segments, seven cp-derived mtDNAs, 106 segments of mtDNAs transferred to the nuclear genome, and 653 predicted RNA editing sites. Based on the sequence of the mitogenomes, we obtained the resolved phylogeny of the seven Saxifragales species. CONCLUSIONS: These results presented the mitogenome features and expanded its potential applications in phylogenetics, species identification, and cytoplasmic male sterility (CMS) in the future.

Predictors of nursing home conveyances to emergency department.

BACKGROUND: With increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital. METHODS: This was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances. RESULTS: A total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005). CONCLUSIONS: Unstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.

Reestablishment of the Smile after Hypoglossal-Facial Nerve Transfer: What Can We Learn?

Objective The aim of this study was to assess the ability to smile following a hypoglossal-facial nerve transfer (N12-N7). Design This is a retrospective chart review. Setting National tertiary referral center for skull base pathology. Participants Seventeen patients. Main Outcome Measures The ability to smile following an N12-N7 transfer was assessed by five medical doctors on photographs of the whole face and frontal, orbital, and oral segments. The (segmented) photographs were scored for the symmetry, asymmetry, and correct or incorrect assessment of the affected side. Results Seventeen patients were analyzed by 5 assessors providing 85 assessments. The whole face at rest was judged symmetrical in 26% of the cases and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20, and 35%, respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15, and 6%, respectively. The affected side of the frontal, orbital, and buccal facial segments during smiling was correctly identified in 89, 89, and 96%, respectively. Interobserver variability with Fleiss' kappa analysis showed that the strength of the agreement during smile of the total face was good (0.771) Conclusion Following an N12-N7 transfer, a good facial symmetry at rest can be achieved. During smiling, almost all patients showed asymmetry of the face, which was predominantly determined by the orbital and oral segments. To improve the ability to smile after an N12-N7 transfer, additional procedures are needed.

Effects of an Intervention on Black Family Incomes on Self-Rated Health and Obesity in Black and White Adolescents and Young Adults.

Structural racism contributes to health disparities between U.S. non-Hispanic Black and non-Hispanic white populations by differentially distributing resources used to maintain health. Policies that equitably redistribute resources may mitigate racialized health disparities. Using National Longitudinal Study of Adolescent to Adult Health data and time-to-event parametric g-formula methods, we investigate a hypothetical intervention to reduce Black-white family income inequities on racialized differences in self-rated health (N=11,312) and obesity (N=10,547). We first intervene to increase individual Black family incomes by $11,000, creating Black-white equity in median incomes in 1995. Then, we measure social multiplier effects by additionally increasing county-level Black median household incomes by $11,000. By Wave 4, individual, direct effects models comparing Black intervention to Black control groups show no risk differences in self-rated health (RD=-0.009; 95% CI: -0.026, 0.008) or obesity (RD=0.003; 95% CI: -0.017, 0.023). Social multiplier effects models suggestively reduce Black-white inequalities in obesity by increasing obesity in white intervention versus white control groups (RD=0.050=; 95% CI: -0.011, 0.110), but exacerbate Black-white disparities in self-rated health by reducing self-rated health in Black intervention versus white control groups (RD=0.184; 95% CI: 0.018, 0.351). In this cohort, income transfers may not reduce racialized disparities in obesity and self-rated health.

The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury.

OBJECTIVE: To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes. DESIGN: A retrospective observational case series. SETTING: A specialist brain injury inpatient rehabilitation service. SUBJECTS: Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022. MAIN MEASURES: Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery. RESULTS: There was no relationship between admission wait and initial complexity (rs = 0.006; p = 0.923), functional status (rs = -0.070; p = 0.284) or care needs (rs = 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation (rs = -0.240; p = 0.0002) and change of care needs (rs = -0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants (n = 115; rs = -0.243; p = 0.009), with a tracheostomy (n = 46; rs = -0.362; p = 0.013), requiring enteral nutrition (n = 137; rs = -0.237; p = 0.005) or having had intracranial surgery (n = 97; rs = -0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants (rs = -0.319; p = 0.0005) and requiring enteral nutrition (rs = -0.269; p = 0.001). CONCLUSION: Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.

Enabling Sustainable Ammonia Synthesis: From Nitrogen Activation Strategies to Emerging Materials.

Ammonia (NH3) is one of the most important precursors of various chemicals and fertilizers. Given that ammonia synthesis via the traditional Haber-Bosch process requires high temperatures and pressures, it is critical to explore effective strategies and catalysts for ammonia synthesis under mild reaction conditions. Although electrocatalysis and photocatalysis can convert N2 to NH3 under mild conditions, their efficiencies and production scales are still far from the requirements for industrialization. Thermal catalysis has been proven to be the most direct and effective approach for ammonia synthesis. Over the past few decades, significant efforts have been made to develop novel catalysts capable of nitrogen fixation and ammonia generation via thermal catalytic processes. In parallel with catalyst exploration, new strategies such as self-electron donation, hydride fixation, hydridic hydrogen reduction, and anionic vacancy promotion have also been explored to moderate the operating conditions and improve the catalytic efficiency of ammonia synthesis. In this review, the emergence of new materials and strategies for promoting N2 activation and NH3 formation during thermal catalysis is briefly summarized. Moreover, challenges and prospects are proposed for the future development of thermal catalytic ammonia synthesis.

Money and mental health: The impact of intergenerational transfers on elderly people in China.

Using three waves of the China Health and Retirement Longitudinal Study, this paper examines whether financial transfers from adult children to elderly parents affect the latter's mental health. Both OLS and instrumental variable (IV) estimates show that financial transfers significantly attenuate depressive symptoms of elderly individuals, with a much larger size of the IV estimates. We also examine the income and cultural channels through which intergenerational transfers work and further discuss the explanatory powers of these two channels through a decomposition analysis. The results suggest the cultural channel accounts for a larger proportion of the financial transfer effect. This means that the unique beneficial impact of intergenerational financial transfers on the mental health of older adults cannot be fully substituted in the foreseeable future.

Systematic Review on the Impact of Various Types of Universal Basic Income on Mental Health in Low- and Middle-Income Countries.

In the past two decades, a significant surge in interest in investigating mental disorders and challenges faced by low- and middle-income countries in the realm of mental health has been observed. Various types of universal basic income (UBI) programs have already demonstrated significant impacts on individuals' mental health in high-income countries. Therefore, this review focuses on the situation in low- and middle-income countries. A literature review was conducted using seven electronic databases. Empirical studies of any design that implemented different types of UBI interventions in middle- and low-income countries and applied any type of mental health measures were searched for. After systematically reviewing 6822 articles, 13 empirical studies examining the relationship between various types of UBI interventions and different aspects of mental health in developing countries were identified. The collective findings of the studies suggest that UBI programs have significant positive effects on the mental health of individuals from developing countries, with the potential mediating role of unconditionality and payment frequency being noteworthy. However, these implications are limited due to the small number of studies conducted in this area and their methodological constraints. Further research with rigorous design is needed, particularly focusing on experimental control and length of follow-up periods.

Nerve Versus Tendon Transfers in the Management of Isolated Upper Extremity Peripheral Nerve Injuries.

Upper extremity peripheral nerve injuries present functional deficits that are amenable to management by tendon or nerve transfers. The principles of tendon and nerve transfers are discussed, with technical descriptions of preferred tendon and nerve transfers for radial, median, and ulnar nerve injuries.

Poverty reduction and childhood opportunity moves: A randomized trial of cash transfers to low-income U.S. families with infants.

Black and Hispanic children have a higher likelihood of experiencing neighborhood poverty than white children. This study uses data from the Baby's First Years (BFY) randomized trial to examine whether an unconditional cash transfer causes families to make opportunity moves to better quality neighborhoods. We use Intent to Treat linear regression models to test whether the BFY treatment, of receiving $333/month (vs. $20/month) for three years, leads to moves to neighborhoods of greater childhood opportunity. Overall, we find no relation between the BFY treatment and neighborhood opportunity across time. However, we find effect modification by maternal baseline health. High-cash receipt among mothers with poor health at baseline corresponds with moves to neighborhoods of greater childhood opportunity.

Interhospital transfer dynamics for patients with intracranial hemorrhage in Massachusetts.

Introduction: Intracranial hemorrhages present across a spectrum of clinical phenotypes, with many patients transferred across hospitals to access higher levels of neurocritical care. We sought to characterize patient dispositions following intracranial hemorrhage and examine disparities associated with interhospital transfers. Methods: Using the Healthcare Cost and Utilization Project database, we mapped and identified factors influencing the likelihood of patient transfers and receipt of specialist interventional procedures following intracranial hemorrhage. Results: Of 11,660 patients with intracranial hemorrhage, 59.4% had non-traumatic and 87.5% single compartment bleeds. After presentation, about a quarter of patients were transferred to another facility either directly from the ED (23.0%) or after inpatient admission (1.8%). On unadjusted analysis, patients who were white, in the upper income quartiles, with private insurance, or resided in suburban areas were more frequently transferred. After adjusting for patient-and hospital-level variables, younger and non-white patients had higher odds of transfer. Hospital capabilities, residence location, insurance status, and prior therapeutic relationship remained as transfer predictors. Transferred patients had a similar hospital length of stay compared to admitted patients, with 43.1% having no recorded surgical or specialist interventional procedure after transfer. Discussion: Our analysis reveals opportunities for improvement in risk stratification guiding transfers, as well as structural challenges likely impacting transfer decisions.