Back(s) to basics: The concept of backing in stone tool technologies for tracing hominins' technical innovations.

The evolution of Paleolithic stone tool technologies is characterized by gradual increase in technical complexity along with changes in the composition of assemblages. In this respect, the emergence of retouched-backed tools is an important step and, for some, a proxy for "modern" behavior. However, backed tools emerge relatively early and develop together with major changes in Middle-Upper Pleistocene stone tool technologies. We provide an updated review of the emergence and development of the "backing" concept across multiple chrono-cultural contexts and discuss its relationship to both the emergence of hafting and major evolutionary steps in the ergonomics of stone tool use. Finally, we address potential mechanisms of context-specific re-invention of backing based primarily on data from the late Middle Paleolithic of Western Europe.

Hardware Schemes for Smarter Indoor Robotics to Prevent the Backing Crash Framework Using Field Programmable Gate Array-Based Multi-Robots.

The use of smart indoor robotics services is gradually increasing in real-time scenarios. This paper presents a versatile approach to multi-robot backing crash prevention in indoor environments, using hardware schemes to achieve greater competence. Here, sensor fusion was initially used to analyze the state of multi-robots and their orientation within a static or dynamic scenario. The proposed novel hardware scheme-based framework integrates both static and dynamic scenarios for the execution of backing crash prevention. A round-robin (RR) scheduling algorithm was composed for the static scenario. Dynamic backing crash prevention was deployed by embedding a first come, first served (FCFS) scheduling algorithm. The behavioral control mechanism of the distributed multi-robots was integrated with FCFS and adaptive cruise control (ACC) scheduling algorithms. The integration of multiple algorithms is a challenging task for smarter indoor robotics, and the Xilinx-based partial reconfiguration method was deployed to avoid computational issues with multiple algorithms during the run-time. These methods were coded with Verilog HDL and validated using an FPGA (Zynq)-based multi-robot system.

High Acoustic Impedance and Attenuation Backing for High-Frequency Focused P(VDF-TrFE)-Based Transducers.

Backing materials with tailored acoustic properties are beneficial for miniaturized ultrasonic transducer design. Whereas piezoelectric P(VDF-TrFE) films are common elements in high-frequency (>20 MHz) transducer design, their low coupling coefficient limits their sensitivity. Defining a suitable sensitivity-bandwidth trade-off for miniaturized high-frequency applications requires backings with impedances of >25 MRayl and strongly attenuating to account for miniaturized requirements. The motivation of this work is related to several medical applications such as small animal, skin or eye imaging. Simulations showed that increasing the acoustic impedance of the backing from 4.5 to 25 MRayl increases transducer sensitivity by 5 dB but decreases the bandwidth, which nevertheless remains high enough for the targeted applications. In this paper, porous sintered bronze material with spherically shaped grains, size-adapted for 25-30 MHz frequency, was impregnated with tin or epoxy resin to create multiphasic metallic backings. Microstructural characterizations of these new multiphasic composites showed that impregnation was incomplete and that a third air phase was present. The selected composites, sintered bronze-tin-air and sintered bronze-epoxy-air, at 5-35 MHz characterization, produced attenuation coefficients of 1.2 and >4 dB/mm/MHz and impedances of 32.4 and 26.4 MRayl, respectively. High-impedance composites were adopted as backing (thickness = 2 mm) to fabricate focused single-element P(VDF-TrFE)-based transducers (focal distance = 14 mm). The center frequency was 27 MHz, while the bandwidth at -6 dB was 65% for the sintered-bronze-tin-air-based transducer. We evaluated imaging performance using a pulse-echo system on a tungsten wire (diameter = 25 µm) phantom. Images confirmed the viability of integrating these backings in miniaturized transducers for imaging applications.

A Metamaterial Inspired AMC Backed Dual Band Antenna for ISM and RFID Applications.

This work presents the design and fabrication of a metamaterial-based stimulated dual band antenna on FR4 material (dielectric constant 4.3) to operate in Industrial, Scientific and Medical (ISM) and Radio-frequency Identification (RFID) applications. The antenna model had an overall dimension of 70 × 31 × 1.6 mm3 with etched T-slots and L-slots for dual band resonance. The main objective of this work was to enhance the gain performance characteristic at the selected dual band frequencies of 0.915 GHz and 2.45 GHz. Initially, it achieved a narrow bandwidth of 0.018 GHz with a gain of 1.53 dBi at a lower frequency, and 0.13 GHz of bandwidth featuring 4.49 dBi of gain at a higher frequency. The antenna provided an impedance bandwidth of 2% (0.905-0.923 GHz) and 5% (2.382-2.516 GHz) at two resonating frequencies. The antenna was integrated with a designed novel AMC structure to enhance the gain in CST Microwave Studio software with the finite integration method. The characteristic features of the AMC unit cell were observed at 0.915 GHz and 2.45 GHz frequencies and after antenna integration, the final prototype achieved a gain of 2.87 dBi at 0.915 GHz and 6.8 dBi at 2.45 GHz frequencies.

Lead-Free Sodium Potassium Niobate-Based Multilayer Structures for Ultrasound Transducer Applications.

Thick films with nominal composition (K0.5Na0.5)0.99Sr0.005NbO3 (KNNSr) on porous ceramics with identical nominal composition were investigated as potential candidates for environmentally benign ultrasonic transducers composed entirely of inorganic materials. In this paper, the processing of the multilayer structure, namely, the thick film by screen printing and the porous ceramic by sacrificial template method, is related to their phase composition, microstructure, electromechanical, and acoustic properties to understand the performance of the devices. The ceramic with a homogeneous distribution of 8 µm pores had a sufficiently high attenuation coefficient of 0.5 dB/mm/MHz and served as an effective backing. The KNNSr thick films sintered at 1100 °C exhibited a homogeneous microstructure and a relative density of 97%, contributing to a large dielectric permittivity and elastic constant and yielding a thickness coupling factor kt of ~30%. The electroacoustic response of the multilayer structure in water provides a centre frequency of 15 MHz and a very large fractional bandwidth (BW) of 127% at -6 dB. The multilayer structure is a candidate for imaging applications operating above 15 MHz, especially by realising focused-beam structure through lenses to further increase the sensitivity in the focal zone.

Efficient Drug Delivery into Skin Using a Biphasic Dissolvable Microneedle Patch with Water-Insoluble Backing.

Dissolvable microneedle patches (MNPs) enable simplified delivery of therapeutics via the skin. However, most dissolvable MNPs do not deliver their full drug loading to the skin because only some of the drug is localized in the microneedles (MNs), and the rest remains adhered to the patch backing after removal from the skin. In this work, biphasic dissolvable MNPs are developed by mounting water-soluble MNs on a water-insoluble backing layer. These MNPs enable the drug to be contained in the MNs without migrating into the patch backing due to the inability of the drugs to partition into the hydrophobic backing materials during MNP fabrication. In addition, the insoluble backing is poorly wetted upon MN dissolution in the skin, which significantly reduces drug residue on the MNP backing surface after application. These effects enable a drug delivery efficiency of >90% from the MNPs into the skin 5 min after application. This study shows that the biphasic dissolvable MNPs can facilitate efficient drug delivery to the skin, which can improve the accuracy of drug dosing and reduce drug wastage.

A Fluidics-Based Double Flexural Membrane Piezoelectric Micromachined Ultrasonic Transducer (PMUT) for Wide-Bandwidth Underwater Acoustic Applications.

In acoustic receiver design, the receiving sensitivity and bandwidth are two primary parameters that determine the performance of a device. The trade-off between sensitivity and bandwidth makes the design very challenging, meaning it needs to be fine-tuned to suit specific applications. The ability to design a PMUT with high receiving sensitivity and a wide bandwidth is crucial to allow a wide spectrum of transmitted frequencies to be efficiently received. This paper presents a novel structure involving a double flexural membrane with a fluidic backing layer based on an in-plane polarization mode to optimize both the receiving sensitivity and frequency bandwidth for medium-range underwater acoustic applications. In this structure, the membrane material and electrode configuration are optimized to produce good receiving sensitivity. Simultaneously, a fluidic backing layer is introduced into the double flexural membrane to increase the bandwidth. Several piezoelectric membrane materials and various electrode dimensions were simulated using finite element analysis (FEA) techniques to study the receiving performance of the proposed structure. The final structure was then fabricated based on the findings from the simulation work. The pulse-echo experimental method was used to characterize and verify the performance of the proposed device. The proposed structure was found to have an improved bandwidth of 56.6% with a receiving sensitivity of -1.8864 dB rel 1 V µPa. For the proposed device, the resonance frequency and center frequency were 600 and 662.5 kHz, respectively, indicating its suitability for the targeted frequency range.

Thermal stability of poly[1-(trimethylsilyl)-1-propyne] and the gas chromatographic stationary phase based on it.

The thermal stability of poly[1-(trimethylsilyl)-1-propyne] is investigated by heating the capillary column with this polymer as the stationary phase with the subsequent separation of the test mixture of light hydrocarbons. It is shown that heating of the column up to 130°C does not cause a decrease in efficiency or in the retention time of solutes. A further increase in temperature results in both decrease in column efficiency and sorbate retention. However, a decrease in column retentivity goes in one way for all the tested hydrocarbons. At the same time, the efficiency of the column is changed to a lesser degree for methane and ethane up to the temperature of polymer degradation, while for propane, butane, and iso-butane the difference is rather sharp. The most expressed decrease in efficiency was found for iso-butane: the column efficiency for this sorbate versus temperature of heating had two stages. The diffusion coefficients for sorbates in the polymeric phase were also evaluated and the sharp decrease in their values was found after the column heating.

Development of Drug-in-Adhesive Patch with a Honeycomb Film as a Backing Layer.

Excess stripping of stratum corneum (SC) layers by patch-peeling from the skin surface is one cause of skin irritation. High SC hydration by patch occlusion may also cause skin irritation, although the occlusive technique is preferable to increase the skin permeation of topically applied drugs. In the present study, film having a honeycomb structure was selected as the backing layer of a drug-in-adhesive (DIA) patch to reduce peeling of the SC without losing adhesion force to the skin surface, as well as decreasing the skin permeation of a model drug, tulobuterol. The usefulness of the DIA patch with honeycomb film was evaluated by transepidermal water loss (TEWL) changes, amount of SC removed by patch-peeling, distribution pattern of removed SC on the adhesive layer, and water permeation through the patch. Furthermore, skin permeation and release profiles of tulobuterol from the DIA patch were investigated. Significantly (p<0.05) less TEWL change was observed after removal of the patch with a honeycomb film compared with the conventional pressure-sensitive adhesive patch, and no difference in tulobuterol permeation through skin from the patches was confirmed regardless of the type of backing layer. In addition, a lower amount of SC was removed by the peeling of the patch with a honeycomb film. The results suggest that DIA patches with a honeycomb film as a backing layer may be used to achieve less SC removal without reducing the skin permeation of drugs.

Broad bandwidth and excellent thermal stability in BiScO3-PbTiO3 high-temperature ultrasonic transducer for non-destructive testing.

High-temperature ultrasonic transducer (HTUT) is essential for non-destructive testing (NDT) in harsh environments. In this paper, a HTUT based on BiScO3-PbTiO3 (BS-PT) piezoelectric ceramics was developed, and the effect of different backing layers on its bandwidth were analyzed. The HTUT demonstrates a broad bandwidth and excellent thermal stability with operation temperature up to 400 °C. By using a 10 mm thick porous alumina backing layer, the HTUT achieves a broad -6 dB bandwidth of 100 %, which is about 4 times superior to the transducer with an air backing layer. The center frequency (fc) of the HTUT remains stable with fluctuations of less than 10 % across the temperature range from room temperature to 400 °C. The HTUT successfully detected simulated defects in pulse-echo mode for NDT over 200 °C. This research not only advances high-temperature ultrasonic transducer technology but also expands the NDT applications in harsh environmental conditions.

Double-Bending Tension Band Wire for Olecranon Fractures: A Novel Technique.

Purpose: This retrospective study aimed to compare the clinical outcomes and complications of conventional tension band wire (TBW), TBW with penetrating technique, and double-bending technique. Methods: A total of 40 patients (17 men and 23 women; mean age: 64.0 ± 19.0 years) who underwent surgery for displaced olecranon fractures between January 2018 and December 2021 were included and divided into three groups based on the surgical method used (group A, conventional TBW; group B, TBW with penetrating technique; and group C, double-bending technique). Thirteen patients were assigned to group A, 17 to group B, and 10 to group C, including 2 Mayo type IB, 30 Mayo type IIA, and 8 Mayo type IIB fractures. Postoperative outcomes (elbow extension and flexion arc) and complications, such as backing out of the Kirschner wire (K-wire), were retrospectively evaluated. Results: No significant difference was found in the general characteristics of the patients and fracture type among the three groups. The mean elbow extension arc values were 6.2°, 10.9°, and 0° in groups A, B, and C, respectively; it was significantly better in group C than in group B (P = .001). The rates of backing out of the K-wire were 84.6% (11/13) in group A, 41.2% (7/17) in group B, and 0% (0/10) in group C; the rate was significantly lower in group C than in group A (P < .001). Conclusions: The double-bending technique may be the best procedure for preventing the backing out of the K-wire and postoperative complications, such as range of motion restriction, for treating olecranon fractures that are treatable by TBW. Type of study/level of evidence: Therapeutic IV.

Enhancing electrostatic charge stability of corona charged Teflon electret films for radiation dosimetry by optimizing metal electrode backing material.

Metal electrode backing (MEB) material was found to have a significant role on the electrostatic surface charge stability of Teflon polytetrafluoroethylene (PTFE) electret films. PTFE films of different thicknesses were positively and negatively charged by using our home-made modified point-to-plane corona poling rotating systems. Different MEB materials and thicknesses; aluminum, copper, stainless steel, zinc, silver, and gold were applied. The electrostatic surface charge stability of charged PTFE films was monitored for 200 h at similar storage conditions. Proper MEB material enhances the electrostatic surface charge stability of electret films due to the work function of the metal electrodes and high potential barrier formation at the interface of MEB material and electret film. The studies show that thinner MEB materials provide higher electrostatic surface charge stability in PTFE films. Therefore, thinner MEB material with higher work function is an effective compromise for producing electret films with higher electrostatic surface charge stability. The findings are extremely important for the applications of highly stable electret films for different applications in particular for radiation dosimetry with special regards to radon monitoring.

A Miniature Multi-Functional Photoacoustic Probe.

Photoacoustic technology is a promising tool to provide morphological and functional information in biomedical research. To enhance the imaging efficiency, the reported photoacoustic probes have been designed coaxially involving complicated optical/acoustic prisms to bypass the opaque piezoelectric layer of ultrasound transducers, but this has led to bulky probes and has hindered the applications in limited space. Though the emergence of transparent piezoelectric materials helps to save effort on the coaxial design, the reported transparent ultrasound transducers were still bulky. In this work, a miniature photoacoustic probe with an outer diameter of 4 mm was developed, in which an acoustic stack was made with a combination of transparent piezoelectric material and a gradient-index lens as a backing layer. The transparent ultrasound transducer exhibited a high center frequency of ~47 MHz and a -6 dB bandwidth of 29.4%, which could be easily assembled with a pigtailed ferrule of a single-mode fiber. The multi-functional capability of the probe was successfully validated through experiments of fluid flow sensing and photoacoustic imaging.

Hydrocaffeic acid-chitosan coating of gastric patch provides long-acting mucoadhesive delivery of model chemotherapeutic agent.

The development of a long-acting orally administered dosage form is a challenge. Here, we report development of a multi-layered mucoadhesive gastric patch that could deliver entrapped chemotherapeutic agent for eight days after oral administration. The multi-layered patch was designed to contain core layer, mucoadhesive layer and backing layer. The core layer contained the model chemotherapeutic agent, regorafenib. The mucoadhesive layer made of chitosan-hydrocaffeic acid conjugate showed greatest mucoadhesion strength of 18.1 ± 0.78 kPa in freshly excised rat gastric mucosa. The backing layer made of hydrophobic polycaprolactone-polydimethylsiloxane composite showed the contact angle of 120 ± 4.7° after placement of water drop. The entrapped regorafenib predominantly released from the mucoadhesive-side of the patch into simulated gastric fluid and showed a zero-order release profile. The patches were found to be stable for desired characteristics for up to 3 months in long term storage conditions. The pharmacokinetic studies in rat model revealed constant plasma concentration of regorafenib sustained for 8 days after oral administration of gastric patch. The gastric tissue where the patch adhered for 8 days did not show any significant histological changes compared with the normal gastric tissue. The oral administration of single dose of regorafenib-loaded gastric patch in FaDu cell xenografted tumor bearing athymic nude mice has shown significant (P < 0.05) reduction in the tumor volume over 7 days compared to the control group. Taken together, the multi-layered mucoadhesive gastric patch can be developed as a long-acting oral drug delivery system.

A Backing-Layer-Shared Miniature Dual-Frequency Ultrasound Probe for Intravascular Ultrasound Imaging: In Vitro and Ex Vivo Validations.

Intravascular ultrasound (IVUS) imaging has been extensively utilized to visualize atherosclerotic coronary artery diseases and to guide coronary interventions. To receive ultrasound signals within the vessel wall safely and effectively, miniaturized ultrasound transducers that meet the strict size constraints and have a simple manufacturing procedure are highly demanded. In this work, the first known IVUS probe that employs a backing-layer-shared dual-frequency structure and a single coaxial cable is introduced, featuring a small thickness and easy interconnection procedure. The dual-frequency transducer is designed to have center frequencies of 30 MHz and 80 MHz, and both have an aperture size of 0.5 mm × 0.5 mm. The total thickness of the dual-frequency transducer is less than 700 µm. In vitro phantom imaging and ex vivo porcine coronary artery imaging experiments are conducted. The low-frequency transducer achieves spatial resolutions of 40 µm axially and 321 µm laterally, while the high-frequency transducer exhibits axial and lateral resolutions of 17 µm and 247 µm, respectively. A bandpass filter is utilized to separate the ultrasound images. Combining in vitro phantom imaging analysis with ex vivo imaging validation, a comprehensive demonstration of the promising application of the proposed miniature ultrasound probe is established.

Design of a functionally graded porous uncemented acetabular component: Influence of polar gradation.

The functionally graded porous metal-backed (FGPMB) acetabular component has the potential to minimize strain-shielding induced bone resorption, caused by stiffness mismatch of implant and host bone. This study is aimed at a novel design of FGPMB acetabular component, which is based on numerical investigations of the mechanical behavior of acetabular components with regard to common failure scenarios, considering various daily activities and implant-bone interface conditions. Both radial and polar functional gradations were implemented, and the effects of the polar gradation exponent on the failure criteria were evaluated. The relationships between porosity and orthotropic mechanical properties of a tetrahedron-based unit cell were obtained using a numerical homogenization method. Strain-shielding in cancellous bone was relatively lesser for the FGPMB than solid metal-backing. Few nodes around the rim were susceptible to implant-bone interfacial debonding, irrespective of the polar gradation exponent. Although the most favorable bone remodeling predictions were obtained for a polar gradation exponent of 0.1, a sudden change in the porosity was observed near the rim of FGPMB. Bone remodeling patterns were similar for polar gradation exponent of 5.0 and solid metal-backing. Moreover, the volumetric wear was maximum and minimum for polar gradation exponents of 0.1 and 5, respectively. Furthermore, the micromotions of different polar gradation exponents were within a range (20-40 µm) that might facilitate bone ingrowth. Considering common failure mechanisms, the FGPMB having polar gradation exponents in the range of 0.1-0.5 appeared to be a viable alternative to the solid acetabular component, within which a gradation exponent of 0.25 seemed the most appropriate design parameter.

Ultrasensitive Acoustic Detection Using an Enlarged Fabry-Perot Cavity with a Graphene Diaphragm.

For exerting high sensitivity of ultrathin graphene to detection deformation, an enlarged backing air cavity (EBC) structure is developed to further enhance the mechanical sensitivity (SM) of a graphene-based Fabry-Perot (F-P) acoustic sensor. COMSOL acoustic field simulation on the air cavity size-dependent SM confirms the optimal length and radius of the EBC of 0.2 and 1.5 mm, respectively, with the maximum simulation SM of 26.16 nm/Pa@1 kHz. Acoustic experiments further demonstrate that the frequency response of the fabricated graphene-based F-P acoustic sensor after the use of the EBC is enhanced by 5.73-79.33 times in the range of 0.5-18 kHz, compared with the conventional one without the EBC. Especially the maximum SM is up to 187.32 nm/Pa@16 kHz, which is at least 17% higher than the SM values ranging from 1.1 to 160 nm/Pa in previously reported F-P acoustic sensors using various diaphragm materials. More acoustic characteristics are examined to highlight various merits of the EBC structure, including a signal-to-noise ratio (SNR) of 60-75 dB@0.5-18 kHz, a time stability of less than ±1.3% for 90 min, a detection resolution of 0.01 Hz, and a high-fidelity speech detection with a cross-correlation coefficient of greater than 0.9, thereby revealing its high-performance weak acoustic sensing and speech recognition applications.

Evaluation of Newly Designed Blister Packs for Easier Handling to Prevent Pill Dropping.

BACKGROUND: Blister packs with paperboard backing, which is useful for displaying instructions and information, are the most popular type of packaging for osteoporosis drugs in Japan. However, the main users of drugs are the aged, who often find blister packs difficult to open or drop their pills during opening. In this study, we compared different types of blister packs in terms of usability and handling. METHODS: We conducted a subjective and objective study to compare commonly used blister packs with newly designed ones that have a jagged notch designed to hold a pill temporarily and a perforated line that enables the pack to be held easily in one hand. Regarding subjective data, packaging and sensory tests were performed. The participants in the sensory test were healthy older adults and patients with rheumatoid arthritis (RA). We also measured the pinch power of all participants. RESULTS: A comparison of several items, including opening status, prevention of pill dropping, and understanding of the instructions, using a numerical rating scale revealed no significant differences between ordinary (type A) and newly designed (type B) packaging. However, the scores for type B were the same or better than those for type A for every evaluation item. In addition, more than 85% of the participants reported preferring to use type B. More than 80% of the participants in both groups reported dropping pills using type A, which seemed to be related to their preference for type B. In the evaluation by the examiner (objective study), all participants could successfully remove their pills without dropping using type B, including those in the RA group who had difficulty handling packages. CONCLUSION: These findings suggest that the new type of blister pack assessed in this study (type B) is preferable among older and shows promise for a universal design.

Immediate detachment of microneedles by interfacial fracture for sustained delivery of a contraceptive hormone in the skin.

Despite their high efficacy and safety, long-acting contraceptive methods are underutilized among women in some settings because they usually require injection or implantation by healthcare personnel. Here, we report a self-administrable microneedle (MN) patch for the rapid administration of a sustained-release contraceptive hormone delivery system into the skin that increases the simplicity and reliability of the MN delivery. We developed an immediate microneedle detachment system using a porous patch backing that has sufficient strength during MN insertion into skin under compression, but enables immediate detachment (< 1 s) of the MNs due to fracture at the MN - backing interface upon patch removal under tension from the skin surface. After patch application, the removed patch produced no biohazardous sharps waste, and was designed to achieve long-acting contraception by formulating poly(lactic-co-glycolic acid) MNs to slowly release the contraceptive hormone levonorgestrel for up to 1 month. Our combined strategy using immediate MN detachment in the skin and sustained drug delivery from the MNs could facilitate greater access to long-acting contraception by providing a simple and convenient option for self-administered, long-acting contraception.

Screw-in-screw fixation of fragility sacrum fractures provides high stability without loosening-biomechanical evaluation of a new concept.

Surgical treatment of fragility sacrum fractures with percutaneous sacroiliac (SI) screw fixation is associated with high failure rates. Turn-out is detected in up to 20% of the patients. The aim of this study was to evaluate a new screw-in-screw implant prototype for fragility sacrum fracture fixation. Twenty-seven artificial hemipelvises were assigned to three groups (n = 9) for instrumentation of an SI screw, the new screw-in-screw implant prototype, ora transsacral screw. Before implantation, a vertical osteotomy was set in zone 1 after Denis. All specimens were biomechanically tested to failure in upright position. Validated setup and test protocol were used for complex axial and torsional loading applied through the S1 vertebral body to promote turn-out of the implants. Interfragmentary movements were captured via optical motion tracking. Screw motions were evaluated by means of triggered anteroposterior X-rays. Interfragmentary movements and implant motions were significantly higher for SI screw fixation compared to both transsacral and screw-in-screw fixations. In addition, transsacral screw and screw-in-screw fixations revealed similar construct stability. Moreover, screw-in-screw fixation successfully prevented turn-out of the implant that remained during testing at 0° rotation for all specimens. From biomechanical perspective, fragility sacrum fracture fixation with the new screw-in-screw implant prototype provides higher stability than an SI screw, being able to successfully prevent turn-out. Moreover, it combines the higher stability of transsacral screw fixation with the less risky operational procedure of SI screw fixation and can be considered as their alternative treatment option.