Does the Nottingham Hip Fracture Score Help Predict Which Patients Will Benefit From a Modern Modular Hemiarthroplasty for the Treatment of Intracapsular Proximal Femoral Fractures?

Introduction: Hemiarthroplasty for the management of intracapsular neck of femur fractures is common but current practice in the UK still varies regionally and individually. Guided by the National Institute of Health and Care Excellence (NICE) we have observed a move towards modern, modular prostheses such as the Exeter V40 Stem but the use of older, monoblock prostheses such as the Thompsons Hemiarthroplasty remains controversial. Use of the Nottingham Hip Fracture Scores (NHFS) can help surgeons stratify patients according to risk and select the most appropriate prosthesis to meet their individual needs. Materials and Methods: 765 hip hemiarthroplasties were analysed over a 28-month period at a single, high-volume, orthopaedic department in the UK. We calculated the NHFS and recorded the choice of prosthesis. Patients were then followed up for at least a year. Outcomes were mortality and change in residential status. Results: Six hundred and forty-six (446) patients were treated with monoblock prostheses (mean age=85.6; range 62-105). 319 patients received modular prostheses (mean age=81.0; range 61-98). Patients who were selected to receive a monoblock prosthesis were over twice as likely to be dead at a year (32.87% vs. 13.65%) and over twice as likely to require increased assistance with living (50.12% vs. 23.81%). Amongst patients with equivocal NHFS, those who receive a monoblock stem suffered worse outcomes in all but the very highest risk group, who experienced lower mortality (OR=0.71, CI 0.52-0.96) and change in residential status (OR=0.76, CI 0.58-0.99). Conclusion: Nottingham Hip Fracture Score (NHFS) can confer predictable outcomes in hip fracture patients treated with modular stems. Modular stems should be the default choice when performing hemiarthroplasties for intracapsular neck of femur fractures. However, in keeping with other studies, we found that in very old, frail, or co-morbid patients, modular stems are not associated with better survival or return to pre-morbid function.

Evaluation of bile duct stones extracted by ERCP (Endoscopic Retrograde Cholangio-Pancreatography).

Objective: To determine the frequency of different types of gallstones on ERCP stone extraction from bile duct. Study Design: Cross Sectional study. Setting: Department of Gastroenterology of the Nishtar Hospital Multan. Period: September 2019 to October 2020. Material & Methods: Patients with bile duct stones on imaging of either sex aged 18 – 70 years were included in our study while patients with IHD, malignancies, liver cirrhosis, asthma, TB, COPD, ILD and pregnant women were excluded from our study. During ERCP the gross appearance of extracted stones and related findings were noted. Results: Our study included 139 patients meeting inclusion criteria, of these 139 study cases, 49 (35.3%) were male and 90 (64.7%) were female patients with bile duct stone. Mean age was 45.78 ± 12.05 year (range; 27 – 68 years). Of these 139 study cases, 56 (40.3%) were from rural areas, 83 (59.7 %) were from urban areas, 52 (37.4%) had poor socioeconomic status and 87 (62.6%) were from middle income family background. Diabetes was noted in 35 (25.2%), hypertension in 53 (38.1%) and obesity in 32 (23 %) (Mean BMI was 26.53±214kg/m2). Mean stone size in our study was 15.82 ± 6.34 mm while 78 (56.12 %) had single stones. Pure cholesterol gallstones were noted in 47 (33.8%), mixed cholesterol stones in 71 (51.1%) and brown pigmented gall stones in 21 (15.1%). Conclusion: Mixed cholesterol stones were more frequent followed by pure cholesterol and brown pigmented stones in bile duct gallstones patients. Mixed cholesterol stones were significantly associated with rural residential status and hypertension while brown pigmented stones were residential status, hypertension and obesity.

In the Eyes of the Beholder: The Effect of the Perceived Authenticity of Sanfang Qixiang in Fuzhou, China, among Locals and Domestic Tourists

Many historic and cultural heritage destinations have faced queries about authentic travel experiences and crises of commoditization related to tourism products. This study is based on the dyadic function of heritage destinations for both locals and domestic tourists: heritage as a spatial-temporal object for tourists, using authenticity as a theoretical framework. It examined the (1) effects of cultural motivations and prior knowledge on both object-based and existential authenticities, (2) effects of authenticity on destination experiences, and (3) moderating role of residential status on the relationship between authenticity and destination experience. The data were collected from 173 locals and 159 domestic tourists on site in the Sanfang Qixiang tourist district and analyzed using the SEM technique. The results indicated that cultural motivation and prior knowledge had significant effects on authenticity; however, only existential authenticity enhanced the destination experience, whereas object-based authenticity did not have an effect on the destination experience. In addition, residential status had a key moderating function in the relationship between the perception of authenticity and the destination experience. This study contributes to the literature by integrating the mutual gaze into heritage tourism literature and emphasizing the importance of a balance between authenticity and commoditization in heritage destination development in Asia. The findings hold some practical implications for the development of balanced management strategies to minimize potential conflicts and maximize user satisfaction with heritage tourism.

Disparities in Unmet Health Service Needs Among People with Disabilities in China

Background Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population. Objective The aim of this study was to examine differences in the prevalence of unmet health care needs by residential status (hukou status) and disability type among people with disabilities. Methods Our data were from the National Survey on Basic Services and Needs of Persons with Disabilities, a large-scale, register-based survey conducted by the China Disabled Persons’ Federation in 2019. The analysis sample included a nationally representative sample of 9,642,112 adults (16+) with disabilities. Associated factors were obtained from both individual-level and community-level. Cross-sectional multivariable logistic regression analyses were conducted to compare people with different residential status and different types of disabilities on unmet medical, care, rehabilitation and accessibility needs. Results The estimated prevalence of unmet medical, care, rehabilitation need and accessibility need are 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13%-40% increase in unmet healthcare needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation, and health professionals. Disparities across type of disability were smaller, but on average people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs whereas those with physical disability had the highest unmet rehabilitation need. Conclusions Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Purpose To determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients. Methods Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points. Results Patients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74). Conclusion Treatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

Promotion without Examination: An Analysis of the Student’s Views

The purpose of the study was to outline, analyze and compare the views of students towards promotion without examination with respect to gender, residential status and educational qualification. The survey method under descriptive research method was used for conducting the research study. A survey form, constructed by the researcher on Google form, was used to collect data. The survey form consisted of the items related to the gender, residential status and level of education and items related to understand and explain views about promotion without examination. There were ten (10) items in the survey form. The collected data was organized and statistically treated with the help of frequencies, percentage and χ2 (chi-square) test. The conclusion of the study suggested that student’s views about promotion without examination were not differing with respect to gender, residential status and educational qualification.

DIVERSITY AND RESIDENTIAL STATUS OF WADER BIRDS AT HODAL IN PALWAL DISTRICT, IN HARYANA, INDIA.

Waders belonging to order Charadriiformes are commonly found along shorelines and mudats that wade in order to forage for food (such as insects or crustaceans) in the mud or sand. Bogs, marshes, mudats, shorelines, ponds, and ooded areas are all popular habitats for wading birds. The waders include storks, spoonbills, cranes, herons, egrets and ibises. They have certain physical and behavioural adaptations for living on or near water. Wading birds depend on water as a source of food, shelter, and nesting sites. Wading birds wade into shallow water to obtain food, instead of swimming and diving in water in search of feed that is not found on land. If we study the morphology of wading birds, they have lots of characteristics and adaptations that are useful in a watery habitat. Long legs of the wading birds help them to keep their feathers high and dry when wading into water in search of food. A long neck and a long bill are adaptations that make it possible to strike at prey while walking around on long legs. The benets of wading bird′s long, thin, spread-out toes are three-fold: toes help them to keep their balance and also help them to walk in mud without sinking. While walking in water and mushy mud, thin toes are easier to lift and set down. Spread-out toes also prevent them from sinking into soft mud in the water and at the water's edge, and above all those toes also disperse the weight of these big, tall birds, helping them keep their balance over their long legs. Waders are ecologically dependent on wetlands, as they provide good habitat to them for feeding, roosting, breeding, nesting, pre-migratory requirements, migration and protection from predators. So, wet lands plays an important part in the life cycle of wading birds. Wetlands have got highest capacity and are often extremely rich in bird and animal life. The present study aims at the assessment of diversity and residential status of wading birds in Yamuna basin near Hodal in Palwal District. It is located at 27°53′39″N and 77°22′09″E having an average elevation of 190 meters. Many ornithologists pay lots of their attention on eld study of birds during the eighteenth, nineteenth and twentieth century and till today many more are involved in the study of avian diversity near rivers. Avian fauna of Kalesar forests in immediate vicinity of River Yamuna in Yamuna-nagar District has been analysed by Kalsi (1998). Kulkarni et al.(2011) reported 151 species of birds from river Godavari; Balapureet al. (2012) reported 63 avian species from river Narmada. Other workers like Bahuguna(2008), Taketal.(2010), Gupta & Kaushik (2011), Gupta et.al(2012), Anupma et al (2014), Ankita et al (2019) have studied wetlands birds in various regions along the banks of rivers.

502 OUTCOMES OF HOSPITALISED PATIENTS WITH COVID-19 SIX MONTHS AFTER INDEX ADMISSION

Introduction Early outcomes for hospitalised patients with covid-19, including admissions to critical care and mortality have been widely published. Less is known about the longer-term patient outcomes such as readmissions, deaths after discharge and level of care required on discharge. Methods Following an audit of 360 consecutive admissions of patients with covid-19 requiring level 1 inpatient care in spring 2020, we collated data about mortality, readmissions, and residential status for the same cohort at six months after index admission. Results The cohort had a median age of 78: 70% survived to discharge. Median length of stay was nine days (range 1–90). Of 252 patients discharged, a further 35 (14%) had died by six-month follow-up. 95 patients (38%) required at least one further hospital admission in the following six-month period. 40 (16%) of discharged patient required increased support, defined as new or increased package of care or an alternative interim or permanent change of residence. (Table 1). Table 1 emailed separately as will not transfer into this space Of the 40 patients requiring increased support on discharge, 7 (18%) died, 15 (38%) returned to their preadmission residential status, and 17 (43%) still required increased support. Conclusions Covid-19 has a high mortality rate in those admitted to hospital. Patients receiving level 1 care in hospital and surviving to discharge have a high risk of readmission or death in the following six-months. For those requiring increased support on discharge, the majority do not return to their pre-admission residential status.

Association of Freshman Retention Rates with Instructional Expenditure and Residential Status : A Case Study for Large Public Colleges

Retention is a key indicator of institutional effectiveness in education research. Retaining full-time freshman students has been a long-standing problem for institutions of higher education. Overall, 40% of U.S. college students leave college among which the majority are freshman students. About 30% of freshman students drop out before their sophomore year of college. The primary causes for leaving college include financial pressure, falling behind in classwork, lack of social connections, and loss of family support. Higher educational institutions need to understand the dynamic between different expenditures and freshman retention rates to responsibly and strategically allocate funds to what will best support institutional success. This study investigates how freshman retention rates at large public colleges are associated with instructional expenditures and residential status. Findings of this study indicate that regarding freshman retention at large public colleges, spending more money on instruction goes further for residential colleges compared to non-residential ones. In other words, for most levels of instructional expenditure, residential colleges have higher freshman retention rates than non-residential colleges. Findings of this study can assist higher education institutions in directing their efforts toward what will best support institutional success.