Final Plan Research Articles

An evaluation of a virtual musculoskeletal podiatry service implemented to address prolonged National Health Service waiting times.

The COVID-19 pandemic had a substantial impact on healthcare systems globally, particularly in the public sector. To address the challenges posed by the pandemic, musculoskeletal (MSK) healthcare providers had to rapidly adopt virtual platforms for delivering care, representing a major shift in how healthcare was delivered. This manuscript aims to retrospectively evaluate a virtual MSK podiatry service offered by a private provider under a National Health Service commission, in terms of patient access, waiting times and patient-reported pain. This service was developed and implemented in response to the COVID-19 pandemic and the extended waiting times. A retrospective clinical service evaluation was conducted on MSK podiatry services delivered via telephone or virtual consultations. The evaluation covered a cohort of 574 referred patients over a 19-month period (July 2021 to January 2023). It analysed demographic data, initial and final visual analogue pain scores, pathology categories, orthoses prescriptions and exercise rehabilitation plans. Data from a total of 492 patients (male=152 and female=340) were analysed, with 82 patients excluded for non-attendance. The average waiting time from referral-to-first appointment and referral-to-discharge was 35 and 91days, respectively. Results showed statistically significant improvement (p<0.001) in the mean visual analogue scale when patients received orthoses with and without a rehabilitation plan (4.12±2.55 and 3.33±2.88, respectively). Most patients (61.5%) were aged 40-69, with "foot pain" being the main reported pathology category. Patients had an average of two appointments. 56.5% of patients remained virtual throughout their journey and were successfully discharged to self-management. 43.9% were discharged to other face-to face services. The study provided evidence that the virtual MSK podiatry service achieved a statistically significant reduction in patient-reported pain for various pathologies with reasonable waiting times. The service delivered favourable outcomes and complemented traditional services at a time with limited access due to the COVID-19 pandemic.

Contestation in social acceptance of direct air capture (DAC) technologies in Korea by differing framings over governance principles

Recently, DAC technologies have been recognized as a viable innovation in Korea’s mitigation efforts. In 2023, while formulating a specific implementation plan to meet the national mitigation target in Korea’s 2030 nationally determined contribution (NDC), the government considered setting a separate mitigation target for DAC technologies alongside the existing target for carbon capture, storage, and utilization (CCUS) technologies. During government-wide meetings, a clear divide emerged between supporters and opponents. Despite strong demand from supporters, the final national implementation plan did not include a mitigation target for DAC technologies. Focusing on this contestation, this paper explores why setting a separate target for DAC technologies was contested and not accepted at the policy-drafting stage. From the theoretical ground of social acceptance of new and innovative technologies, this paper utilizes four governance principles as social norms with which stakeholders understand and interpret DAC technologies, and analyzes differing framings on DAC technologies. Research results show that dominant framing approaches, hindering the establishment of a DAC technology-specific mitigation target, are i) risks of considering short-term and binding targets in commensurate with long-term targets through DAC technologies, ii) the uncertainty of mitigation potentials by technologically and methodologically under-developed DAC technologies, and iii) the inefficiency of financial investment for DAC technologies. This paper concludes with policy recommendations, emphasizing the need to establish binding short- and mid-term targets in alignment with the 2050 long-term target, government support for technology demonstrations, methodological assistance for leveraging carbon markets, and a redefinition of the relationship between CCUS and DAC technologies.

Multi-stage automatic and rapid ablation and needle trajectory planning method for CT-guided percutaneous liver tumor ablation.

Computer-assisted planning methods have increasingly contributed to preoperative ablation planning; however, these methods cannot automatically obtain the final optimal solution within a short time and are rarely validated in practice, greatly limiting their clinical applicability. We aimed to propose a full-automatic multi-stage ablation and needle trajectory planning method for CT-guided percutaneous liver ablation to attain the final optimal plans under multiple clinical constraints rapidly. Our proposed method integrates the ablation zone planning fulfilling complete tumor coverage and critical structure avoidance while reaching a trade-off between ablation number and healthy tissue damage, and needle trajectory planning under multiple clinical constraints. Our needle trajectory planning determines feasible skin entry regions based on hard constraints, where the multi-objective optimization (MOO) considering soft constraints is performed using the Pareto Optimality and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods for the final optimal solution. The performance of our proposed method was evaluated on 30 tumors of various characteristics from 23 patients and clinically validated in five clinical cases. Our proposed method achieved 99.8% treatment zone coverage and 40.5% ablation efficiency without involving critical structures, and completely satisfied multiple clinical constraints in all needle trajectory planning results. The average planning time was 23.6 s for tumors of different sizes. All the plans were considered clinically acceptable by the doctors' evaluation. Our method achieved complete tumor coverage without complications in clinical case validation. Our proposed planning method can generate a final optimal plan satisfying multiple clinical constraints within a short time, potentially facilitating preoperative planning for hepatic tumor ablation.

Spatial distribution and fixed-precision sequential sampling plans for Popillia japonica (Coleoptera: Scarabaeidae) adults in primocane raspberry: influence of foliar insecticides.

The Japanese beetle, Popillia japonica Newman (Coleoptera: Scarabaeidae), an invasive species from northern Japan, was first detected in Minnesota in 1968. According to fruit growers and the Minnesota Department of Agriculture, population size and feeding damage has been an increasing concern since 2010. Based on trap-catch data, populations have recently exceeded 4,000 beetles/trap/week during July-August near raspberry fields, and can increase by an order of magnitude within 7-10 days. The primary goals of this study were to assess the spatial distribution of P. japonica adults in raspberry, and to develop and validate a practical fixed-precision sequential sampling plan for grower use. Taylor's Power Law (TPL) regression was used to characterize the beetle's spatial pattern in research plots and commercial fields, either with or without insecticide applications. We then used Green's plan to develop an enumerative sequential sampling plan to estimate P. japonica density in primocane raspberry. Beetle population data were collected at two locations in southern Minnesota, including the Rosemount Research and Outreach Center, and a commercial field near Forest Lake. The TPL results, via slope comparisons, indicated no significant differences in P. japonica spatial pattern between insecticide treated plots versus untreated plots, or among 4 different insecticides (P>0.05). Utilizing all spatial pattern data, we characterized the distribution of P. japonica beetles to be highly aggregated in raspberry, with TPL slopes ranging from b = 1.38 to 1.55; all slopes were found to be >1.0. Although the slopes were not significantly different, we accounted for variability in spatial pattern by using 33 independent data sets, and the Resampling for Validation of Sampling Plans (RVSP) model to validate a sampling plan with a final average precision level of 0.25 (SEM/mean), recommended for integrated pest management (IPM) purposes. The final sampling plan required an average sample number of only 15, 1-m-row samples, while providing high relative net precision (RNP), and thus a cost-effective, efficient sample plan for growers.

HYBRID PLANNING A SIMPLE TECHNIQUE FOR CRANIOSPINAL IRRADIATION (CSI)

Purpose: A simple planning technique for craniospinal irradiation using Eclipse treatment planning system. Material and methods: In RT treatment planning, base plan optimization feature is used in sequential RT planning by anticipating the dose delivered to organ at risk (OAR) &amp; planning target volume (PTV) in the base plan. In hybrid planning technique, the whole PTV is divided into two parts, Brain PTV &amp; Spine PTV. Spine PTV is overlapped minimum 2-3 cm over the Brain PTV at their junction while creating structures for RT planning. Brain PTV is planned with conventional RT technique &amp; the Spine PTV planned with rapid arc technique (VMAT). In the plan optimization process of spine PTV, first base plan is selected then the optimization parameter is set accordingly as per total prescribed dose of 36 Gy for both the PTVs. The base plan is the dose calculated plan which is incorporated in the rapid arc plan optimization hence the pre-existed doses of Brain PTV &amp; OAR help to understand the plannerfor achieving desired planning objectives during Spine PTV, RT plan optimization. Finally for the dose calculation of Spine PTV RT plan, planner has to copy fields of Brain PTV &amp; paste it in Spine PTV plan and need to calculate dose for these copied fields. The final plan contains a dose calculated of Brain PTV fields and Spine PTV fields termed as hybrid plan. Result: Reduction in the total number of monitor units is observed for the hybrid plan compared to single VMAT plan, which is statistically significant (p&lt;0.05). Conclusion: Present study introduced the hybrid planning technique which can exploit benefits of conventional and modern techniques.

Retrieval of the Clipped Axillary Lymph Node and Its Impact on Treatment Decisions.

We examined clinically node-positive (cN+) breast cancer patients undergoing neoadjuvant chemotherapy and clipped lymph node (CLN) localization to determine the rate of CLN = non-sentinel lymph node (SLN), the factors associated with cN+ to pN0 conversion, and the treatment impact. We conducted a single institution review of cN+ patients receiving NAC from 2016 to 2022 with preoperative CLN localization (N = 81). Demographics, hormone receptor (HR) and HER2 status, time to surgery, staging, chemotherapy regimen, localization method, pathology, and adjuvant therapy were analyzed. Pathologic complete response (pCR) of the CLN was observed in 41 patients (50.6%): 18.8% HR+/HER2-, 75% HR+/HER2+, 75% HR-/HER2+, and 62.5% triple-negative breast cancer (p-value = 0.006). CLN = SLN in 68 (84%) patients, while CLN = non-SLN in 13 (16%). In 14 (17.3%) patients, the final treatment was altered based on +CLN status: 11 patients underwent axillary lymph node dissection (ALND), and 3 had systemic treatment changes. pCR rates varied, with the highest conversion rates observed in HER2+ disease and the lowest in HR+/HER2- disease. In 2 (2.5%) patients, adjuvant therapy changes were made based on a non-sentinel CLN, while in 97.5% of patients, a SLN biopsy alone represented the status of the axilla. This demonstrates that a +CLN often alters final plans and that, despite also being a SLN in most cases, a subset of patients will be undertreated by SLN biopsy alone.

Environmental impact and cost study of vehicles

In the traditional automobile industry, which was dominant from the mid-20th century to the early 21st century, the nitrogen oxides produced by auto mobile exhaust would pollute the air. After entering the 21st century, with lithium batteries as the representative, the energy density of energy storage units has rapidly increased, solving the endurance problem that has plagued the electric vehicle industry for nearly a century. The development path of electric vehicles has become wider and gradually become mainstream products in the market. This paper explores the environmental impact of transitioning from partial to complete tram usage in an urban area with a population of at least 500,000. Initially, this paper calculates the Ecological Evaluation Index to compare the environmental effects of the two types of vehicles. Subsequently, introducing four variables to set the entire model in motion, aiming to predict the environmental conditions of the urban area when entirely reliant on tram services. Furthermore, this paper considers the realistic financial issues that need to be faced and build a model for the financial impact that the transition to pure electric buses will soon bring. The excessive costs and potential external funds caused by the transition, which will affect the final ten-year transformation plan for the city. Finally, this transit company has successfully achieved an operational income of up to 13.3 billion over the past decade even in the absence of government subsidies. This underscores the robust foundation of its financial operations and economic sustainability, providing reliable financial support for future electric bus procurement and maintenance.

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation.

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies obstructing airway access are at risk of airway management failure once they lose spontaneous respiration. Awake flexible scope intubation is considered the gold standard for controlling the airway in such patients. Following a feasibility trial involving 25 patients with challenging airways, this article presents a step-by-step protocol for awake nasotracheal intubation using a flexible video rhino-laryngoscope, which is significantly shorter than conventional intubating flexible scopes. The flexible video laryngoscope only exceeds the intubating tube length by a few centimeters, allowing the tube to closely follow the flexible scope during the procedure. Once the scope reaches the pharynx, it can be easily manipulated with one hand, enabling the operator to focus on the safe advancement of the scope-intubating tube assembly through the glottis. Based on previous results and experience gained, this article highlights the potential benefits of the technique: the opportunity for a minimally invasive "quick look" preoperatively to establish a final management plan, a more convenient and safer tool for navigating distorted anatomy with a lower chance of intubating tube impingement and airway injury, and a fast and smooth procedure resulting in improved patient satisfaction.

Quality Improvement Project to Develop a Pictorial Chronic Obstructive Pulmonary Disease (COPD) Action Plan.

Introduction Chronic obstructive pulmonary disease (COPD) is a global health concern and a leading cause of morbidity and mortality worldwide. COPD action plans help patients manage exacerbations by recognizing symptoms early and taking necessary steps. We found our COPD written action plan difficult to understand, potentially affecting the patient's ability to self-manage their COPD. Aims We aim to design a new COPD action plan to increase the knowledge scores of our patients during competency checks by 20%. Methods We employed the quality improvement methodology of needs analysisand root cause analysis and used a Pareto chart to identify the top four contributory factors to an ineffective COPD action plan. These include being too wordy, lacking pictorial illustrations, being only available in a single language (English), and too much medical jargon. Using the prioritization matrix to assess possible solutions, the team decided to implement a pictorial COPD action plan. After two cycles of Plan-Do-Study-Act, the final pictorial COPD plan was compared with the original written action plan. Results Ten English-speaking COPD patients from our outpatient respiratory clinics were surveyed with the original action plan while 11 more were surveyed after the introduction of the pictorial action plan. There was an improvement in mean knowledge scoresby 92.8%(t(19) = 6.67, p < 0.01, at 95% CI). Patient satisfaction rates also increased from 44% to 100%. Sixty-three percent (63.6%) of patients surveyed said they referred back to the pictorial action plan 3 months after being introduced to it. Conclusion Pictorially enhanced COPD action plans have been shown to improve our patients' knowledge of COPD self-management.

Enhanced method for evaluating remodeling floor plans for apartment complexes with an emphasis on efficiency and accuracy

A social issue in Korea has recently emerged regarding the structural performance and living environment improvement of aged apartment houses (i.e., 20 or more years old). The available methods to improve the issues related to aged apartment houses are remodeling and reconstruction, and there is a trend to recommend environmentally friendly remodeling. During the initial design stage of a typical remodeling project, several floor plan drafts are prepared and undergo several revisions to produce the final floor plan. As such, this study aims to develop a program capable of promptly offering quantitative structural guides during the initial design stage, thereby reducing the duration and workforce required to complete the final floor plan. The developed program was utilized to conduct a structural evaluation of five existing apartment complexes in Korea. Subsequently, to validate the usability of the developed program, the accuracy and time efficiency of its evaluation results were compared to those using commercial structural analysis software. While the calculated structural indices showed a variance within 5 % between the two programs, there were considerable differences in processing time, at 35 min vs. 8–16 h per building. Therefore, the program developed in this study will be beneficial during the initial design stage, and it will significantly reduce the time, effort, and cost necessary for decision-making in a remodeling project while maintaining accuracy in structural assessment.

메타버스를 활용한 e-PBL 프로그램 개발 연구

Objectives The purpose of this study is to develop an e-PBL program using Metaverse and apply it to classes to verify its effectiveness. Methods For this purpose, this study developed a program according to the ADDIE design model procedure. First, after conducting literature and case analysis according to the content analysis method, design principles and support structures were derived through a categorization process. And a draft was completed based on the design principles. Second, improvements and supplements were derived through expert FGI on the draft program. After completing the final draft of the program by reflecting the results of FGI, validity verification was conducted. Third, after applying the final draft to the class, a satisfaction survey and an interview regarding open-ended survey items were conducted. Results The results of this study are as follows. First, five design principles and support structures were derived through the third categorization process of the content analysis method, and a draft program was derived by combining them. Second, expert FGI was conducted on the draft program to identify points of improvement and supplementation, and the final draft of the program was completed by reflecting these points. Third, validity (.88) and reliability (.76) were secured by conducting an expert validation (CVI) test and an inter-rater reliability test on the final draft of the program. Fourth, after applying the final plan of the program to the class, pre- and post-satisfaction was conducted, and it was confirmed that post-satisfaction (4.63) improved compared to pre-satisfaction (4.57). As a result of conducting individual interviews with five students in response to open survey questions, it was confirmed what was helpful, what was difficult, and what improvements or wishes were made in the program. Conclusions This study developed an e-PBL program using Metaverse for collaboration and problem-solving learning in virtual space required in the digital era, and investigated the effects of applying it to classes. It is expected that this will be able to provide meaningful information for the possibility of using the metaverse needed in future educational fields and for professorial research and development.

Integrating topographic factors for effective urban sponge construction in mountainous regions: A case study

The construction of sponge cities in mountainous areas is crucial to achieving high-quality development in these regions. Owing to rugged terrain, significant changes in elevation, and uneven distribution of cities, the construction of sponge cities in mountainous areas faces challenges such as difficulties in clearing mountains and roads, high cost, and varying regional development requirements. However, there is currently limited research focusing on the impact of terrain on sponge city construction plans. In this study, we developed an optimal low impact development (LID) system layout method based on the annual runoff control rate. This study suggests implementing LID plans in stages to balance cost-effectiveness and enhance resilience. The optimized case1_100 scheme, which takes regional differences into account, can effectively achieve a runoff control coefficient of less than 0.25 in 98.86% of the area. Remarkably, this achievement comes at a significantly lower total cost of only 1.22 billion RMB compared to the unoptimized case2_100 scheme (which does not consider regional differences) with a cost of 3.03 billion RMB. Interestingly, the optimized case1_100 plan, selected using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method, has an LID layout that is closely related to the surface terrain. Structural equation modeling analysis indicates that terrain affects land types, which in turn impacts the surface impermeability and runoff coefficients, ultimately influencing the corresponding LID deployment plan. The coefficients of relative elevation and slope on the final plan are determined as −0.13 and −0.77, respectively, with a high overall explanatory power of 0.84. This indicates that terrain characteristics have a significant impact on the spatial patterns and surface features of typical mountainous cities in China and the optimal LID strategy largely depends on the initial terrain conditions. This study provides valuable insights for optimizing LID construction in sponge cities, particularly in the context of new mountainous urban planning.

A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study.

More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants' willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.

Using nominal group technique to identify the planning considerations for UK Armed Forces medical personnel delivering defence engagement first aid training activities

IntroductionDefence Medical Services personnel regularly deploy overseas to deliver training activities as part of defence engagement (DE) to positively influence partners and others. There remains scope for medical planners to...

Fixed cost allocation based on a data envelopment analysis aggressive game approach

The literature on organizational strategy and production operations suggests that establishing a shared platform would be beneficial for addressing competition and mitigating risks. However, the creation of a common platform inevitably incurs expenditures and costs, prompting the natural question of how to equitably distribute the total fixed cost among all participating units. While the fixed cost allocation (FCA) problem has been explored in the context of data envelopment analysis (DEA), this paper addresses a distinct decentralized environment wherein there is no central decision-maker, and each individual decision-making unit (DMU) pursues a self-interested strategy to minimize its allocated cost share. In tackling the challenge of proposing an acceptable allocation plan within this decentralized setting, we initially improve the non-egoistic principle by considering the perspective of operational size. This improvement mandates that each DMU bears the maximum fixed cost per unit of operational size in its own allocation proposal. The improved non-egoistic principle implicitly addresses the platform constraint and fairness concerns, while each DMU remains committed to maximizing other DMUs’ cost shares and minimizing their own performance efficiency. Additionally, we introduce an aggressive game process to amalgamate all DMUs’ allocation proposals into the DEA efficiency analysis. A DEA aggressive game approach and its corresponding computational algorithm are developed to facilitate consensus and determine the final FCA plan. Mathematically, we prove that all average post-allocation efficiencies, incorporating fixed costs, converge to the same aggressive game cross-efficiency for each DMU in the iterative algorithm. To the best of our knowledge, this paper represents the first study that employs an aggressive strategy in the FCA problem to minimize efficiency scores, while existing literature predominantly focuses on maximizing or maintaining efficiency scores. Finally, we apply the proposed approach to a classical numerical example and an empirical study involving nine independent truck fleets to showcase its characteristics and efficacy.

A qualitative study of final year student veterinary nurses' career plans and expectations

Introduction: The limited longevity of veterinary nurses' clinical careers is a current challenge faced in the veterinary industry. In order for veterinary nurse job vacancies to be filled, it is essential for graduate veterinary nurses to be motivated to seek employment in clinical practice. The aim of this study was to explore the career plans and expectations of final year student veterinary nurses. Method: Online semi-structured interviews with ten final year student veterinary nurses were used to collect qualitative data. Thematic analysis was used to analyse the data. Results: The results revealed that there were aspects of clinical practice the participants were looking forward to and others they perceived would be challenging and may threaten the longevity of their clinical career. An example was the demanding nature of the job role. Discussion: All participants expressed a desire to work in clinical practice following their graduation, but were aware that they were unlikely to have long-term clinical careers. It is recommended that veterinary nurse educators should support students to develop the resilience necessary for them to face the challenges of clinical practice and also help them to gain the transferrable skills they may require for alternative future career paths.

Research and experimental verification of lightweight loader rims

The safety performance and structural stiffness of a rim, which is the main load-bearing structure of the loader during operation, influence the overall performance, stability, and braking capabilities of the machine. In the industry, researchers are currently pursuing lightweight and high-strength rims as a primary objective. A low weight not only enhances machinery fuel efficiency but also aligns with societal demands for sustainable development, energy conservation, and emission reduction. In this article, multiobjective optimization analysis on rims composed of three different materials is performed, and the relationships between various optimization parameters and target parameters are established using the results of response surface construction. Multiobjective genetic algorithms are utilized to derive various optimization plans, which are subsequently evaluated through static analysis, fatigue analysis, and weight loss analysis. The final optimization plan is determined based on the calculation results while considering production costs. Field tests are conducted on the optimized rims under various working conditions to verify the test results, evaluate the reliability of the finite element analysis results, and confirm the safety of the optimized rim.

High in-vivo accuracy of a novel robotic-arm-assisted system for total knee arthroplasty.

Robotic-assisted total knee arthroplasty (TKA) has been shown to improve the accuracy and precision of bony resections and implant position. However, the in vivo accuracy of the full surgical workflow has not been widely reported. The primary objective of this study is to determine the accuracy and precision of a robotic-arm-assisted system throughout the intraoperative workflow. This was a retrospective cohort study of adult patients who underwent primary TKA with various workflows and alignment targets by three arthroplasty-trained surgeons with previous experience using the ROSA® Knee System (Zimmer Biomet) over a 3-month follow-up period. Accuracy and precision were determined by measuring the difference between various workflow time points, including the final preoperative plan (PP), robot-validated (RV) resection angleand postoperative radiographs (PR). The absolute mean difference between the measurements determined accuracy, and the standard deviation represented precision. The lateral distal femoral angle, medial proximal tibial angle, femoral flexion angle and tibial slope were measured on postoperative coronal long-leg radiographs and true short-leg lateral radiographs. A total of 77 patients were included in the final analyses. The accuracy for the coronal femoral angle was 1.62 ± 1.11°, 0.75 ± 0.79°and 1.96 ± 1.29° for the differences between PP and PR, PP and RVand RV and PR. The tibial coronal accuracy was 1.44 ± 1.03°, 0.81 ± 0.67°and 1.57 ± 1.14° for PP/PR, PP/RVand RV/PR, respectively. Femoral flexion accuracy was 1.39 ± 1.05°, 0.83 ± 0.59°and 1.81 ± 1.21° for PP/PR, PP/RVand RV/PR, respectively. Tibial slope accuracy was 0.99 ± 0.72°, 1.19 ± 0.87°and 1.63 ± 1.11°, respectively. The proportion of patients within 3° was 93.2%, 95.3%, 97.3%and 94.6% for the distal femur, proximal tibia, femoral flexionand tibial slope angles when the final intraoperative plan was compared to PRs. No patients had a postoperative complication at the final follow-up. The ROSA Knee System has acceptable accuracy and precision of coronal and sagittal plane resections with few outliers at various steps throughout the platform's entire workflow in vivo. Level III.

Is low-dose anticoagulation a therapeutic option for patients at high risk of bleeding with high-risk pulmonary thromboembolism

This issue of Chinese Journal of Tuberculosis and Respiratory Diseases published an interesting case illustrating the identification, treatment, and post-treatment management of a high-risk pulmonary thromboembolism (PTE) that occurred during surgery. It was a high-risk case of PTE, but during treatment, the risk stratification changed to medium-high risk. We should dynamically assess risk stratification and develop diagnosis and treatment plans based on changes in the patient's condition. At the same time, there was a high risk of bleeding in this patient. We should try to decrease the risk of bleeding as much as possible, consider all the conditions that can be applied at that time and on a local level, and devise a safe and effective treatment plan. The socio-economic status of patients may have an impact on how the final diagnosis and treatment plan are implemented. We need to communicate fully with patients, consider comprehensively, and prepare contingency plans to ensure patients' life safety to the greatest extent possible.

How social innovations emerge in a rigid regulatory context: the case of demand responsive transport in Switzerland

ABSTRACT Demand responsive transport (DRT) solutions may improve rural transport systems. These solutions often emerge as social innovations in rural areas. In Switzerland, their planning process is embedded in a rigid regulatory framework of the public transport system. The objective of this paper is to understand in which way the regulatory framework of the public transport system influences planning processes of a DRT solution in a rural setting. The methodological approach of social innovation biographies helps to examine the necessary planning steps to start mybuxi, a DRT in two Swiss rural municipalities. Our findings show that regulatory constraints dominate the final planning stage of the social innovation. Protections of current public transport regulations hinder federal offices from subsidizing the DRT, having direct implications on the financial sustainability of the system. The findings of this paper help actors to better address regulatory questions in the early stage of the respective innovation process.