Mean Fall Research Articles

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

A walking aid selection, training, and education program (ADSTEP) to prevent falls in multiple sclerosis: A randomized controlled trial

Background: People with multiple sclerosis (MS) fall frequently. Poor walking aid selection, fit, and use contribute to falls in those who use walking aids. Objectives: To determine if the Assistive Device Selection, Training, and Education Program (ADSTEP), with six weekly one-on-one virtual sessions with a physical therapist prevents falls and improves other outcomes in people with MS who use walking aids but still fall. Methods: A total of 78 people were randomized to ADSTEP or control. Participants recorded falls daily through 6 months post-intervention. Other outcomes were assessed at baseline, intervention completion, and 6 months later. Outcomes were compared between groups. Results: The ADSTEP group’s mean fall rate (falls/person/month) decreased from baseline to intervention completion (ADSTEP = −0.75, control = +0.90, p < 0.001) and to 6 months later (ADSTEP = −1.02, control = +0.03, p = 0.017) compared to controls. At 6 months, the ADSTEP group had improved physical activity (days/week walking ⩾ 10 minutes at a time: ADSTEP = +0.69, control = −0.58, p = 0.007; minutes/day sitting: ADSTEP = −57, control = +56, p = 0.009) and walking aid fit (proportion with good fit: ADSTEP = +25%, control = −13%, p = 0.018) compared to controls. Conclusions: ADSTEP likely reduces falls, increases physical activity, and improves walking aid fit in people with MS who use walking aids and fell in the past year.

The Effects of Bariatric Surgery on the Requirement for Antihypertensive Treatment in Type 2 Diabetes: Insights from a Long-Term Follow-Up Study.

Bariatric surgery (BS) has emerged an effective intervention in achieving significant and sustained weight loss in patients with type 2 diabetes (T2D). However, comprehensive data on the long-term impact of BS on hypertension is scarce. We aimed to investigate the long-term impact of BS on blood pressure management in individuals within a T2D cohort. This retrospective cohort study was conducted on 119 patients who underwent BS between 2009 and 2012. Baseline and follow-up observations, including blood pressure, HbA1c, BMI, and antihypertensive medication use were obtained from electronic patient records at regular intervals up to and beyond 10-year follow-up. The median follow-up period for the 119 patients was 11.5years. Mean fall in BMI 4-8weeks post-surgery was 12%. A sustained reduction in systolic BP was observed up to 10years post-surgery (154.5mmHg pre-op vs. 132.8mmHg at 10years; p < 0.0001. From 5years onwards, there were increases in mean glycated hemoglobin (HbA1c) and body mass index (BMI). At latest follow-up (> 5years after bariatric surgery), the number of individuals prescribed an antihypertensive agent started to increase. This is in the context of the number of the number of individuals on 2-3 antihypertensive agents declining up until 5years post-BS. Specifically, there was a reduction in the number of prescriptions of an antihypertensive agent over time from 164 prescriptions pre-operatively to 81 at 8weeks post-operatively, 78 at 6months, 72 at 1year, 66 at 5years before rising at 10years to 95 prescriptions. Our study shows an overall benefit in the years after bariatric surgery in terms of blood pressure and requirement for antihypertensive medication. However, at 5years and beyond after surgery, the beneficial effect of bariatric surgery diminishes with respect to an increase in number of antihypertensive medication prescriptions, BMI, and HbA1c.

Digital Image Correlation Structural Strain Analysis of S235 Fillet-Welded Joints under Low-Cycle Fatigue Loadings

The main objectives of the present study were the application and validation of the newly proposed Digital Image Correlation equivalent structural strain approach for assessing the low-cycle fatigue life of S235 welded joints. Low-cycle fatigue tests were performed at a displacement ratio of minus one. Experimental tests were performed using two different ways of controlling the displacement amplitude: applying traditional low-cycle fatigue tests at a constant amplitude and stepwise succession tests at increasing amplitudes. A comprehensive, independent experimental procedure, proposed by the authors and not yet validated for steel welded joints, was applied to assess the equivalent structural strain range using the Digital Image Correlation technique for the traditional low-cycle fatigue tests and stepwise succession tests at increasing amplitudes. It is noteworthy that the values of the DIC equivalent structural strain (ΔEs from the DIC), calculated on the external sides of the samples, were utilized to predict fatigue life in correlation with the ASME mean curve and fall within the ±3σ scatter bands (external bands). In particular, most of the tests lie within the ±2σ boundary of the design curves except for some tests at low applied displacements. Moreover, it was shown that this method is applicable to stepwise succession tests with increasing displacement amplitudes, leading to significant time savings compared to conventional experimental tests.

Arginine in sickle cell vaso-occlusive crisis: A randomised placebo control trial

Sickle cell disease is one of the most common hemoglobinopathies in India. A vaso-occlusive crisis is one of the most common indications for hospitalization, it accounts for 70% of hospitalization. To compare efficacy of Arginine in vaso-occlusive episode(VOE) management in terms of mean fall in pain score at discharge between intervention (Arginine) &amp; placebo group among sickled children with skeletal vaso-occlusive crisis between 2-14 years of age. This randomized placebo control study was carried out after getting clearance from the institutional ethical &amp; research committee, from November 2019 to October 2021 in the Indoor of Pediatrics Department, Veer Surendra Sai Institute of Medical Science (VIMSAR), Burla, Sambalpur. There is significant fall in pain score in case group as compared with control group as evidenced by p value being less than 0.001, indicating that l-arginine has significant role in reducing sickle cell vaso-occlusive episode. Mean Length of stay (LOS) in hospital in case group was 2.16, while in control group was 2.69. p value being calculated showed the value to be less than 0.001, which shows importance of l-arginine in reducing in mean length of stay in hospitalization. L-arginine plays a vital role in treating vaso-occlusive episodes. It helps to reduce the pain gradually as evidenced by noting down pain score at the time of admission &amp; every 24 hours of therapy till discharge. It also helps to reduce the mean duration of hospitalization in vaso-occlusive episode.

Enhancing safety in the ischaemic and haemorrhagic stroke population: exploring the efficacy of self-releasing chair alarm belts

IntroductionA quality improvement study evaluated the effectiveness of implementing self-releasing chair alarm belts in an inpatient rehabilitation facility (IRF) for patients who had a stroke. The objective of this study...

Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70years: Boon or bane?

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70years). Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12months. Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2days (1-8days). The average duration of surgery was 58 ± 6min (44-96min) with an average blood loss of 126 ± 24mL (90-380mL). HHS at the end of 12months was 77. The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.

Long-term entecavir therapy of chronic hepatitis B in real-life setting-Importance of quantitative HBsAg level.

The global burden of chronic hepatitis B remains high and the best possible treatment remains long-term viral suppression expecting cure. Total 154 patients of chronic hepatitis B (48 HBeAg positive, e + ve) treated with oral entecavir (0.5mg/1mg per day) were recruited from June 2007 and followed prospectively until December 2022 for persistent HBV DNA negativity, HBeAg and HBsAg loss/seroconversion and other liver and drug-related events in real-life settings. The mean duration of therapy was 6.78 (2-14) years with 1364 person-years of follow-up. All patients were HBV DNA negative by 15months and remained so until the last follow-up. As many as 16.7% lost HBeAg after eight to 13 years of therapy, but not HBsAg. The mean fall in serum HBsAg level per year was 0.158 log IU/mL, being significantly higher in e + ve patients at baseline and until two years of therapy. The decline was significant until six years in e + ve patients compared to two years in e - ve ones. None had biochemical or virological breakthrough (except eight defaulters), flares or any untoward effects. The incidence of liver-related events, hepatocellular carcinoma and death was 10.4%, 1.9% and 14.3%, respectively, and 5.2% deaths were liver-related whose predictors were presence of cirrhosis (log rank 46.5, p > 0.001) and higher HBsAg level > 4 log IU/mL (log rank 18.15, p < 0.001) at baseline. Long-term entecavir therapy provides additional benefits of continuous reduction of serum HBsAg levels beyond suppression of HBV DNA.

The effectiveness of home modifications on the risk of falling in older adults with dementia: A randomized clinical trial

Introduction: This study aimed to investigate the effectiveness of modifying the home environment on falls in older adults with dementia. Methods: In this single-blind clinical trial study, 44 older adult patients with dementia who met the inclusion criteria, were included in the study and then randomly assigned to intervention ( n = 22) and control ( n = 22) groups using a balanced block randomization method. The intervention group received home modifications, while the control group did not receive any modifications. After intervention, The HOME Fall and Accident Screening Tool was used to assess falls. The ethics committee of Tehran University of Medical Sciences approved the study procedure (IR.TUMS.FNM.REC.1399.163) and this study was registered in the Iranian Registry of Clinical Trials with the code: IRCT20210106049950N1. Results: Comparing the mean fall risk scores between the two groups at the beginning of the study showed no significant difference in the risk of falling ( p = 0.6). By contrast, at the end of the study, this difference became significant between groups ( p &lt; 0.001). This comparison in the control group at the beginning and end of the study indicated no significant difference ( p = 0.32). However, it was significant in the intervention group at the beginning of the study and after modifications ( p &lt; 0.001). Conclusion: Modifications by applying changes and reforms to the home environment reduced the risk of falling in older adults with dementia.

Identifying Important Microphysical Properties and Processes for Marine Fog Forecasts

Abstract In this study, a marine fog event that occurred from 0000 to 1800 UTC 7 September 2018 near Canada’s Grand Banks is used to investigate the sensitivity of simulated fog properties to six model parameters found primarily in the microphysics scheme. To do so, we ran a large suite of regional simulations that spanned the life cycle of the fog event using the Regional Atmospheric Modeling System (RAMS). We randomly selected parameter combinations for the simulation suite and used Gaussian process regression to emulate the response of a variety of simulated fog properties to the parameters. We find that the microphysics shape parameter, which controls the relative width of the droplet size distribution, and the aerosol number concentration have the greatest impact on fog in terms of spatial extent, duration, and surface visibility. In general, parameters that reduce mean fall speed of droplets and/or suppress drizzle formation lead to reduced visibility in fog but also delayed onset, shorter lifetimes, and reduced spatial extent. The importance of the distribution width suggests a need for better characterization of this property for fog droplet distributions and better treatment of this property in microphysics schemes.

Parvovirus B19 infection after kidney transplantation: A single centre experience

BackgroundParvovirus B19 is an uncommon cause of anaemia in kidney transplant recipients (KTRs). The study aims to determine the incidence, clinical presentation, laboratory findings and outcome of parvovirus B19-related anaemia in KTR. MethodWe conducted a 12-year retrospective, single-centre study describing the clinical profile of KTRs with parvovirus B19-related anaemia. ResultAmongst the 714 patients who underwent kidney transplantation between January 2011 and January 2023, (cumulative follow-up: 1287 patient-years), six females and one male, developed parvovirus B19-related anaemia. The incidence proportion (risk) is 0.98% with an incidence rate of 5.43 cases per 1000 patient-year. The median duration from transplant to development of anaemia was 6 weeks (range: 4–40 weeks). The mean fall in haemoglobin was 2.88 ± 1.55 gm/dl; concomitant leukopenia and thrombocytopenia were observed in 57.1 and 28.6% of patients. Three patients responded to a reduction in immunosuppression, the four non-responders required the administration of low-dose intravenous immunoglobulin. The mean duration from initiation of therapy to a sustained rise in haemoglobin was 7.71 ± 2.62 weeks. None of the patients had a relapse of the infection. ConclusionsParvovirus B19 infection is an uncommon cause of post-transplant refractory anaemia. The key to successfully managing such patients includes a high index of suspicion, early diagnosis and reduction of immunosuppression with or without administration of intravenous immunoglobulin.

Intraocular pressure changes following small-incision cataract surgeries in a tertiary care center: a prospective study

Aim This study aims to identify the pattern of intraocular pressure (IOP) changes after uneventful small-incision cataract surgery (SICS) in previously normotensive eyes, to know the cause for these postoperative changes, and to correlate the preoperative anterior chamber depth (ACD) to the postoperative IOP change. Patients and methods A prospective study was conducted at Yenepoya Medical College, Mangalore, India on 87 non-glaucomatous eyes that underwent an uneventful SICS with posterior chamber intraocular lens implantation. The IOP was measured preoperatively and postoperatively on days 1, 3, and weeks 1, 3, and 6. We tried to identify the cause of the IOP change. The preoperative and postoperative ACD change was also noted and correlated with the IOP change. Results The mean preoperative IOP was 14±1.81 mm Hg. On the first postoperative day (POD-1), 54% of the eyes showed a statistically significant rise in IOP (mean IOP=17.03±7.17 mm Hg, P=0.0002), and 28% showed a mean fall in IOP of 9.28 mm Hg. On the third postoperative day (POD-3), the IOP showed a statistically significant rise (14.82±3.93 mm Hg, P=0.028) compared with the preoperative value. At the end of the first postoperative week (POW-1), the IOP showed a statistically nonsignificant rise (P=0.66). By the third postoperative week (POW-3), the IOP decreased to 13.82±2.83 mm Hg, with a statistically nonsignificant difference compared with the preoperative IOP (P=0.45). However, there was a statistically significant decrease in the IOP (P=0.0001) in the sixth postoperative week (POW-6). Postoperatively, there was a statistically significant increase in ACD from 3.01±0.31 to 3.23±0.36 mm (P=0.0001) by the POW-3. The preoperative ACD showed a statistically significant moderate negative correlation with late postoperative IOP (r=−0.7394, P&lt;0.0001). Conclusion After SICS, at the end of 6 weeks, there was a statistically significant decrease in the mean IOP with an increase in the ACD. A moderate negative correlation existed between the preoperative ACD and late postoperative IOP. It was found that 2.3% of the eyes were steroid responders and showed a rise in IOP at POW-3.

#6359 DAPAGLIFLOZIN TREATMENT IN AUTOSOMAL DOMINANT ALPORT SYNDROME (ADAS)

Abstract Background and Aims Alport Syndrome (AS; ORPHA 63) is one of the most frequent hereditary kidney diseases (HKD). Its autosomal dominant form due to COL4A3-4 heterozygous mutations is being increasingly diagnosed thanks to the generalization of genetic studies. Since there is no curative treatment for the disease, management is based on drugs that slow its progression, mainly RAAS inhibitors. The SGLT2 inhibitor Dapagliflozin has demonstrated to slow chronic kidney disease (CKD) progression by decreasing proteinuria, however very few ADAS patients were included in its clinical trial. Our aim is to analyze whether dapagliflozin is associated with a decrease in proteinuria in ADAS patients. Method In this prospective observational study, we analyzed 12 ADAS patients that started dapagliflozin due to proteinuria in spite of maximum tolerated RAAS inhibitor treatment and eGFR &amp;gt; 25 ml/min/1.73 m2. We analyzed diabetes and hypertension presence (and its control), weight changes, possible adverse effects and laboratory variables before and after treatment initiation (Cr, eGFR, K, uric acid, albuminuria, proteinuria). Results During a mean follow-up period of 7±4 months, we observed 12 patients, 5 (41.7%) male, 61±10 years old. 2 (33.3%) had type 4 diabetes, 2 (16.7%) had impaired fasting glucose (IFG), 11 had hypertension diagnosis, 1 patient had obesity (BMI 36) and other 7 were overweight (mean BMI 28±2). 9 patients had the higher dose of an RAASi, the other three couldn’t achieved it because of hypotension events. 3 patients also took an antagonist of mineralocorticoid. Only one had another diuretic prescription (furosemide 40 mg/d). Mean proteinuria prior to Dapagliflozin initiation was 1.0±0.4 gr/d, protein-to-creatinine ratio (UPCR) 1275±635 mg/g and albumin-to-creatinine ratio (ACR) 784±418 mg/g. 10 out of the 12 patients had some grade of decrease in their proteinuria, with a mean decrease of 416±183 mg/g of UPCR (p = 0,046) and a mean decrease of 292±178 mg/g of ACR (p = 0,020). Looking only at patients without diabetes, they had a lesser degree of estimated glucosuria than diabetes patients, but maintained the improvement in proteinuria quite similar to the overall group (mean ACR improvement 244±95 mg/g). All patients had optimal blood pressure control, and there were no significant body weight losses. Mean eGFR previous to SGLT2i initiation was 50±22 ml/min/1.73 m2, and after 45±19 ml/min/1.73 m2 (p = 0,008), with a mean fall of 8±8%. There were no differences in potassium levels (p = 0,079) and a decrease of uric acid levels (6.7±1.3 mg/dl vs 6.0±1.4 mg/dl, p = 0,016). The two patients who didn’t achieve an improvement in their proteinuria were not diabetic patients and had optimal blood pressure control, one of them had a weight gain of two kilograms, and the other had no weight changes. They had a similar eGFR fall to the overall group. Possible adverse events were monitored, although we didn’t find any of them: no urine tract infections, hyperpotassemia, acute kidney injury, dehydration. No patient required treatment suspension. Two of them required a withdrawal in their other diabetes medications and the one on furosemide tried a lesser dose but had to increase it again. Conclusion Slower progression drugs are the main treatment of ADAS nowadays. Dapagliflozin had demonstrated its beneficial effects in other proteinuric CKD, but it hasn’t been well studied in ADAS. In our sample, it seems to achieve a proteinuria improvement without significant adverse effects and known bearable eGFR fall. Large studies must be considered to determine its beneficial use in a long-time basis.

0507 A wireless patch-based polysomnography system for conducting in-lab sleep studies

Abstract Introduction Current attended in-lab polysomnographic sleep studies are time-consuming and costly, primarily due to the time required to “hook-up” a patient to multiple electrodes and sensors and meet the quality assurance and safety requirements of an in-lab study. We developed a wireless PSG system (Onera STS - Onera Health, NL) consisting of four disposable patches and reusable pods to record full polysomnography that may reduce hook-up time while preserving standards of an attended polysomnography in the lab. Methods We used the Onera STS system for monitoring EEG, EOG, EMG, forehead reflectance SaO2, ECG, bioimpedance derived respiratory airflow and effort, airflow via nasal cannula, snoring sounds, body position, actigraphy, and leg movements, and accessory online monitoring of finger SaO2, ECG, nasal cannula airflow and video via RemLogic 4.0 or REM logic MPR system for Q/A and safety monitoring. Seventeen subjects (8 male, 9 female, age 18-to-75 yrs, BMI 29.9±6.0 kg/m2) were monitored for the evaluation of sleep apnea. We measured hook-up times and observed oxygen saturation and cardiac rhythm throughout the night. Results Mean hook-up time for the Onera STS was 5:22±1:17 minutes and for the additional on-line sensors (Finger SaO2, ECG and nasal cannula) was 3:15±1:10 minutes, resulting in an average hook-up time of less than 10 minutes. Onera PSG data revealed a mean oxygen desaturation event rate of &amp;gt;3% (ODI3) of 8.8 (SD 18.6) and a mean fall of oxygen saturation (ΔSaO2/event) of 4.4 (SD 1.2). The accessory online SaO2, ECG and video monitoring showed that no subjects demonstrated sustained nocturnal hypoxia, severe cardiac arrhythmia or parasomnia events that would have required interventions. Conclusion The Onera STS system substantially lowers the burden to conduct attended polysomnographic sleep studies. In combination with standard monitoring of SaO2, ECG and video, it meets the safety requirements for attended sleep studies while reducing the overall operational and capital equipment costs. The ease of application together with the reduced hook-up time makes it now possible to implement polysomnographic sleep studies in the hospital setting, particularly in addition to conventional bedside monitoring units such as ICU-, step-down unit- or hospital beds. Support (if any)

Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Propensity-matched Analysis

BackgroundPartial nephrectomy is the preferred treatment option for the management of small renal masses. On-clamp partial nephrectomy is associated with a risk of ischemia and a greater loss of postoperative renal function, while the off-clamp procedure decreases the duration of renal ischemia, leading to better renal function preservation. However, the efficacy of the off- versus on-clamp partial nephrectomy for renal function preservation remains debatable. ObjectiveTo compare perioperative and functional outcomes following off- and on-clamp robot-assisted partial nephrectomy (RAPN). Design, setting, and participantsThis study used the prospective multinational collaborative Vattikuti Collective Quality Initiative (VCQI) database for RAPN. Outcome measurements and statistical analysisThe primary objective of this study was the comparison of perioperative and functional outcomes between patients who underwent off- and on-clamp RAPN. Propensity scores were calculated for age, sex, body mass index (BMI), renal nephrometry score (RNS) and preoperative estimated glomerular filtration rate (eGFR). Results and limitationsOf the 2114 patients, 210 had undergone off-clamp RAPN and others on-clamp procedure. Propensity matching was possible for 205 patients in a 1:1 ratio. After matching, the two groups were comparable for age, sex, BMI, tumor size, multifocality, tumor side, face of tumor, RNS, polar location of the tumor, surgical access, and preoperative hemoglobin, creatinine, and eGFR. There was no difference between the two groups for intraoperative (4.8% vs 5.3%, p = 0.823) and postoperative (11.2% vs 8.3%, p = 0.318) complications. Need for blood transfusion (2.9% vs 0, p = 0.030) and conversion to radical nephrectomy (10.2% vs 1%, p < 0.001) were significantly higher in the off-clamp group. At the last follow-up, there was no difference between the two groups for creatinine and eGFR. The mean fall in eGFR at the last follow-up compared with that at baseline was equivalent between the two groups (–16.0 vs –17.3 ml/min, p = 0.985). ConclusionsOff-clamp RAPN does not result in better renal functional preservation. Alternatively, it may be associated with increased rates of conversion to radical nephrectomy and need for blood transfusion. Patient summaryWith this multicentric study, we noted that performing robotic partial nephrectomy without clamping the blood supply to the kidney is not associated with better preservation of renal function. However, off-clamp partial nephrectomy is associated with increased rates of conversion to radical nephrectomy and blood transfusion.

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study.

Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the yearsand one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had asolitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.

Assessment of OTT Parsivel2 Raindrop Fall Speed Measurements

Abstract This study was to assess the raindrop fall speed measurement capabilities of OTT Parsivel2 disdrometer through comparisons with measurements of a collocated High-speed Optical Disdrometer (HOD). Raindrop fall speed is often assumed to be terminal in relevant hydrological and meteorological applications, and generally predicted using terminal speed–raindrop size relationships obtained from laboratory observations. Nevertheless, recent field studies have revealed that other factors (e.g., wind, turbulence, raindrop oscillations, and collisions) significantly influence raindrop fall speed, necessitating accurate fall speed measurements for many applications instead of reliance on laboratory-based terminal speed predictions. Field observations in this study covered rainfall events with a variety of environmental conditions, including light, moderate, and heavy rainfall events. This study also involved rigorous laboratory experiments to faithfully identify the internal filtering and calculation algorithm of OTT Parsivel2. Our assessments revealed that, for the smaller diameter bins, Parsivel2 filters out many of the observed raindrops that fall faster than predicted terminal speeds, bringing down the mean fall speed for those size bins without observational evidence. Furthermore, Parsivel2 fall speed measurements exhibited notable artificial bell-shaped deviations from the predicted terminal speeds toward subterminal fall starting at around 1 mm diameter raindrops with peak deviations around 1.625 mm diameter bin. Such bell-shaped fall speed deviation patterns were not present in collocated HOD measurements. Assessment results along with the faithfully identified Parsivel2 algorithm are presented with discussions on implications on reported raindrop size distributions (DSD) and rainfall kinetic energy.

Hastanede yatan yaşlı hastaların düşmeyi önleme davranışları ile sağlık okuryazarlığı arasındaki ilişkinin incelenmesi

Aim: This study aims to investigate the relationship between falls, fall prevention behaviors, and health literacy in hospitalized older adults.&#x0D; &#x0D; Materials and Methods: A descriptive, cross-sectional design was used. Study data were collected from patients aged ≥65 who were hospitalized in the hospital’s internal medicine and surgery clinic between December 2021-June 2022. The data was collected using a Socio-demographic and Clinical Characteristics Form, the Health Literacy Scale (HLS), and the Fall Behavioral Scale for Older People (FaB). Multiple linear regression analysis was used to determine the contribution of factors associated with older patients’ falling behaviors.&#x0D; &#x0D; Results: The mean age of 204 older patients participating in the study was 75.38±8.95, and 57.8% were female. The older people’s mean fall behaviors and health literacy scores were determined as 3.06±0.44 and 41.35+19.35, respectively. It was determined that the predictors of the cognitive adaptation subdimension of the falls behavioral scale for older people were understanding and applying and being single, the predictor of the protective mobility was fear of falling, the predictors of the pace were status of mobilization and fear of falling. In addition, the predictor of the practical strategies was fear of falling, the predictors of the displacing activities sub-dimension were the understanding sub-dimension of the HLS, presence of chronic disease, mobilization status, and fear of falling and the predictor of the changes in level was the mobilization status.&#x0D; &#x0D; Conclusion: Practices aimed at increasing the health literacy of older people, reducing the regression in their cognitive status, and improving it may increase fall prevention behaviors.

Safety and Efficacy of Sleeve Gastrectomy with Sleeve Jejunal Bypass: An Advantage over Other Bypass Procedures – Multicenter 3 and 5 year Data

Abstract Background: The sleeve gastrectomy with sleeve jejunal (SG + SJ) bypass is a single anastomosis, sleeve plus procedure which was introduced as a loop modification of the transit bipartition and the single-anastomosis sleeve-ileal bypass, continuing with the original idea of maintaining biliary access by avoiding duodenal transection, while creating a functional bypass to achieve weight loss and resolution of the metabolic syndrome. Objectives: This study was done to evaluate the extent of weight reduction, control of type 2 diabetes mellitus (T2DM), their maintenance up to 5 years, nutritional stability, and documentation of any complications, following this procedure. Methods: This is a retrospective analysis of prospectively collected data of patients who underwent SG + SJ bypass, with a follow-up of 1–5 years, in three centers, amounting to 112 patients. A SG is followed by anastomosis of a loop of jejunum, usually at 200 cm distal to the duodenojejunal flexure (sometimes at 150 cm or even 100 cm depending on total small bowel length [TSBL]), with the antrum. The cohort included 41 male and 71 female patients with a mean age of 42 years and mean preoperative body mass index (BMI) of 45.8 kg/m2 (range: 30.15–74.6 kg/m2). Seventy-three (65.2%) patients had T2DM, with mean glycated hemoglobin (HbA1c) of 7.5% (range: 4.9%–16%). The primary outcome of this study was weight loss and remission of T2DM, and the secondary outcome was its safety and nutritional stability. Results: Of these 112 patients analyzed in this study, 110 (98.2%) followed up at 1 year, 45 out of 58 (77.6%) at 3 years, and 14 out of 25 (56%) at 5 years. Operative duration was 120–180 min with an average hospital stay of 2–4 days with no postoperative problems. The mean TSBL was 793 cm (range: 530–1035 cm); the mean common channel (CC) was 587 cm (range: 330–835). Reduction in BMI was observed from 45.8 to 28.2 kg/m2 at 1 year, 27.4 kg/m2 at 3 years, and 27.3 at 5 years. The mean percentage of total body weight loss was 37.9% at 1 year, 40.7% at 3 years, and 40.6% at 5 years. Remission of diabetes was seen in 98.6% at 1 year, 97% at 3 years, and 91.7 at 5 years, with a mean fall in HbA1c from 7.5% to 5.2% at 1 year, 5% at 3 years, and 4.96% at 5 years. No mortality was seen in any of these 112 patients. Four patients had complications such as nausea, vomiting, diarrhea, dumping syndrome, hypoproteinemia, and hypoalbuminemia. Two patients required a partial reversal of the procedure (disconnection of the jejunal bypass while retaining the sleeve), while the rest were managed conservatively. Conclusions: This procedure was found to be safe and effective in achieving and maintaining weight loss and diabetes remission, along with nutritional stability, even at 3 and 5-year follow-up; long-term data are awaited. It has the advantage of maintaining biliary access and if necessary a partial reversal can be done in a simpler manner compared to other bypass procedures.

PRODIGE – envelope to disk with NOEMA

Context. In the past few years, there has been a rise in the detection of streamers, asymmetric flows of material directed toward the protostellar disk with material from outside a star’s natal core. It is unclear how they affect the process of mass accretion, in particular beyond the Class 0 phase. Aims. We investigate the gas kinematics around Per-emb-50, a Class I source in the crowded star-forming region NGC 1333. Our goal is to study how the mass infall proceeds from envelope to disk scales in this source. Methods. We use new NOEMA 1.3 mm observations, including C18O, H2CO, and SO, in the context of the PRODIGE MPG – IRAM program, to probe the core and envelope structures toward Per-emb-50. Results. We discover a streamer delivering material toward Per-emb-50 in H2CO and C18O emission. The streamer’s emission can be well described by the analytic solutions for an infalling parcel of gas along a streamline with conserved angular momentum, both in the image plane and along the line-of-sight velocities. The streamer has a mean infall rate of 1.3 × 10−6 M⊙ yr−1, five to ten times higher than the current accretion rate of the protostar. SO and SO2 emission reveal asymmetric infall motions in the inner envelope, additional to the streamer around Per-emb-50. Furthermore, the presence of SO2 could mark the impact zone of the infalling material. Conclusions. The streamer delivers sufficient mass to sustain the protostellar accretion rate and might produce an accretion burst, which would explain the protostar’s high luminosity with respect to other Class I sources. Our results highlight the importance of late infall for protostellar evolution: streamers might provide a significant amount of mass for stellar accretion after the Class 0 phase.