Minimum Step Research Articles

A Complete Procedure for a Constraint-Type Fictitious Time Integration Method to Solve Nonlinear Multi-Dimensional Elliptic Partial Differential Equations

In this paper, an efficient and straightforward numerical procedure is constructed to solve multi-dimensional linear and nonlinear elliptic partial differential equations (PDEs). Although the numerical procedure for the constraint-type fictitious time integration method overcomes the numerical stability problem, the parameter’s definition, numerical accuracy and computational efficiency have not been resolved, and the lack of initial guess values results in reduced computational efficiency. Therefore, the normalized two-point boundary value solution of the Lie-group shooting method is proposed and considered in the numerical procedure to avoid the problem of the initial guess value. Then, a space-time variable, including the minimal fictitious time step and convergence rate factor, is introduced to study the relationship between the initial guess value and convergence rate factor. Some benchmark numerical examples are tested. As the results show, this numerical procedure using the normalized boundary value solution can significantly converge within one step, and the numerical accuracy is better than that demonstrated in the previous literature.

Multi-criteria decision making and project portfolio management for transport infrastructure investment in Thailand

Transport project selection is always critical in government planning due to limited resources and diverse demands. Project portfolio management (PPM) was proposed in this study to suggest an optimal set of projects under predetermined constraints. With multiple conflicting criteria, comprehensive steps of multi-criteria decision making (MCDM) procedures were proposed in this study. The process begins with a step of pre-screening the projects and selecting the criteria for project evaluation. Sequential steps of: 1) weight determination process using the proportion method; 2) MCDM process using preference ranking organisation method for enrichment evaluations (PROMETHEE) II; 3) constraint consideration process using PROMETHEE V, was proposed to evaluate and select an optimal project portfolio. The study showed that decision making could be successfully done for the transport infrastructure investment with minimal complex calculation steps and questionnaire input from experts.

An Inchworm and Stick-Slip Dual Mode Piezoelectric Linear Actuator for Cell Injection

Cell injection system for biomedical engineering demands that actuators have large stroke, high resolution and speed for cell positioning and injection. Single mode piezoelectric actuators could meet some of these requirements but hardly all. Stick-slip actuator is easy to achieve high-speed operation, but it is prone to setback; The speed characteristics of the inchworm actuator are lower than those of the stick-slip actuator, but the step is more stable and the setback is lower. This study proposes an inchworm and stick-slip dual mode piezoelectric actuator (ISSPA) for cell injection. It integrates two working modes into one actuator and both modes drive the same slider. The stick-slip mode works at high frequency for fast positioning to the cell and the inchworm mode drives the needle to puncture the cell membrane and accurately locates to the specified location. The structure and working principle of the ISSPA are provided. A prototype of the proposed ISSPA is fabricated and experiments are conducted. When the driving voltage of the piezoelectric stack is 100 V and the frequency is 500 Hz,the maximum speed of the ISSPA is 2.287 mm/s in the stick-slip mode. When the driving voltage of the piezoelectric stack is 60 V, the frequency is 3 Hz and the load is 0.5 kg,the minimum step displacement is 57 nm in inchworm mode. Demonstration of cell injection is carried out by using the ISSPA to positioning and puncturing a zebrafish embryo. Fast positioning with the stick-slip mode and accurate puncture with the inchworm mode are achieved with the ISSPA alone, taking 12 seconds for the whole injection process. It could be expected to apply the ISSPA to cells with wide range of diameter, as the frequency of the stick-slick mode and the voltage of the inchworm mode could be well regulated.

Preparation and in vitro evaluation of hot-melt extruded pectin-based pellets containing ketoprofen for colon targeting

This work developed high drug-load pellets for colon targeting in minimal steps by coupling hot-melt extrusion (HME) with a die-surface cutting pelletizer, offering a potential continuous pellet manufacturing process. Ketoprofen (KTP) was selected as a model drug for this study due to its thermal stability and severe upper gastrointestinal side effects. Low and high methoxyl grade pectins were the enzyme-triggered release matrix, and hydroxypropyl methylcellulose (HME 4 M/HME 100LV) was used as a premature release-retarding agent. The powder X-ray diffraction technique and the differential scanning calorimetry results revealed that KTP exists in the solid-solution state within the polymeric matrix after the HME step. The scanning electron micrographs of the fabricated pellets showed a smooth surface without any cracks. The lead formulation showed the lowest premature drug release (∼13%) with an extended KTP release profile over a 24 h period in the presence and absence of the release-triggering enzyme. The lead formulation was stable for 3 months at accelerated stability conditions (40 °C/75 ± 5% RH) concerning drug content, in vitro release, and thermal characteristics. In summary, coupling HME and pelletization processes could be a promising technology for developing colon-targeted drug delivery systems.

Person-Job Allocation Optimization using Genetic Algorithm with Mutated-Crossover (GAMC)

The Job Allocation/Assignment Problem has been a pivot of research for numerous well-known researchers around the world. However, as this problem is considered to be NP -complete, it is still not possible to find a deterministic number of steps that solves the said problem within a polynomial time. In this paradigm, the research community is focused to develop and design algorithms which produce results with minimum computational steps. As a result, without any doubt there is a great opportunity to examine the effectiveness of previously developed algorithms and compare them with solutions developed by other research scientists. In this paper, we have proposed a new variant of standard Genetic Algorithm (GA) referred to as Genetic Algorithm with Mutated-Crossover (GAMC) to solve this problem, implement it and analyze the results. The key point in this approach is to present the idea of Mutated-Crossover to avoid infeasible children generated by the crossover used in standard GA that has provided optimal results with lesser computational steps.

Simple and Sensitive Analysis of Clenbuterol in Urine Matrices by UHPLC-MS/MS Method with Online-SPE Sample Preparation

Clenbuterol is one of the most misused anabolic agents in professional sports. Therefore, the monitoring of clenbuterol in body fluids such as human urine is related to the development of rapid, selective and sensitive analytical methods that produce reliable results. In this work, these requirements were met by a two-dimensional separation method based on online solid-phase extraction coupled with ultra-high performance liquid chromatography–tandem mass spectrometry (SPE–UHPLC–MS/MS). The developed method provides favorable performance parameters, and it is characterized by minimum manual steps (only dilution and the addition of an internal standard) in the sample preparation. A limit of quantification (LOQ) of 0.1 ng/mL, excellent linearity (0.9999), remarkable precision (1.26% to 8.99%) and high accuracy (93.1% to 98.7%) were achieved. From a practical point of view, the analytical performance of the validated SPE–UHPLC–MS/MS method was demonstrated on blinded spiked urine samples from ten healthy volunteers. The estimated concentrations of clenbuterol were in accordance with their corresponding nominal values, as supported by the precision and accuracy data (relative standard deviation ≤5.4%, relative error ≤11%). The fulfillment of the World Anti-Doping Agency’s screening and confirmation criteria indicates that the proposed method is suitable for implementation in routine use in toxicologic and antidoping laboratories. Due to its high orthogonality and separation efficiency, the SPE–UHPLC–MS/MS method should also be easily adapted to the separation of structurally related compounds (such as clenbuterol metabolites). Thus, future antidoping applications could also include monitoring of clenbuterol metabolites, providing a longer detection widow.

Online distributed optimization for spatio-temporally constrained real-time peer-to-peer energy trading

The proliferation of distributed renewable energy triggers the peer-to-peer (P2P) energy market formations. To make profits, prosumers equipped with photovoltaic (PV) panels and even the energy storage system (ESS) can actively participate in the real-time P2P energy market and trade energy. However, in real situations, system states such as energy demands and renewable energy power generation are highly uncertain, making it difficult for prosumers to make optimal real-time decisions. Moreover, severe problems with the physical network can arise from the real-time P2P energy trading, such as bus voltage violations and line overload. To handle these problems, this work first formulates the real-time P2P energy trading problem as a spatio-temporally constrained stochastic optimization problem by considering ESS and the spatial physical network constraints. To deal with the uncertainties online, a modified Lyapunov optimization method is innovatively proposed to approximately reformulate the stochastic optimization problem into an online one by relaxing the time-coupling constraints. Compared with the state-of-the-art online methods, the proposed one renders more flexibility and better performance for the real-time P2P energy market operation. Additionally, to protect the prosumers’ privacy, an online distributed algorithm based on the consensus alternating direction method of multipliers (ADMM) is developed to solve the reformulated online problem by decoupling the spatial constraints. The theoretical near-optimal performance guarantee of the proposed online distributed algorithm is derived, and its performance can be further improved by minimizing the performance gap. Simulation results demonstrate that the proposed online distributed algorithm can guarantee the fast, stable, and safe long-term operation of the real-time P2P energy market. Allied with a performance gap minimization step, the proposed online distributed algorithm can obtain approximately a 53.10% cost reduction compared to the greedy algorithm for the intraday market operation.

Green voltammetric nano scaled determination of toldimfos and its residues in cattle meat and milk in presence of its toxic metabolite and Co-administered vitamin C

Our main focus is the green chemistry challenge, which is already a trend in all environmental processes. Voltammetry is an eco-friendly technique as it requires fewer solvents through minimum steps, producing no hazards. In the developed method, a novel electrochemical sensor was utilized to increase the sensitivity, selectivity, and enable minor detection of veterinary compound toldimfos sodium (TDS) in many matrices. The multi-walled carbon nanotube composite modified with zeolite (ZY/MWCNT) creates the sensor. A good linear relationship was obtained over a range of 0.2–100 nM with a high correlation of 0.9995. Its sensitivity was proved by the detection and quantification limits, which were calculated and found to be 50 pM and 151.5 pM, respectively. In order to test for food safety, it is utilized to determine the qualitative and quantitative amounts of TDS residue in cattle meat and milk. The obtained results were statistically compared with the reported method successfully. A greenness assessment was performed using Analytical Eco-Scale (AES) and Green Analytical Procedure Index (GAPI) tools, revealing an excellent green profile for the suggested method.

In Vitro Dissolution Profile of Antihypertensive Mixture: Comparison Between Multivariate Methods and Statistical and Graphical Representation of Different Univariate Spectrophotometric Data.

Triplixam® is a new antihypertensive drug combination consisting of perindopril, amlodipine, and indapamide, which have a synergistic mechanism of action in combination with each other. Comparative study of different spectrophotometric approaches used for the simultaneous determination of perindopril, indapamide, and amlodipine in bulk powder and in dosage form Triplixam. The methods include univariate and multivariate spectrophotometric methods depending on either mathematical calculation or graphical representation of data. For the univariate methods: perindopril was resolved from other components using constant multiplication followed by spectrum subtraction resolution technique, and then two base point, AUC, constant value, and concentration value (CNV) methods were applied. For both amlodipine and indapamide: constant multiplication resolution technique was used, and then constant value and CNV methods were applied. CNV depends on graphical representation of data rather than statistical data. PLS and PCR chemometric assisted spectrophotometric techniques were also applied. The proposed methods are considered a green alternative to the reported methods as the greenness of the proposed methods was evaluated qualitatively and quantitatively by four green analytical evaluation tools. The methods were applied for the analysis of the mixture in the pharmaceutical dosage form Triplixam and in vitro release at intestinal pH (7.4) using a USP dissolution tester. The proposed green analytical methods are considered to be greener than the reported methods and simpler, so they could be used as an alternative for routine analysis of the mixture in quality control laboratories for the reason of their accurate results beside minimum manipulation steps that reduced the error and time required of the analysis with no harmful effect on analyst health as well as the environment. The study was the first in vitro dissolution profiling of perindopril, amlodipine, and indapamide. The developed methods were excellent green methods without compromising the analytical criteria.

New accurate algorithms of circularity evaluation

The minimum circumscribed circle (MCC), maximum inscribed circle (MIC), and minimum zone circle (MZC) methods for circularity evaluation are difficult to execute due to the lack of specific rules in mathematics, especially the MZC. New accurate algorithms have been proposed to realize the MIC, MCC and MZC evaluation methods. First, the diameter criterion and acute triangle criterion of control points defining the MIC or MCC are presented. The definition of the crossing sector structure is introduced in the minimum zone criterion and transformed into an angular relationship of control points, making it easy to identify the MZC. Then the key points of the algorithms are presented in details including the initial circle or the initial region, centre moving direction, minimum step size and updating rules of control points. Flow charts are provided to make the algorithm producible. Finally, four cases are selected to demonstrate the advantages of the algorithms. The results show that the proposed MZC algorithm is more general than that in the published reference. Compared to the traditional ergodic searching algorithms, the efficiency of the new algorithm for the MIC, the MCC and the MZC evaluations of circularity can be improved by 100% when the point set increases to 100 and above.

A Novel Monopolar Cross-Scale Nanopositioning Stage Based on Dual Piezoelectric Stick-Slip Driving Principle.

The precise characterization and measurement of new nanomaterials and nano devices require in situ SEM nanorobotic instrumentation systems, which put forward further technical requirements on nanopositioning techniques of compact structure, cross-scale, nanometer accuracy, high vacuum and non-magnetic environment compatibility, etc. In this work, a novel cross-scale nanopositioning stage was proposed, which combined the advantages of piezoelectric stick-slip positioner and piezoelectric scanner techniques and adopted the idea of macro/micro positioning. A new structure design of a single flexible hinge shared by a small and large PZT was proposed to effectively reduce the size of the positioning stage and achieve millimeter stroke and nanometer motion positioning accuracy. Then, the cross-scale motion generation mechanism of the dual piezoelectric stick-slip drive was studied, the system-level dynamics model of the proposed positioning stages was constructed, and the mechanism design was optimized. Further, a prototype was manufactured and a series of experiments were carried out to test the performance of the stage. The results show that the proposed positioning stage has a maximum motion range of 20 mm and minimum step length of 70 nm under the small piezoceramic ceramic macro-motion stepping mode, and a maximum scanning range of 4.9 μm and motion resolution of 16 nm under the large piezoceramic ceramic micro-motion scanning mode. Moreover, the proposed stage has a compact structure size of 30 × 17 × 8 mm3, with a maximum motion speed of 10 mm/s and maximum load of 2 kg. The experimental results confirm the feasibility of the proposed stage, and nanometer positioning resolution, high accuracy, high speed, and a large travel range were achieved, which demonstrates that the proposed stage has significant performance and potential for many in situ SEM nanorobotic instrument systems.

A sample-to-answer COVID-19 diagnostic device based on immiscible filtration and CRISPR-Cas12a-assisted detection

In response to the ongoing coronavirus disease 2019 (COVID-19) pandemic and disparities of vaccination coverage in low-and middle-income countries, it is vital to adopt a widespread testing and screening programme, combined with contact tracing, to monitor and effectively control the infection dispersion in areas where medical resources are limited. This work presents a lab-on-a-chip device, namely ‘IFAST-LAMP-CRISPR’, as an affordable, rapid and high-precision molecular diagnostic means for detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The herein proposed ‘sample-to-answer’ platform integrates RNA extraction, amplification and molecular detection with lateral flow readout in one device. The microscale dimensions of the device containing immiscible liquids, coupled with the use of silica paramagnetic beads and guanidine hydrochloride, streamline sample preparation (including RNA extraction, concentration and purification) in 15 min with minimal hands-on steps. The pre-amplification in combination with CRISPR-Cas12a detection assays targeting the nucleoprotein (N) gene achieved visual identification of ≥ 470 copies mL−1 genomic SARS-CoV-2 samples in 45 min. On-chip assays showed the ability to isolate and detect SARS-CoV-2 RNA from 100 genome copies mL−1 of replication-deficient viral particles in 1 h. This simple, affordable and integrated platform demonstrated a visual, faster, and yet specificity- and sensitivity-comparable alternative to the costly gold-standard reverse transcription-polymerase chain reaction (RT-PCR) assay, requiring only a simple heating source. Initial testing illustrates the platform viability both on nasopharyngeal swab and saliva samples collected using the easily accessible Swan-brand cigarette filter, providing a complete workflow for COVID-19 diagnostics in low-resource settings.

Energy conservation, minimum steps, and adaptations when needed: A scoping review.

Although many therapeutic approaches use energy conservation, only a few effectively report the steps involved. Thus, it is intended to identify energy conservation practices to be organized in flexible and adaptable stages. A scoping review was carried out, whose search strategies were applied in seven databases (CINAHL, Cochrane Library, Portal BVS, PsycINFO, PubMed, Scopus, and Web of Science) following guidelines by Arksey and O'Malley on the Rayyan software. Searches were carried out from January 2010 to December 2020. Inclusion of refered publications with different study designs, participation of adults with or by demands of energy conservation, joint protection, and control of fatigue and/or pain. Exclusion of productions without an occupational therapist or involving merely pharmacological or surgical therapeutic strategies. 653 articles were identified, after the selection and eligibility steps, 30 articles were full review, 18 articles were included and 635 excluded. Energy conservation studies have been increasingly focusing on neurological and systemic diseases, especially regarding symptoms of fatigue and pain. The findings were arranged in six strategies whose interventions are essentially based on guidelines and setting goals for patients, client-centered approach. Merely supervised interventions are less frequent. The number of sessions is closed, but the duration of treatment is not yet. The signs of pain and fatigue are confirmed as indicators of energy conservation strategies, this delivery can be condensed from planning and organization, priorities, activity analysis, balance between activity and rest, outsourcing of tasks and physical/environmental adaptation. https://osf.io/rsyq4.

Higgs boson precision measurements at a 125 GeV muon collider

The $s$-channel resonant production of the Higgs boson at a 125 GeV muon collider enables a unique way to determine the Higgs properties. However, a clear picture of the achievable Higgs precision has not yet been established. We perform a phenomenological study of the Higgs measurements at such a resonant muon collider Higgs factory and present a systematic, detailed, and consistent extraction of Higgs precision measurements. Many new aspects about the line shape scan, including the scaling with luminosity, optimal scan range, minimal scan steps, correlations with exclusive measurement, effective cross section modeling, etc., are quantitatively studied in this work. All major exclusive Higgs channels are simulated and analyzed with Standard Model background, detection efficiencies, acceptance, angular distributions, and cross-channel correlations. Global analyses of the Higgs couplings are performed in the $\ensuremath{\kappa}$ framework and the effective-field-theory one. The results suggest that the 125 GeV muon-collider Higgs factory provides significant improvement to the Higgs coupling reach of the High-Luminosity LHC and provides independent and distinct Higgs precision information concerning future ${e}^{+}{e}^{\ensuremath{-}}$ colliders. We report results for both 5 and $20\text{ }\text{ }{\mathrm{fb}}^{\ensuremath{-}1}$ integrated luminosity. These results provide comprehensive and quantitative physics understandings helpful in planning for the muon collider road map and global high-energy physics programs.

Machine Learning-Based Prediction of Hospitalization Using Daily Step Counts for Patients Undergoing Chemoradiation

<h3>Purpose/Objective(s)</h3> Unplanned hospitalizations during cancer treatment can impact cancer outcomes, quality of life, and healthcare costs. Prior studies have suggested that early prediction may facilitate interventional strategies to reduce hospitalization rates. Consumer wearable devices and patient-generated health data (PGHD) have created much enthusiasm, but their clinical utility remains unclear. The objective of this study was to develop and internally validate machine learning (ML) approaches to daily step counts before and during chemoradiation (CRT). <h3>Materials/Methods</h3> Patients enrolled in three prospective, single-institution trials of activity monitoring during chemoradiation (NCT02649569, NCT03102229, NCT03115398) were included in this retrospective ML model development study. Study patients were asked to wear commercial fitness trackers continuously before and during curative-intent CRT for multiple cancer types. Patient (age, ECOG performance status, sex, and diagnosis), radiotherapy plan metrics (mean esophagus, heart, and lung dose), and step count data were integrated. Patients with missing demographics or a hospitalization within a week prior to CRT were excluded. Step counts were smoothed as a 3-day running average and normalized. Weekly features were developed, including mean, median, minimum, maximum, range, and standard deviation, and the absolute and relative differences in weekly features between two given weeks were determined. An elastic net-regularized logistic regression (EN) was trained in a training cohort, with and without step count-derived features, to predict a first hospitalization event within one week based on data from the preceding two weeks. The models were then evaluated on a separate, hold-out test population in terms of the area under the receiver operating characteristic curve (AUC). <h3>Results</h3> 214 patients, median age 61 (IQR 53-68), were included in this study. The most common diagnoses were head and neck cancer (30%) and lung cancer (29%). 151 patients (70%) were in the training cohort, and 63 (30%) were in the validation cohort. EN with step count features had strong predictive performance (AUC = 0.81 [0.62-0.91]) and significantly outperformed EN without step counts (AUC = 0.57 [0.40-0.74], p = 0.004). Top five contributing variables were step counts from each of the past two days, absolute difference in minimum step counts over the past two weeks, relative decrease in the maximum step count over the past two weeks, and relative decrease in the step count range over the past two weeks. <h3>Conclusion</h3> PGHD has the potential to improve predictive ML modeling and direct clinical care. The results highlight the ability to predict hospitalization events based on daily step counts. This model is planned for clinical validation in NRGF-001, which will randomize patients undergoing CRT for lung cancer to treatment with or without daily step count monitoring.

(Digital Presentation) Synthesis of Fluorescent Carbon Nanoparticles (CNPs) By Microwave-Assisted Polymerization of Sp-Carbon Rich Precursors

Carbon nanoparticles (CNPs) have emerged as one of the most promising nanomaterials due to their distinct optoelectronic properties for a diverse range of applications. These unique properties arise from the network of hybridized sp2 carbon atoms as it allows delocalization of the electrons over the entire surface of the molecule. These surface groups help CNPs emit strong fluorescence in visible region. The significant fluorescence of CNPs combined with low toxicity, and photostability makes them suitable for various applications in biosensing, bio-imaging, and OLEDs. Despite several advantages and unique properties, the transformation from laboratory to industrial products has been slow for carbon nanoparticles. The synthetic methods reported until now chemically inert nanoparticles, increasing the difficulty to modulate their morphological, optical, and electronic properties. The organic synthesis methods for synthesizing CNPs often involve several synthesis steps, long reaction time, low yield, non-scalable and inefficient purification methods. Most of these synthesis methods involve several catalysts and removal of catalysts is always a challenge. Resulting nanoparticles also need functionalization using another synthesis step to give them properties such as fluorescence and making them soluble. Therefore, a synthesis method with minimum steps, minimum catalysts which could result in soluble and fluorescence nanoparticles is desired.This work investigates the use of highly reactive sp-carbon rich precursors for polymerization with microwave heating with minimum use of catalysts resulting in fluorescent CNPs. The sp-carbon rich precursors such as TMS-Benzene, butadiyne and acetylene were used as starting material. These alkynes are highly reactive and reacts to other alkynes present in the system in the presence of heat and form polyyne intermediates which are thermodynamically unstable in the form of long chains and decompose to provide us with CNPs. The plan is to use the high reactivity with microwave heating for polymerization without catalysts and further investigate the use of oxidants or minimum catalysts to increase the rate of polymerization and conversion into CNPs. The resulting nanoparticles required minimum purification in centrifuge and were isolated easily as there were no catalysts involved. The resulting nanoparticles were characterized with various techniques to study the morphology, structure, composition, and optical properties of CNPs. The resulting nanoparticles had blue fluorescence under the UV lamp. The single step synthesis of blue fluorescence CNPs was performed with microwave assisted polymerization of sp-carbon rich precursors without any catalysts. Further investigation of this method will provide a single step synthesis method for fluorescent CNPs which would be suitable for application in sensing and OLEDs.

Ten Steps for Writing an Exceptional Personal Statement.

Ten Steps for Writing an Exceptional Personal Statement.

Validation and clinical implementation of a fast, standardised and closed vitrification system for human oocytes

Background and Aim: Improvements of laboratory efficiency and standardisation during oocyte vitrification are important for routine IVF. Application of physiological temperature (37°C) during vitrification prevents spindle depolymerisation and results in significantly faster vitrification cycles. Using straightforward methods, with minimal handling steps and by avoiding mixing of solutions, contributes to standardisation of procedures. This study aimed to evaluate if a sealed carrier device, in combination with a fast and standardised vitrification protocol at physiological temperature, can be successfully used for human oocyte vitrification.

Novel External Fixation Device for the Treatment of Hallux Distal Phalanx Fractures

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The great toe plays a large role in activity, including maintenance of balance and substantial weight bearing capabilities. Fractures of the hallux distal phalanx, especially when displaced or unstable, can lead to significant dysfunction of the interphalangeal joint (IP) and pain and may need operative intervention. Surgical options include wire pinning, screw fixation, external fixation, arthrodesis, or amputation. For patients with significant comminution and shortening who would like to attempt toe salvage without fusion, external fixation can lead to great outcomes. Unfortunately, the use of these devices is hindered by cost, size, and availability. We recommend the use of a novel low cost external fixation device that can be made intraoperatively using common materials found in the operative room. Methods: A 27-year-old female, with a severely comminuted right distal phalanx fracture with interphalangeal (IP) joint dislocation, presented 4 days after a skiing accident. We discussed treatment may require IP joint arthrodesis or partial amputation, however, salvage fixation could be attempted initially. First, a transverse percutaneous wire was placed through the distal phalanx tip since the fragment was still mostly intact. The wire exited the skin medially. Two Kocher clamps to each side of the wire were applied for distraction of the fracture site while simultaneous manual manipulation of the more proximal fragments was performed. Once reduced, three more proximal transverse wires were placed through a 3cc syringe, which acted as a rail to hold the fracture length stable. The distal transverse wire was then impaled through the rail so that all four wires were within the rail providing two points of fixation in the distal phalanx and proximal phalanx. Results: The patient's weight-bearing status was non-weight bearing to the right lower extremity for 6 weeks. This was actually being dictated by the more proximal tibial plateau fracture for which she was non-weight bearing. With regard specifically to the hallux fracture, she could have been heel weight beared immediately. At her most recent post-operative visit at 6 weeks, she was doing well with minimal pain. The external fixation device was removed in clinic and she was transitioned to a post-op shoe and allowed to weight bear as tolerated. She was motor and sensate intact with the ability to actively range her IP joint. Radiographs at the most recent visit revealed excellent alignment of the toe with minimal articular step off. Conclusion: With severely unstable hallux distal phalanx fractures, operative intervention should be considered. For those with a significant degree of comminution who still would like to undergo salvage fixation, external fixation is an excellent option. Unfortunately, the use of these devices is hindered by cost, size, and availability. Hand surgeons solved this problem by introducing small, low cost external fixators composed of common materials such as needle sheaths, IV cannulas, and syringes. We adapted their model to the toes and were able to obtain great clinical outcomes with low cost, all the while maintaining the patient's expectations for cosmesis.

Vocal for Local Growth of Domestic Supply Chain

One of the positive fallouts of the Covid crisis seems to be the policy initiatives of GOI in line with PM’s clarion call for Vocal for Local targeted to expand the efficiency and competitive edge of the indigenous industries. Basically it may be in line with the Swaraj calls during the pre-independence India or the earlier steps like Make in India but there were obvious risk minimization steps necessitated by the dislocation of the international supply chain as a result of the world wide shut down due to covid impacts. Many segments of the economy have already started benefitting from the policy and it seems to be on a firm course for greater good for the overall economy.