BACKGROUND: A coracoid process fracture combined with an acromioclavicular (AC) joint dislocation is an uncommon injury that typically causes significant pain and limits shoulder movement. Open reduction and internal fixation have been the traditional treatment approach. However, arthroscopic techniques are emerging as a promising alternative for managing these injuries.
METHODS: A 35-year-old woman presented with right shoulder pain following an accidental fall. Imaging studies revealed a coracoid process fracture along with an AC joint dislocation. The fracture was classified as an Eyres Type IIIA, which warranted surgical intervention. Our team performed arthroscopic coracoid fracture reduction and internal fixation surgery, as well as AC joint dislocation repair using Kirschner wires. Six months after surgery, the patient demonstrated a satisfactory functional outcome with complete bone healing.
CONCLUSIONS: This case report highlights the potential of arthroscopic reduction and fixation as a novel treatment option for fractures of the coracoid base.

Objective: This study aimed to examine the effect of a contextualized intervention program on the level of noises in the neonatal intensive care unit (NICU) in Konya, Turkey. Background: For the healthy development of preterm infants, NICUs should have noise levels within safe limits. Methods: A single-center, before-and-after study design was employed. Participants included one head nurse, four physicians, 42 nurses, six physician assistants, and 14 other staff members. The contextualized intervention program involved environmental modification, behavioral modification, and resource management. Sound level measurements were recorded at two-hour intervals over a week before the program\'s initiation, after the first cycle, and following the installation of central monitor screens. Data analysis utilized SPSS 25, employing percentile calculations, one-way analysis of variance, and Bonferroni tests. Results: The evaluations in the second level of NICU showed that the noise level recorded on weekday mornings and evenings was significantly lower for the third measurement compared to the first and second measurements. However, at the weekend the noise level recorded in the morning was higher in the second measurement than the first, with no significant difference found for the third measurement. The evaluations in the third level of NICU showed that on weekdays the noise level recorded in the third measurement was significantly lower than in the first and second measurements (p < .05). Conclusion: The implementation of a contextualized noise reduction program in our NICU led to significant improvements in noise levels, particularly during morning and evening shifts.

BACKGROUND: Total talus dislocation without ankle (malleoli) fracture is a very rare injury with prevalence of only 0.06% of all dislocations and only 2% of talar injuries, and are usually associated with common complications such as infection, avascular necrosis, and posttraumatic arthritis. The treatment usually involves debridement, reduction, stabilization of the ankle joint, and primary or secondary closure of the wound.
METHODS: We present the case of a 40-year-old South Asian woman who was involved in an accident. She was rushed to our hospital, whereby subsequent examination revealed an open total talus dislocation with the talus being exposed in its entirety from a contaminated wound in the medial side. Furthermore, radiograph confirmed total talus dislocation without concomitant malleoli fracture. She was immediately taken to the operating theater whereby debridement and immediate reduction was performed under anesthesia, and the ankle was stabilized with external fixator for about 6 weeks. She is now able to bear weight on the affected ankle with minimal tolerable pain and has normal range of motion of the ankle.
CONCLUSIONS: Open total talus dislocation without concomitant malleoli fracture is a rare injury. Reduction of the talus in combination with complete wound debridement potentially successfully avoids infection, provides early revascularization preventing avascular necrosis, and preserves the normal ankle anatomy.

OBJECTIVE: The current recommended treatment for patients with recurrent episodes of schizophrenia and related conditions is antipsychotic medication. However, many antipsychotic users remain functionally impaired and experience serious physical and mental side effects. This study aims to assess the cost-effectiveness of a gradual antipsychotic reduction and discontinuation strategy compared to maintenance treatment over 24 months from a mental health services, health and social care, and societal perspectives.
METHODS: Nineteen mental health trusts recruited patients to the RADAR randomised controlled trial. Quality adjusted life years (QALYs) were calculated from patient-reported EQ-5D-5L, with years of full capability (YFCs) calculated from the patient-reported ICECAP-A. Mental health services use and medication was collected from medical records. Other resource use and productivity loss was collected using self-completed questionnaires. Costs were calculated from published sources.
RESULTS: 253 participants were randomised: 126 assigned to antipsychotic dose reduction and 127 to maintenance. There were no significant differences between arms in total costs for any perspectives. There were no significant difference in QALYs (-0.035; 95% CI: -0.123 to 0.052), whereas YFCs were significantly lower in the reduction arm compared to the maintenance arm (baseline-adjusted difference: -0.103; 95% CI: -0.192 to -0.014). The reduction strategy was dominated by maintenance for all analyses and was not likely to be cost-effective.
CONCLUSIONS: It is unlikely that gradual antipsychotic reduction and discontinuation strategy is cost-effective compared with maintenance over two-years for patients with schizophrenia and other recurrent psychotic disorders who are on long-term antipsychotics.

UNASSIGNED: In LMICs, the nonoperative management of posterior elbow dislocation associated with radial head fracture is still a therapeutic option with favorable outcomes.
UNASSIGNED: Elbow dislocation associated with radial head fracture is a rare lesion. The occurrence of such a lesion requires high energy trauma. The restoration of joint and radial head fracture that allows early mobilization is the best guarantee of a good functional outcome. We report a case of posterior elbow dislocation associated with radial head fracture managed by closed reduction and 1 week cast immobilization in neutral prono-supination and 90°flexion followed by early mobilization was performed favorable functional outcome was obtained after 12 weeks. We review the different pattern of elbow dislocation and question the need of open reduction and internal fixation for displaced radial head fractures.

David Wallace\'s \'Dennett\'s Criterion\' plays a key part in establishing realist claims about the existence of a multiverse emerging from the mathematical formalism of quantum physics, even after decoherence is fully appreciated. Although the philosophical preconditions of this criterion are not neutral, they are rarely explicitly addressed conceptually. I tease apart three: (I) a rejection of conceptual bridge laws even in cases of inhomogeneous reduction; (II) a reliance on the pragmatic notion of usefulness to highlight quasi-classical patterns, as seen in a decoherence basis, over others; and (III) a structural realist or \'functional realist\' point of view that leads to individuating those patterns as real macroscopic objects at the coarse-grained level, as they are seen from the Classical Stance (analogous to Dennett\'s Intentional Stance). I conclude that the justification of Dennett\'s Criterion will be intimately tied up with the fate of strong forms of naturalism, and in particular that Wallacian quantum mechanics is a key case study for concretely evaluating his \'math-first\' structural realism (Wallace 2022).

Medial clavicle fractures and injuries to the sternoclavicular joint are rare injuries but can have life-threatening consequences. There are no standardized treatment algorithms or guidelines for the diagnostics and treatment. This article provides an overview of the individual topographies as well as the conservative and surgical treatment strategies.Conservative treatment is preferred for medial clavicle fractures. The indications for surgical treatment are variable but this is frequently carried out if there is a fracture displacement > 1 cm or 1 shaft width and high functional demands. In the case of accompanying injuries to neurovascular structures, an open fracture or the threat of perforation of the skin, surgical treatment is mandatory. Open reduction and internal fixation using (locking) plates is currently the preferred form of treatment.In the case of posterior dislocation of the sternoclavicular joint, an immediate closed reduction must be attempted with the patient under analgosedation and with emergency treatment on standby. This temporal urgency does not exist for anterior and superior dislocations. Surgical treatment is indicated in cases of unsuccessful reduction, persistent symptomatic instability or injuries of the neurovascular bundle. From a multitude of treatment options, arthrodesis with suture cerclage has shown good results. Tendon grafts as well as special hook plates are increasingly being used due to better biomechanical qualities. The surgical treatment of combined injuries is determined by the individual injury pattern.Despite the variety of treatment strategies, the long-term outcome has consistently been positively described.
UNASSIGNED: Mediale Klavikulafrakturen und Verletzungen des Sternoklavikulargelenks sind selten, können jedoch lebensbedrohliche Folgen haben. Standardisierte Behandlungsalgorithmen oder Leitlinien zu Diagnostik und Therapie existieren nicht. Dieser Beitrag gibt einen Überblick zu den einzelnen Topografien und ihrer sowohl operativen als auch konservativen Versorgung.Mediale Klavikulafrakturen werden überwiegend konservativ behandelt. Die Indikationsstellung zur operativen Versorgung variiert, erfolgt jedoch häufig bei Frakturdislokationen > 1 cm bzw. einer Schaftbreite und hohem funktionellen Anspruch. Absolute Versorgungsindikationen stellen begleitende Verletzungen neurovaskulärer Strukturen, offene Fraktur oder eine drohende Perforation der Haut dar. Bevorzugt wird mittlerweile die offene Reposition und interne Fixierung mithilfe der (winkelstabilen) Plattenosteosynthese.Bei posterioren Luxationen im Sternoklavikulargelenk muss eine geschlossene Reposition unter Analgosedierung/in Versorgungsbereitschaft unmittelbar versucht werden. Diese zeitliche Dringlichkeit besteht nicht bei anterioren oder superioren Luxationen. Eine operative Therapie ist bei frustraner Reposition, anhaltender symptomatischer Instabilität oder bei Verletzungen des neurovaskulären Bündels indiziert. Aus mannigfaltigen Versorgungsoptionen hat sich die Arthrodese mit Faden-Cerclagen bewährt. Aufgrund besserer biologischer Eigenschaften werden zunehmend Sehnentransplantate verwendet. Bei Kombinationsverletzungen wird das operative Verfahren durch die einzelnen Verletzungsmuster festgelegt.Trotz der Vielseitigkeit der therapeutischen Strategien wird das langfristige Outcome durchweg positiv beschrieben.

In this paper, a versatile heterogeneous nanocatalyst was fabricated employing a self-assembly technique. To commence, Fe3O4 MNPs were coated with a thin layer of SiO2 using the stobbers method. Subsequently, the surface was further functionalized with 3-CPMS, followed by a reaction with a Schiff base. Finally, nickel NPs were deposited on the surface through in situ deposition, forming the Fe3O4@SiO2@3-CPMS@L-Ni magnetic nanocatalyst. The architecture of this magnetic nanocatalyst was meticulously characterized through an array of sophisticated techniques: XRD, FT-IR, SEM, TEM, BET and VSM. The XRD diffraction pattern confirmed the presence of Fe3O4 MNPs, SiO2, and Ni peaks, providing evidence for successful synthesis. Moreover, the successful functionalization with a Schiff base was demonstrated by the presence of an azomethane peak in the FTIR spectra of the synthesized nanocatalyst. The fabricated nanocatalyst was adeptly utilized for the reduction of 4-NP, NB, and MO demonstrating a remarkably elevated rate of catalytic efficacy. Moreover, this catalyst was effortlessly retrievable through the application of an external magnet, and it maintained its catalytic prowess across at least six consecutive cycles. The utilization of water as an environmentally friendly solvent, coupled with the utilization of abundant and cost-effective nickel catalyst instead of the costly Pd or Pt catalysts, along with the successful recovery and scalability of the catalyst, render this method highly advantageous from both environmental and economic perspectives for the reduction of 4-NP, NB, and MO.

The reduction of nitrobenzene to aniline is very important for both pollution control and chemical synthesis. Nevertheless, difficulties still remain in developing a catalytic system having high efficiency and selectivity for the production of aniline. Herein, it was found that PdO nanoparticles highly dispersed on TiO2 support (PdO/TiO2) functioned as a highly efficient catalyst for the reduction of nitrobenzene in the presence of NaBH4. Under favorable conditions, 95% of the added nitrobenzene (1 mmol/L) was reduced within 1 min with an ultra-low apparent activation energy of 10.8 kJ/mol by using 0.5%PdO/TiO2 as catalysts and 2 mmol/L of NaBH4 as reductants, and the selectivity to aniline even reached up to 98%. The active hydrogen species were perceived as dominant species during the hydrogenation of nitrobenzene by the results of isotope labeling experiments and ESR spectroscopic. A mechanism was proposed as follows: PdO activates the nitro groups and leads to in-situ generation of Pd, and the generated Pd acts as the reduction sites to produce active hydrogen species. In this catalytic system, nitrobenzene prefers to be adsorbed on the PdO nanoparticles of the PdO/TiO2 composite. Subsequently, the addition of NaBH4 results in in-situ generation of a Pd/PdO/TiO2 composite from the PdO/TiO2 composite, and the Pd nanoclusters would activate NaBH4 to generate active hydrogen species to attack the adsorbed nitro groups. This work will open up a new approach for the catalytic transfer hydrogenation of nitrobenzene to aniline in green chemistry.

BACKGROUND: Frequent premature ventricular contractions (PVCs) in children are usually considered benign. Symptoms and/or left ventricular dysfunction are indications for treatment with anti-arrhythmic drugs (AAD).
OBJECTIVE: To evaluate the efficacy of flecainide versus metoprolol in reducing PVCs in children.
METHODS: A randomized open label cross-over trial children with a PVC-burden of >15% on Holter; successively treated with metoprolol and flecainide or vice versa, with a drug free interval of at least two weeks. Holter measurements were repeated before and after the start of the AAD.
RESULTS: Sixty patients were screened, 19 patients could be included. Median age was 13.9 years (IQR 5.5 years). Mean baseline PVC-burden was 21.7% (N=18, SD±14.0) before the start of flecainide and 21.2% (N=17, SD±11.5) before the start of metoprolol. In a mixed model analysis the estimated mean reduction in PVC-burden was 10.6 percentage-points (95%-CI 5.8-15.3) for flecainide and 2.4 percentage-points (95%-CI -2.7-7.5) for metoprolol, with a significant difference of 8.2 percentage-points (95%-CI of 0.86-15.46, P=0.031). Exploratory analysis revealed that 9/18 patients treated with flecainide and 1/17 patients treated with metoprolol, had a reduction to a PVC-burden below 5%. No discriminating factors between flecainide-responders and non-responders were found; the mean plasma level was not significantly different (0.34 mg/L versus 0.52 mg/L, P=0.277).
CONCLUSIONS: In children with frequent PVCs flecainide led to a significant greater reduction of PVC-burden, compared to metoprolol. Flecainide was effective in only a subgroup of patients, which appears to be unrelated to the plasma level. (Dutch Trial Register number 26689).