Objective: To find out which surgical approach, optimize the functional outcomes and reduce the risk of complications in terrible triad of elbow. Methods: Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had terrible triad of elbow (TTIE) that compared lateral approach (LA) with combined lateral and Anteromedial approach (CML), and were published in English. Outcomes of interest were functional outcomes, complications, and operative time. Results: Four studies, involving 470 patients were included in the systematic review. Mean follow up after surgery was typically 24 to 30 months. We found significant more range of motion (ROM) of elbow in CML as compared to LA group (MD:-14. 21, 95% CI:-21. 13 to-7. 29, p<0. 00001). There was significant more forearm rotation in CML as compared to LA group (MD:-18. 88, 95% CI:-32. 35 to-5. 40, p<0. 00001). Mayo elbow performance score (MEPS) was significantly more in CML (MD:-3. 31, 95% CI:-7. 23 to 0. 62, p=0. 00001). Blood loss, operative time, VAS and complications were more in CML group; however, the difference was not significant. The heterogeneity of the study and synthesizing retrospective data were the primary limitations. Conclusion: Our analysis demonstrated that combined lateral and medial approach had significantly more elbow ROM and forearm rotation. The combined approach also had significantly more MEPS. However, using combined approach significantly increased the operative time.

Background: This study aimed to compare a new posteromedial approach with a conventional Anteromedial approach to treat extra-articular distal tibia fractures. Method: Thirty-two patients underwent distal tibia fracture surgery. The patients were divided into two groups (Anteromedial: n=17 and posteromedial: n=15) and followed for one year. approaches were compared regarding their union time, American Orthopedics Foot and Ankle Society (AOFAS) score, and complications. Results: AOFAS score was 87. 3 ±,3. 1 and 88. 5 ±,2. 8 in Anteromedial and posteromedial groups, respectively, and there was no statistically significant difference (P-value = 0. 282). The union time was 6. 1 ±,3. 8 months and 6. 4 ±,3. 1 months in the groups, which was not statistically significant (P-value = 0. 807). The prevalence of non-union and delayed union was not significantly different between the two groups (p-value = 0. 99). Conclusion: The modified posteromedial approach is a safe and feasible alternative surgical method for distal tibia extra-articular fractures.

Dear Editor, We read with great interest the article "Lateral approach versus combined lateral and Anteromedial approach for surgical treatment of terrible triad of the elbow: A meta-analysis" by Meena et al., [1]. They carried out this metaanalysis to find out the functional outcomes and the risk of complications in the terrible triad of elbow (TTIE) treated by two different approaches. They concluded that combined lateral and medial approach (CML) had significantly more elbow range of motion (ROM), forearm rotation, higher mayo elbow performance score (MEPS) but at the cost of significantly increased the operative time. . .

Education is a continually developing activity, it shapes the way an individual develops their attitudes, thoughts and behavior. Education is not just about being literate but it is an overall development of the person in every aspect of their lives. A society's educational system can be greatly linked to its culture as the culture that one is in have an affect on the type of curriculum the institutions will develop in order to cater to every individual of that particular culture. Education moulds and shapes a society and it is influenced by the culture of the particular country or society. The educational system acts as a point of reference for the society's needs and demands. The principles that dominate this article is culture and education are interrelated and interconnected. Every educational paradigm is influenced by the culture of the society in which it operates. This essay underlines the extensive connection between culture and education. As a result, the goal of this essay is to depict these features from a Philosophical-Psychological approach.

Dear Editor, We would like to thanks the readers of the Bulletin of Emergency And Trauma (BEAT) for their valuable comments regarding our recently published article. We appreciate their interest in our article [1]. We acknowledge the heterogonous nature of studies included in the analysis and this was duly mentioned in the manuscript. This is one of the limitations of the present meta-analysis. The readers rightly pointed that a discrepancy in the conclusion and forest plot diagrammatic representation. We take this opportunity to correct it. . .

Background and Objectives: Total hip arthroplasty (THA) is the main modality for the treatment of femoral neck fractures, but the traditional surgical approach has certain safety risks, and finding a more effective surgical approach can help to improve the outcome of THA for femoral neck fractures. In this study, we compared the clinical efficacy of THA through the direct anterior approach (DAA) and the Anteromedial approach (AMA) in the treatment of femoral neck fractures to provide a clinical reference. Methods: From August 2020 to February 2023, 120 patients with femoral neck fractures who underwent THA were randomized into DAA group and AMA group with the procedure performed through DAA and AMA, respectively. The surgical conditions and postoperative complications of the two groups were counted. Pain assessment was made using the Visual Analogue Scale (VAS), and hypersensitive C-reactive protein (hs-CRP) and creatine kinase (CK) levels were measured. Patients’ prognoses were followed up for 6 months, and their range of motion (ROM) of the hip joint was measured. Results: DAA and AMA groups were not statistically different in the incidence of complications (P>0. 05),the incision length, intraoperative bleeding, postoperative drainage volume, and hospital stay were lower in DAA group compared with AMA group, while the operation time was longer (Ps<0. 05),DAA group had lower postoperative hs-CRP and CK levels and milder pain than AMA group (P<0. 05). Prognostic follow-up showed no difference in ROM and imaging findings between the two groups (P>0. 05). Conclusion: Compared with AMA-THA, DAA-THA for femoral neck fractures is less traumatic and contributes to faster postoperative rehabilitation and less pain and stress inflammation.

Artifacts are ubiquitous and influential in our world, but their nature and existence are controversial. Several theories have been proposed to explain the ontology of artifacts. Drawing on Popper's theory of three worlds, this paper suggests a metaphysics for artifacts along the line of a critical rationalist (CR) approach. This theory distinguishes between three realms of reality: the physical world (World 1), the mental world (World 2), and the world of objective knowledge (World 3). The paper argues that artifacts have different ontological components that correspond to these three realms, and that each component is real and causal. The paper shows how this perspective can account for the intentional and functional aspects of artifacts, as well as their dependence on plans that influence different realms of reality. The paper explains how this pluralistic ontology, compared to the rival theories, enables one to explain the relevant ontological problems of artifacts. The paper also explores how this proposal can lead to a research program encompassing a broader range of technologies, such as social artifacts. In sum, the paper suggests that Popper's three worlds theory provides a rich and comprehensive framework for understanding the metaphysics of artifacts.

Distributed Denial of Service (DDoS) attacks are among the primary concerns in internet security today. Machine learning can be exploited to detect such attacks. In this paper, a multi-layer perceptron model is proposed and implemented using deep machine learning to distinguish between malicious and normal traffic based on their behavioral patterns. The proposed model is trained and tested using the CICDDoS2019 dataset. To remove irrelevant and redundant data from the dataset and increase learning accuracy, feature selection is used to select and extract the most effective features that allow us to detect these attacks. Moreover, we use the grid search algorithm to acquire optimum values of the model’s hyperparameters among the parameters’ space. In addition, the sensitivity of accuracy of the model to variations of an input parameter is analyzed. Finally, the effectiveness of the presented model is validated in comparison with some state-of-the-art works.

The problem of personal identity among others may stem from the following question—what does be the person that you are, from one day to the next, necessarily consist of? The diachronic problem of personal identity raises question on the necessary and sufficient conditions for the identity of the person over time. The synchronic problem is grounded in the question of what features or traits characterize a given person at one time. To answer these questions, John Locke discarded the soul and the body as necessary and sufficient substances for personal identity over time. He accepted consciousness as the only criterion for personal identity; the only thing capable of remaining the same and preserving personal identity through change. Though Locke’s argument is somewhat clear and coherent but what remains vague and incoherent is embedded in the question—what exactly is consciousness? How and why should it be the basis or criterion for the determination of personal identity? Using the method of critical analysis, I argue that Locke’s choice of consciousness as the determinant of personal identity, though quite novel, is incoherent and vague. Secondly, Locke had already presumed and anticipated clearly though fallaciously the very thing he wishes to substantiate. I therefore conclude that Locke’s argument is just another way of trying to escape but inadvertently prolonging the difficulty of apparently articulating a distinction between the psychological approach and physiological approach to the problem of personal identity. However, in my submission, I propose the concept of the “other” as alternative approach— a sort of an extrinsic-intrinsic approach to the problem of personal identity.