bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection
Authors: Bresee Lauren C. , Lamont Nicole , Ocampo Wrechelle , Holroyd-Leduc Jayna , Sabuda Deana , Leal Jenine , Dalton Bruce , Kaufman Jaime , Missaghi Bayan , Kim Joseph , Larios Oscar E. , Henderson Elizabeth , Raman Maitreyi , Fletcher Jared R. , Faris Peter , Kraft Scott , Shen Ye , Louie Thomas , Conly John M.
Published: December 2023

Background

Clostridioides difficileinfection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +).

Methods

We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilusCL1285®,L. caseiLBC80R® andL. rhamnosusCLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research.

Results

A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals.

Conclusions

Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
Online information-seeking behavior of Iranian web users on Google about Henoch–Schönlein purpura (HSP): an infodemiology study
Authors: Javadi Vadood , Kamfar Sharareh , Zeinali Vahide , Rahmani Khosro , Moghaddamemami Foroughossadat Hosseini
Published: December 2023

Backgrounds

: Previous studies have indicated that users’ health information-seeking behavior can serve as a reflection of current health issues within a community. This study aimed to investigate the online information-seeking behavior of Iranian web users on Google about Henoch–Schönlein purpura (HSP).

Methods

Google Trends (GTr) was utilized to collect big data from the internet searches conducted by Iranian web users. A focus group discussion was employed to identify users’ selected keywords when searching for HSP. Additionally, keywords related to the disease’s symptoms were selected based on recent clinical studies. All keywords were queried in GTr from January 1, 2012 to October 30, 2022. The outputs were saved in an Excel format and analyzed using SPSS.

Results

The highest and lowest search rates of HSP were recorded in winter and summer, respectively. There was a significant positive correlation between HSP search rates and the terms “joint pain” (P = 0.007), “vomiting” (P = 0.032), “hands and feet swelling” (P = 0.041) and “seizure” (P < 0.001).

Conclusion

The findings were in accordance with clinical facts about HSP, such as its seasonal pattern and accompanying symptoms. It appears that the information-seeking behavior of Iranian users regarding HSP can provide valuable insights into the outbreak of this disease in Iran.
“Diving in the deep-end and swimming”: a mixed methods study using normalization process theory to evaluate a learning collaborative approach for the implementation of palliative care practices in hemodialysis centers
Authors: Holdsworth Laura M. , Stedman Margaret , Gustafsson Erika Saliba , Han Jialin , Asch Steven M. , Harbert Glenda , Lorenz Karl A. , Lupu Dale E. , Malcolm Elizabeth , Moss Alvin H. , Nicklas Amanda , Kurella Tamura Manjula
Published: December 2023

Background

Normalization Process Theory (NPT) is an implementation theory that can be used to explain how and why implementation strategies work or not in particular circumstances. We used it to understand the mechanisms that lead to the adoption and routinization of palliative care within hemodialysis centers.

Methods

We employed a longitudinal, mixed methods approach to comprehensively evaluate the implementation of palliative care practices among ten hemodialysis centers participating in an Institute for Healthcare Improvement Breakthrough- Series learning collaborative. Qualitative methods included longitudinal observations of collaborative activities, and interviews with implementers at the end of the study. We used an inductive and deductive approach to thematic analysis informed by NPT constructs (coherence, cognitive participation, collective action, reflexive monitoring) and implementation outcomes. The NoMAD survey, which measures NPT constructs, was completed by implementers at each hemodialysis center during early and late implementation.

Results

The four mechanisms posited in NPT had a dynamic and layered relationship during the implementation process. Collaborative participants participated because they believed in the value and legitimacy of palliative care for patients receiving hemodialysis and thus had high levels of cognitive participation at the start. Didactic Learning Sessions were important for building practice coherence, and sense-making was solidified through testing new skills in practice and first-hand observation during coaching visits by an expert. Collective action was hampered by limited time among team members and practical issues such as arranging meetings with patients. Reflexive monitoring of the positive benefit to patient and family experiences was key in shifting mindsets from disease-centric towards a patient-centered model of care. NoMAD survey scores showed modest improvement over time, with collective action having the lowest scores.

Conclusions

NPT was a useful framework for understanding the implementation of palliative care practices within hemodialysis centers. We found a nonlinear relationship among the mechanisms which is reflected in our model of implementation of palliative care practices through a learning collaborative. These findings suggest that the implementation of complex practices such as palliative care may be more successful through iterative learning and practice opportunities as the mechanisms for change are layered and mutually reinforcing.

Trial registration

ClinicalTrials.gov, NCT04125537. Registered 14 October 2019 – Retrospectively registered.
Assessment of Plasmodium falciparum drug resistance associated molecular markers in Mandla, Madhya Pradesh, India
Authors: Singh Akansha , Singh Mrigendra P. , Ali Nazia Anwar , Poriya Rajan , Rajvanshi Harsh , Nisar Sekh , Bhandari Sneha , Sahu Ram S. , Jayswar Himanshu , Mishra Ashok K. , Das Aparup , Kaur Harpreet , Anvikar Anup R. , Escalante Ananias A , Lal Altaf A. , Bharti Praveen K.
Published: December 2023

Background

Resistance against artemisinin-based combination therapy is one of the challenges to malaria control and elimination globally. Mutations in different genes (Pfdhfr, Pfdhps, Pfk-13 and Pfmdr1) confer resistance to artesunate and sulfadoxine–pyrimethamine (AS + SP) were analysed from Mandla district, Madhya Pradesh, to assess the effectiveness of the current treatment regimen against uncomplicated Plasmodium falciparum.

Methods

Dried blood spots were collected during the active fever survey and mass screening and treatment activities as part of the Malaria Elimination Demonstration Project (MEDP) from 2019 to 2020. Isolated DNA samples were used to amplify the Pfdhfr, Pfdhps, Pfk13 and Pfmdr1 genes using nested PCR and sequenced for mutation analysis using the Sanger sequencing method.

Results

A total of 393 samples were subjected to PCR amplification, sequencing and sequence analysis; 199, 215, 235, and 141 samples were successfully sequenced for Pfdhfr, Pfdhps, Pfk13, Pfmdr1, respectively. Analysis revealed that the 53.3% double mutation (C59R, S108N) in Pfdhfr, 89.3% single mutation (G437A) in Pfdhps, 13.5% single mutants (N86Y), and 51.1% synonymous mutations in Pfmdr1 in the study area. Five different non-synonymous and two synonymous point mutations found in Pfk13, which were not associated to artemisinin resistance.

Conclusion

The study has found that mutations linked to SP resistance are increasing in frequency, which may reduce the effectiveness of this drug as a future partner in artemisinin-based combinations. No evidence of mutations linked to artemisinin resistance in Pfk13 was found, suggesting that parasites are sensitive to artemisinin derivatives in the study area. These findings are a baseline for routine molecular surveillance to proactively identify the emergence and spread of artemisinin-resistant parasites.
Socioeconomic inequality in unmet outpatient healthcare needs among people living in urban informal settlements in Sanandaj city, Iran
Authors: Piroozi Bakhtiar , Safari Hossein , Bolbanabad Amjad Mohamadi , Moradi Ghobad , Zarezadeh Yadolah , Shokri Azad , Moradpour Farhad
Published: December 2023

Background

The growing trend of informal settlements is a serious humanitarian crisis. Unmet need for health care services is an indicator to measure the state of equality and access to healthcare services. This study, for the first time in Iran, examined the prevalence of unmet needs for outpatient healthcare services and related socioeconomic inequalities among residents of informal settlements in Sanandaj city.

Methods

This cross-sectional study was conducted on informal settlements of Sanandaj city with a sample size of 1345 people. Data were collected using a questionnaire. Multivariate logistic regression was used to determine significant predictors of unmet needs for healthcare services. Concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of unmet needs for healthcare services.

Results

The prevalence of unmet needs for outpatient healthcare services was 31.7%. Financial and physical barriers were the most common reasons for not using the needed services. The highest unmet need was related to dental (80.6%) and rehabilitation services (78.8%). Being elderly with about 2.3 times (OR: 2.37, 95% CI: 1.19–4.75), not having a job with about 1.7 times (OR: 1.70, 95% CI: 1.13–2.57) and having a low economic status with about 4 times (OR: 4.46, 95% CI: 2.39–9.70) increased the odds of experiencing unmet need for outpatient healthcare services. The value of concentration index showed that unmet need for outpatient healthcare services was significantly concentrated among people with lower economic status (C= -0.330, 95% CI: -0.432 to -0.227).

Conclusion

The unmet need is high among people living in informal settlements of Sanandaj city and a significant part of the residents of these settlements does not have access to required healthcare services. Regardless of the needs of people living in these settlements, who constitute a large population of Iran, access to universal health coverage is not possible in such areas. Removing the identified obstacles and causes behind the unmet needs requires the interdisciplinary participation of all actors, including the government, the nation, and civil society.
The comprehensive study on the role of POSTN in fetal congenital heart disease and clinical applications
Authors: Xia Yi , Chen Liang , Lu JinWen , Ma Jianhong , Zhang Yuanzhen
Published: December 2023

Background

Congenital heart defect (CHD) is the most common congenital abnormality, and it has long been a clinical and public health concern. Our previous findings have found Periostin (POSTN) and Pappalysin-1 (PAPPA) as potential biomarkers for fetal CHD. We aim to further elucidate POSTN's role in fetal heart development and explore the clinical applicability of POSTN and PAPPA as diagnostic marker for fetal CHD. This study is poised to establish a theoretical framework for mitigating the incidence of CHD and advance a novel approach for prenatal screening of fetal CHD.

Methods

We verified differential expression of POSTN and PAPPA in gravida serum and fetal amniotic fluid based on our previous research. We established the Postn knockout mouse by CRISPR/Cas9 to investigate whether Postn deletion leads to cardiac abnormalities in mice. Besides, we explored the mechanism of POSTN on heart development through Postn knockout mouse model and cell experiments. Finally, we established the logistic regression model and decision curve analysis to evaluate the clinical utility of POSTN and PAPPA in fetal CHD.

Results

We observed a significant decrease in POSTN and increase in PAPPA in the CHD group. Atrial septal defects occurred in Postn−/− and Postn± C57BL/6 fetal heart, while ventricular septal defects with aortic saddle were observed in Postn± C57BL/6 fetal heart. Disruption of the extracellular matrix (ECM) in cardiomyocytes and multiple abnormalities in cellular sub-organelles were observed in Postn knockout mice. POSTN may positively regulate cell behaviors and unsettle ECM via the TGFβ-Smad2/3 signaling pathway. The combination of serum biomarkers POSTN and PAPPA with Echocardiogram can enhance the diagnostic accuracy of CHD. Furthermore, the comprehensive model including POSTN, PAPPA, and two clinical indicators (NT and age) exhibits significantly higher predictive ability than the diagnosis group without the use of serum biomarkers or clinical indicators.

Conclusions

It is the first evidence that Postn deletion leads to cardiac developmental abnormalities in fetal mice. This may involve the regulation of the TGFβ signaling pathway. Importantly, POSTN and PAPPA possess clinical utility as noninvasive prenatal promising screening indicators of CHD.
Ethnomedicinal plants in Champadevi rural municipality, Okhaldhunga district, Nepal
Authors: Karki Deepa , Khadka Dipak , Kunwar Ripu Mardhan , Aryal Prakash Chandra , Paudel Hem Raj , Bhatta Sijar , Shi Shi
Published: December 2023

Background

Okhaldhunga is a hilly district with fragile socioeconomic conditions, limited access to health care, social stigma, and poor resource management, where most people rely on medicinal plants for primary health care. The use of medicinal plants for primary health care varies with socioeconomic attributes. Following the intra-cultural analysis, we documented and tested the hypothesis that use of medicinal plants in Champadevi, Okhaldhunga, Nepal, depends on socioeconomic variables.

Methods

We interviewed 224 respondents, 53.12% female and 46.88% male, including 31 Brahmin, 157 Chhetri, 13 Dalit, and 23 Janajati, and conducted three focused group discussions and seven key informant interviews to record the ethnomedicinal plants used in Champadevi rural municipality, Okhaldhunga District. The relative frequency of citation (RFC) was computed to know the importance of the species. A generalized linear model (GLM) was used to see the relationship between medicinal plants reported with the sociocultural variables, which include age, gender, occupation, education, ethnicity, and religion.

Results

We documented 149 medicinal plants, including 69 herbs, 22 shrubs, nine climbers, 48 trees, and one parasitic plant, belonging to 68 families and 130 genera, and used to treat 48 distinct diseases and ailments. Plant parts, leaf, and digestive disorders were frequently treated during healing. Curcuma angustifolia was the most cited species with RFC 0.9554. The respondents' knowledge of medicinal plant use varied significantly with age (p = 0.0001) and occupation (p = 0.003). Changes in land use, population decline of medicinal plant species, and unsustainable harvesting practices constituted the local threats to medicinal plants and associated knowledge. Elders died without passing on their knowledge to the younger generations during sociocultural transformation, and youth disinterest coupled with the free availability of allopathic medicine led to knowledge erosion.

Conclusions

The use of medicinal plants in Champadevi, Okhaldhunga, was significantly depended on two socioeconomic variables age and occupation. Ethnomedicinal plants are essential in the primary healthcare system in Nepal; however, their availability and practices are declining. Thus, plans regulating land use change and human migration, acknowledging traditional healthcare practices, and raising awareness of the significance of traditional medical practices as complementary healthcare practices should be strengthened.
Response to febuxostat according to clinical subtypes of hyperuricemia: a prospective cohort study in primary gout
Authors: Qi Han , Sun Mingshu , Terkeltaub Robert , Xue Xiaomei , Li Xinde , Cui Lingling , He Yuwei , Yan Fei , Sun Ruixia , Chen Ying , Jia Zhaotong , Cheng Xiaoyu , Ma Lidan , Liu Tian , Dalbeth Nicola , Li Changgui
Published: December 2023

Background

While xanthine oxidase inhibitors target uric acid production, renal urate underexcretion is the predominant subtypes in gout. This study was to compare treatment response to the XOI febuxostat in a gout cohort according to clinical subtypes of hyperuricemia.

Methods

A prospective cohort study was conducted to compare the efficacy and safety of febuxostat (initially 20 mg daily, escalating to 40 mg daily if not at target) in 644 gout patients with the three major clinical subtypes for 12 weeks. Hyperuricemia was defined as the renal overload subtype, the renal underexcretion subtype, or the combined subtype based on UUE > or ≤ 600 mg/d/1.73 m2 and FEUA < or ≥ 5.5%. The primary endpoint was the rate of achieving serum urate (SU) < 6 mg/dL at week 12.

Results

Fewer participants with combined subtype achieved the SU target, 45.5% compared with 64.8% with overload subtype (P = 0.007), and 56.6% with underexcretion subtype (P = 0.022). More participants with combined subtype (82%) had febuxostat escalated to 40 mg than those with overload (62%, P = 0.001) or underexcretion subtype (68%, P = 0.001). In all participants, combined subtype hyperuricemia (OR = 0.64, 95%CI 0.41–0.99, P = 0.048) and baseline SU (OR = 0.74, 95%CI 0.62–0.89, P = 0.001) were independently associated with lower rates of achieving SU target.

Conclusions

People with combined subtype have a lower response to febuxostat, compared to those with either overload or underexcretion subtype. Assessment of hyperuricemia subtype may provide useful clinical data in predicting febuxostat response.
Harnessing stem cell and lineage reprogramming technology to treat cardiac fibrosis
Authors: Zeng Ni , Tang Wei , Wu Yanghong , Fan Hang , Xie Shuanglun , Cao Nan
Published: December 2023

Cardiac fibrosis is a pathological response characterized by excessive deposition of fibrous connective tissue within the heart. It typically occurs following cardiac injuries or diseases. However, the lack of suitable models for disease modeling and high-throughput drug discovery has hindered the establishment of an effective treatments for cardiac fibrosis. The emergence and rapid progress of stem-cell and lineage reprogramming technology offer an unprecedented opportunity to develop an improved humanized and patient-specific model for studying cardiac fibrosis, providing a platform for screening potential drugs and synchronously elucidating the underlying molecular mechanisms. Furthermore, reprogramming cardiac fibroblasts into cardiomyocyte-like cells to reduce scar volume and induce myocardial tissue regeneration is a promising approach in treating cardiac fibrosis. In this review, we summarize the current advancements in stem cell technologies applied to study cardiac fibrosis and provide insights for future investigations into its mechanisms, drug discovery as well as therapy method.
Nine years of development in establishing the journal as a learning and research hub in STEM education
Authors: Li Yeping
Published: December 2023

From August 2014 to July 2023, the International Journal of STEM Education went through nine publication cycle years. In this editorial, I provide a brief summary of the journal’s development up to and including its ninth publication cycle year (August 2022–July 2023), and share insights about the journal’s efforts in establishing itself as a worldwide learning and research hub for the broad STEM education community.
Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis
Authors: Klabbers Robin E. , Hughes Andrea , Dank Meredith , O’Laughlin Kelli N. , Rogers Mutaawe , Stoklosa Hanni
Published: December 2023

Background

Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces sustaining it need to be better understood among specific subpopulations. We aimed to explore risk and protective factors for human trafficking, the health impact of exploitation, and barriers and facilitators of seeking help throughout the human trafficking trajectory among forced labor and sex trafficking victims in Kampala, Uganda.

Methods

Between March and November 2020, in-depth, semi-structured qualitative interviews were conducted with 108 victims of forced labor and sex trafficking who had completed a human trafficking survey conducted by the Uganda Youth Development Link (UYDEL). Participants who experienced various forms of exploitation were purposively invited for qualitative interviews and a convenience sample was interviewed. Interviews explored personal history, trafficking recruitment, experiences of exploitation and abuse, and experiences seeking help. Interviews were analyzed using a combination of deductive and inductive thematic analysis. Themes and subthemes were organized using an adapted conceptual framework of human trafficking.

Results

Poverty and an abusive home life, frequently triggered by the death of a caretaker, underpinned vulnerability to human trafficking recruitment. Limited education, lack of social support, and survival needs pushed victims into exploitative situations. Victims of human trafficking were systematically exploited and exposed to dangerous working conditions. Victims suffered from sexually transmitted diseases, incontinence, traumatic fistulae, musculoskeletal injuries, and mental health symptoms. Lack of awareness of resources, fear of negative consequences, restrictions on movement, and dependence on the trafficker and exploitation income prevented victims from seeking help. The police and healthcare workers were the few professionals that they interacted with, but these interactions were oftentimes negative experiences.

Conclusions

To address and prevent human trafficking, localized interventions are needed at all stages of the human trafficking trajectory. Health impacts of human trafficking are severe. As some of the few professionals trafficking victims interact with, police and healthcare workers are important targets for anti-trafficking training. Improved understanding of human trafficking drivers and barriers and facilitators to seeking help can inform the design of necessary interventions.
Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021
Authors: Duer Emma , Yang Huiqin , Robinson Sophie , Grigore Bogdan , Sandercock Josie , Snowsill Tristan , Griffin Ed , Peters Jaime , Hyde Chris
Published: December 2023

Background

For people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality.

Methods

Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations.

A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analyses. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017, and then further extended to November 2021. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed.

Results

Nine RCTs, with up to 12.3 years of follow-up from randomisation, were included in the direct meta-analysis, which showed that LDCT screening was associated with a statistically significant decrease in lung cancer mortality (pooled relative risk (RR) 0.86, 95% confidence interval [CI] 0.77 to 0.96). There was a statistically non-significant decrease in all-cause mortality (pooled RR 0.98, 95% CI 0.95 to 1.01). The statistical heterogeneity for both outcomes was minimal. Network meta-analysis including the nine RCTs in the direct meta-analysis plus two further RCTs comparing CXR with usual care confirmed the size of the effect of LDCT on lung cancer mortality and that this was very similar irrespective of whether the comparator was usual care or CXR screening.

Conclusions

LDCT screening is effective in reducing lung cancer mortality in high-risk populations. The uncertainty of its effect on lung cancer mortality observed in 2018 has been much reduced with new trial results and updates to existing trials, emphasising the importance of updating systematic reviews. Although there are still a number of RCTs unreported or in progress, we predict that further evolution of summary mortality estimates is unlikely. The focus for debate now moves to resolving uncertainty about the cost-effectiveness of LDCT screening taking into account the balance between benefits and harms which occur in all screening programmes.
Adaptive feature extraction method for capsule endoscopy images
Authors: Wu Dingchang , Wang Yinghui , Ma Haomiao , Ai Lingyu , Yang Jinlong , Zhang Shaojie , Li Wei
Published: December 2023

The traditional feature-extraction method of oriented FAST and rotated BRIEF (ORB) detects image features based on a fixed threshold; however, ORB descriptors do not distinguish features well in capsule endoscopy images. Therefore, a new feature detector that uses a new method for setting thresholds, called the adaptive threshold FAST and FREAK in capsule endoscopy images (AFFCEI), is proposed. This method, first constructs an image pyramid and then calculates the thresholds of pixels based on the gray value contrast of all pixels in the local neighborhood of the image, to achieve adaptive image feature extraction in each layer of the pyramid. Subsequently, the features are expressed by the FREAK descriptor, which can enhance the discrimination of the features extracted from the stomach image. Finally, a refined matching is obtained by applying the grid-based motion statistics algorithm to the result of Hamming distance, whereby mismatches are rejected using the RANSAC algorithm. Compared with the ASIFT method, which previously had the best performance, the average running time of AFFCEI was 4/5 that of ASIFT, and the average matching score improved by 5% when tracking features in a moving capsule endoscope.
Spontaneous ping-pong fracture in a full-term neonate—a case report
Authors: Alhussin Walid , Susnerwala Sukena
Published: December 2023

Background

Non-traumatic depressed skull fracture in a neonate delivered by cesarean section is a rare phenomenon. The incidence reported in literature varies between 1 and 2.5 in every 10,000 live births. The skull is transformed from its normal convex shape to a more concave form due to easy malleability. This is secondary to the lack of complete ossification in the neonatal period. Hence, it is commonly known as ping-pong fracture. The clinical presentation may vary depending on the severity of the fracture and underlying parenchymal injury. Most cases reported in literature have been managed conservatively. However, surgical elevation and the use of medical devices may be advised in severe cases.

Case presentation

We report the presentation, course, and management of a term female neonate with a spontaneous ping-pong fracture. The neonate had no history suggestive of antenatal insult, difficult labor, or trauma due to instrumentation during delivery. The infant was thoroughly investigated for underlying parenchymal injury, observed for neurological abnormality, and managed conservatively.

Conclusion

Thus, ping-pong fractures or spontaneous neonatal skull fractures are rare but can be encountered in clinical practice. A thorough clinical examination and neurological assessment can aid management decisions.
Head and neck malignant lymphoma and squamous cell carcinoma discernment, is DWI conclusive?
Authors: Anis Dina Gameel , Amer Maha Eshak , Gerges Amany Saber , Kader Moustafa Abdel , Ragaee Sara Mahmoud
Published: December 2023

Background

Differentiation between head-and-neck malignant lymphoma and squamous cell carcinoma is crucial as their management is radically different, and this retrospective study aims at demonstrating the value of DWI-MRI for their discrimination. Forty-four patients with pathologically proved untreated head-and-neck ML and SCC (22 ML and 22 SCC) were included in the study, and they underwent conventional MRI imaging (T1WI and T2WI) with DW-MRIs at standard and high b-values with corresponding ADC maps which were generated along with a reference of the ADC values taken at the spinal cord and cerebrospinal fluid as an internal control. The sensitivity and specificity at the optimum cutoff point as well as the area under the receiver operating characteristic (ROC) curve were used for evaluation of diagnostic performance of DW-MRI at b 1000, b 1500, b 2000 s/mm2.

Results

The mean SCC ADC values were much higher than ML at standard (b 1000) and high b-values (b 1500 and b 2000). ROC curve analysis for the ADC values of SCC and ML at b 1000, b 1500 and b 2000 s/mm2 showed that the ADC cutoff values are > 0.83, > 0.75 and > 0.67 × 10−3 mm2/s, respectively, with diagnostic accuracy 95.5%.

Conclusions

As to sum up, we can safely say that we can fully rely on DWI MRI in differentiation between HNSCC and ML whether using standard or high b-values, as well as in discrimination of different histological grades of HNSCC as it revealed impressive results, which confer us to do without contrast in such cases.
Evaluation of smallholder farmers’ use of indigenous knowledge in Ethiopian avocado (Persea americana Mill.) production and fruit preference criteria
Authors: Sina Benta , Demissie Hewan , Rezene Yayis
Published: December 2023

Background

Avocado is a versatile fruit that has been farmed for its flavor, nutritional worth, and socioeconomic benefit in Ethiopia and other parts of the world. The purpose of the current study was to evaluate smallholder farmers’ indigenous knowledge of avocado production, harvesting, repinning, preference, management, and utilization in southern Ethiopia.

Methods

Data were collected from 295 avocado farmers using participatory research evaluation instruments and techniques. The descriptive statistics and the chi-square test were used to analyze the data.

Results

The results of this study demonstrated that smallholder farmers, who vary in age, education, and ethnicity, have a wealth of indigenous knowledge in the areas of production, fruit preference, postharvest handling, and avocado use. Based on their long-term experience in cultivating this crop, farmers determined the best avocado races using different fruit quality traits such as size, color, and appearance. The findings revealed that the three most preferred qualities that can influence consumers’ impressions while buying or consuming avocados were fruit size, skin color, and flesh taste. The findings also demonstrated a significant positive association between farmers’ age and the amount of seedlings they produced (Spearman’s rho, rs = 0.604, p < 0.01). Furthermore, our results showed that younger farmers with higher education grow improved avocado varieties but have less experience with seedlings production, indicating a decline in indigenous knowledge about growing seedlings, particularly among young and more educated people in the study areas.

Conclusion

Findings indicated a need for creating awareness for avocado farmers about modern agronomic practices through a participatory technique to expand avocado seedling farming for future use. The results from this study call for geneticists or researchers to conduct further research on the genes associated with the most essential qualities (e.g., fruit size, skin color, taste, etc.) chosen by avocado farmers or consumers to recommend them for future breeding purposes.
What Is the Role for Pediatric Endocrinologists in the Management of Skeletal Dysplasias?
Authors: Merchant Nadia , Polgreen Lynda E , Rosenfeld Ron G
Published: December 2023

Children with skeletal dysplasias have not been consistently managed by pediatric endocrinologists despite the recognized expertise of these practitioners in managing genetic growth disorders. Growth-altering treatments have broadened the role of the pediatric endocrinologist to manage and sometimes become primary coordinators for genetic disorders such as Turner syndrome and Prader-Willi syndrome. We illustrate how recent advances in understanding the pathophysiology of skeletal disorders and the development of targeted treatments provide an opportunity for pediatric endocrinologists to further expand their role in managing certain skeletal dysplasias, including achondroplasia.
Acute Dystonic Reaction After Propofol Administration: A Pediatric Case Report
Authors: Zhao Lucy , McCann Mary Ellen , Park Raymond Seungjoon , Pier Danielle Bennett , Bajic Dusica
Published: December 2023

We present a case of a 12-year-old female with a history of infantile spasms who developed a propofol-associated acute dystonic reaction after emergence from general anesthesia for foot surgery. Uniquely, the patient’s postoperative symptoms of an acute dystonic reaction were refractory to standard treatment with anticholinergics but were successfully treated with corticosteroids. The absence of any dystonic symptoms following subsequent foot surgery under general anesthesia without propofol supported a propofol-associated etiology. This case may contribute to a better understanding of the underlying mechanisms of propofol-associated acute dystonic reactions and adds a possible new treatment option.
MONITORING OF BOLTED JOINTS WITH ELECTRO- MECHANICAL IMPEDANCE SPECTRA AND ACOUSTO-ULTRASONICS
Authors: DREISBACH A.-L. , KRAEMER P. , FRITZEN C.-P.
Published: December 2023

Bolted connections are one of the most widely used types of joints in various fields of applications. Their functionality depends on the conservation of the preload in the bolt’s shaft, which implies the need to monitor it. This paper addresses a monitoring procedure of the preload. Therefore, two measurement techniques for the preload are compared: On one hand, a technique, which is based on Electro-Mechanical Impedance spectra, on the other hand, a technique, which is based on Acousto-Ultrasonics. Electro-Mechanical Impedance spectra are measured with the help of the Electro-Mechanical Impedance method. This method is deployed in a relative high frequency range and the resulting spectra represent the transfer function between the local excitation of the structure and its response. In the applied Acousto-Ultrasonics procedure a burst excitation is introduced into the bolt on its head and the response is measured in pitch-catch mode at the face side of its shaft. As both techniques make use of so-called piezoelectric wafer active sensors, three different types of these transducers were used in this study and have been compared. For the experiments, three bolts having a size of M72 × 380 are equipped with the required transducers. Subsequently, they are tightened stepwise with a custombuilt testing device for bolts. The several combinations of the measurement techniques and different types of piezoelectric wafer active sensors are then compared with focus on their sensitivity and variability. The most suitable combination in terms of preload monitoring is identified.
ON MEASURING MATERIAL CHANGES AT MOLTEN SALT REACTOR TEMPERATURES IN A THERMAL CONVECTION LOOP WITH GUIDED ULTRASOUND WAVES
Authors: SAXENA INSU FIESLER , PINT BRUCE , LISSENDEN CLIFF
Published: December 2023

Molten salt reactors (MSRs) for nuclear power generation contain liquid halide salts that may be highly corrosive at operating temperatures. The safety and economic viability of MSRs rely upon the continuous, in-situ characterization of the structural integrity of their conduits. Off-line nondestructive inspections of components are simply too expensive, making structural health monitoring in this harsh environment a critical technology. High-temperature capable transducers, such as fused silica optical fibers with a softening point of about 1600 °C, can be utilized to continuously monitor MSR containers. We are using a thermal convection loop (TCL) at Oak Ridge National Laboratory (ORNL) to develop structural diagnostic technology for continuous, autonomous in-situ monitoring of MSR conduits with corrosive molten salts. High temperature- and radiationresistant fused silica fiber optic sensors will measure the effects of chloride salt corrosion on alloy 600 tubing. Structural material changes in alloys containing the molten chloride salts will be measured via guided ultrasound waves in alloy tubes, detected by high-temperature capable fiber optic sensors. Distributed fiber optic sensors can localize structural changes with position-sensitive measures. The described tasks are: • launching guided wave modes at elevated temperatures in alloy 600 tubing in a thermal convection loop, and • detecting tube ultrasound responses at corrosion-prone locations in the TCL piping with fiber optic sensors. TCL studies at MSR operating temperatures could provide a basis for diagnostic systems that measure material changes in more complex structures.
VIRTUAL FREQUENCY DATA FUSION FOR LOCALIZATION OF MULTIPLE DAMAGES FROM BROADBAND LAMB WAVE VELOCITY FIELD
Authors: KANNUSAMY M. , SASMAL SAPTARSHI , KAPURIA SANTOSH
Published: December 2023

In this article, a new damage indicator called reciprocal root mean square (rRMS) index is proposed for the localization of multiple damages in plate-like structures from the velocity field of guided wave propagation measured using Scanning Laser Doppler Vibrometer (SLDV). The Lamb waves are induced by applying voltage excitation to piezoelectric patch transducers pasted on the top of the plate. It is found that the velocity field measurement from one narrowband pulse excitation of a given central frequency may not be adequate in identifying the locations of all damages. To overcome this difficulty, a new methodology is proposed for a combined damage index that fuses measurement data of different excitation frequencies. However, obtaining the velocity field data at multiple narrowband frequencies from SLDV required for frequency fusion can be tedious, time consuming and expensive. To address this issue, velocity fields at various narrowband frequencies are virtually derived by utilizing the one-time physical velocity field measurement from a broadband excitation. The efficacy of the proposed method for damage localization using frequency fusion is experimentally tested. It is found that the proposed technique using rRMS index and frequency fusion is able to localize multiple damages of different types with high sensitivity.
ENHANCING GUIDED-WAVE-BASED STRUCTURAL HEALTH MONITORING USING METAMATERIAL DEVICES DESIGNED BY TOPOLOGY OPTIMIZATION
Authors: LIU ZE , SHAN SHENGBO , CHENG LI
Published: December 2023

Lamb waves inside thin-walled structures have received extensive attention due to their great promise in applications such as structural health monitoring (SHM). Applications point at the common need for effective conditioning and manipulation of the wave propagation in terms of both frequency content and mode components. In this work, the concept of metamaterials is exploited to construct functional metadevices (MDs). The MDs are designed to deliver prescribed functionalities after they are surface-mounted onto a structure conveying Lamb waves. To this end, a unified inverse-design scheme based on topology optimization is proposed and applied to achieve multifold functions such as frequency filtering and single-mode transmission. Typical scenarios with different frequencies and modes are discussed. Functional MDs with broadband working frequencies are obtained by using the established design strategy. A representative MD with a finite number of unit cells is examined through finite element simulations. Numerical simulations show that, through wave modulation of the designed MD, Lamb waves located in pass bands can transmit through the MD, while the waves within bandgaps are prohibited to propagate by the MD, which agrees well with the predicted dispersion features. An experiment is finally carried out to confirm the prescribed wave manipulation functions of the designed MD from the SHM perspective, which is finally validated experimentally using a metal specimen containing local plasticized incipient damage. This work provides a universal approach for topologically customizing MDs for the precise and tactical control of Lamb wave propagation, especially for SHM applications.
DESIGN AND APPLICATION OF A STATISTICAL LEARNING METHODOLOGY TO REMOVE TEMPERATURE EFFECT ON STATIC SIGNALS FOR BRIDGE STRUCTURAL HEALTH MONITORING
Authors: BENEDETTI LORENZO , BONO FRANCESCO MORGAN , RADICIONI LUCA , BELLOLI MARCO
Published: December 2023

Infrastructures are essential for the development and flourishing of countries; in this context, bridges play an irreplaceable role as links for goods and people. Nowadays, their structural integrity is threatened by ageing and increased traffic loads: according to the American Society of Civil Engineering, 42% of US bridges are at least 50 years old. The extension of the problem requires the application of techniques for resource prioritization and effective interventions. Structural health monitoring (SHM) has emerged as a promising quantitative tool for ensuring infrastructural network resilience and optimizing maintenance. In particular, damage detection is crucial in preventing catastrophic failures and minimizing repair costs. However, the influence of exogenous factors on sensor signals often complicates the identification of damage, since they might hide the insurgence of structural anomalies. The problem is especially critical when dealing with early-stage damage, characterized by a small extension. Among such external variables, temperature, in particular, significantly disturbs SHM both on seasonal and daily levels. The latter is further exacerbated by the thermal inertia of bridges, which renders the structural behavior highly non-linear with respect to temperature and solar radiation. This study proposes a novel approach to enhance the identification capability of structural health monitoring systems by removing the temperature effect on static measures thanks to a statistical learning algorithm. In particular, signals from inclinometers and LVDTs collected for a year are considered for temperature influence removal. The method works according to a two-step process described in Figure 1. First, the seasonal dependence is removed; then, the daily influence of temperature and solar radiation is treated by exploiting a machine learning algorithm able to estimate the structural response delay caused by thermal inertia. The methodology herein presented is applied and tested on two railway bridges: a Warren truss steel bridge and a CACP bridge with simply-supported spans. In both case studies, the variability of the measured signals associated with temperature reduced substantially. Indeed, the correlation coefficients dropped close to zero, and the standard deviation of signals diminished by 80% on average. Moreover, the different structural characteristics of the two test cases proved the methodology effective and versatile, suitable for different typologies of bridges. The algorithm described in this work enhances the damage detection power of structural health monitoring systems and fits with the idea of SHM deployment on a larger scale, given its successful application to diverse structural archetypes.
OPERATIONAL HEALTH MONITORING OF BRIDGES USING BAYESIAN MODEL UPDATING AND COMPUTER VISION TECHNIQUES
Authors: MALEKGHAINI NILOOFAR , EBRAHIMIAN HAMED , GHAHARI FARID , SACHIDANANDAM VINAYAK , BOWERS MATTHEW , TACIROGLU ERTUGRUL
Published: December 2023

This study presents a new framework for operational health monitoring of bridges using computer vision and finite element (FE) model updating techniques. In this framework, the bridge acceleration responses and vehicle tracking data are obtained under operational conditions using accelerometers, regular traffic cameras and computer vision techniques. These data are synchronized and integrated with the initial FE model of the bridge through a FE model updating process to jointly estimate the dynamic load of tracked vehicles on the bridge and the unknown FE model parameters. The final estimates of FE model parameters reveal information regarding the location and extent of potential damage in the monitored bridge. This framework is first successfully verified in a numerically simulated environment and then validated using a real-world bridge subjected to traffic excitation due to passage of tri-axle dump trucks.