Charts For Use Research Articles

Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society.

The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.

Ground stability of ellipsoidal cavity due to pipeline defects

The problem of road-related sinkhole stability has long been one of the main safety concerns to pavement engineers. Collapse and blowout failures are two typical types of pipeline-related sinkhole failures. Although much research on sinkhole stability analyses can be found in the literature, most of them assume a simple circular or rectangular shape of a cavity. In this study, the problem of sinkhole stability in an ellipsoidal cavity is investigated under both blowout and collapse conditions using advanced finite element limit analysis with adaptive meshing in an axisymmetric condition. A dimensionless pressure ratio is defined to represent sinkhole stability that is a function of many design parameters such as depth ratio, elliptical shape ratio, and soil strength ratio. Selected results are compared with published solutions, and comprehensive solutions of the parametric study are presented in the form of charts for use by design engineers. The present study contributes to the understanding of sinkhole stability under an ellipsoidal cavity, and it should be of interest to the road engineering community.

Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart.

The use of inhaled corticosteroids (ICS) for the maintenance of bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD) is controversial. While some patients achieve clinical benefits, such as fewer exacerbations and improved symptoms, others do not, and some experience undesired side effects, such as pneumonia. Thus, we reviewed the evidence related to predictors of ICS therapy treatment response in patients with COPD. The first priority clinical markers when considering the efficacy of ICS are type 2 inflammatory biomarkers, followed by a history of suspected asthma and recurrent exacerbations. It is also necessary to consider any potential infection risk associated with ICS, and several risk factors for pneumonia when using ICS have been clarified in recent years. In this article, based on the evidence supporting the selection of ICS for COPD, we propose an ICS composite that can be added to the COPD (ICO) chart for use in clinical practice. The chart divided the type 2 biomarkers into three ranges and provided recommendations (recommend, consider, and against) by combining the history of suspected asthma, history of exacerbations, and risk of infection.

Comparison of smartphone application-based visual acuity with traditional visual acuity chart for use in tele-ophthalmology

PURPOSE:The aim of this study was to compare the visual acuity (VA) by smartphone-based applications – EyeChart and the Peek Acuity to the standard Snellen chart to explore the possibility of using them as an alternative in tele-ophthalmology in the current COVID-19 pandemic.MATERIALS AND METHODS:An analytical type of observational study was done on 360 eyes of 184 patients above 18 years of age. Patients with VA <6/60 and gross ocular pathology were excluded from the study. VA measured by these three methods was converted to logMAR scale for ease of statistical analysis. One-way analysis of variance with post Tukey HSD was used to compare the VA measured by these three methods.RESULTS:There was no statistically significant difference between VA measured using the smartphone-based apps (EyeChart and Peek Acuity) and the Snellen chart (F = 2.5411, P = 0.7925) in 360 eyes assessed. VA measured by Peek Acuity (P = 0.5225) was more comparable to Snellen chart than EyeChart (P = 0.4730). Intraclass correlation coefficient (ICC) demonstrated a strong positive correlation for EyeChart (ICC: 0.982, P < 0.001) and Peek Acuity (ICC: 0.980, P < 0.001) with Snellen chart. A Bland–Altman difference plot showed good limits of agreement for both EyeChart and Peek Acuity with Snellen chart. In subgroup analysis, VA measured by Peek Acuity was not statistically different from Snellen in any subgroups, but in EyeChart, it was statistically different in emmetropes.CONCLUSION:VA measured by smartphone apps (EyeChart and Peek Acuity) was comparable with traditional Snellen chart and can be used as an effective, reliable, and feasible alternative to assess VA in tele-ophthalmology.

Commemorating the Silver Anniversary of the International Association for the Study of Lung Cancer International Workshop on Intrathoracic Staging

Commemorating the Silver Anniversary of the International Association for the Study of Lung Cancer International Workshop on Intrathoracic Staging

Extended growth charts for Indian children

Abstract Objectives While growth charts depicting 7 percentile lines for height and weight are useful for healthcare workers and pediatricians, endocrinologists need indication-specific z score cutoffs to plan investigations and treatment. The current Indian charts do not offer lower percentile/z scores (−2.25, −2.5, and −3 z score) lines. Also, increasing prevalence of childhood overweight and obesity necessitates a quick screening of nutritional status without calculations while using the same growth chart. Our objectives were to produce extended and user-friendly growth charts for 0–18-year-old Indian children that depict −2.25, −2.5, and −3 z score height lines in addition to the standard 7 lines and to add a quick BMI assessment tool as an inset. Methods LMS values from IAP 2015 growth charts (5–18 years) and WHO 2006 MGRS charts (&lt;5 years) were used to generate −2.25, −2.5, and −3 z score height lines (1.2, 0.6, and 0.1 percentiles, respectively) from 0–18 year for boys and girls. These newly generated lines were added to standard 7 (3, 10, 25, 50, 75, 90, 97) percentile lines for height charts. In addition, modified BMI quick screening tool was incorporated as an inset. Results The extended height charts (with 10 lines), standard (7 lines) weight charts, and quick BMI assessment tool are presented in a single unified chart for use by endocrinologists. Conclusions These charts will help in defining specific height z score cutoffs as well as screen for overweight and obesity without any calculations in Asian Indian children.

Stability analysis of twin circular tunnels using shear strength reduction method

This paper investigates the face stability of twin circular tunnels horizontally aligned in cohesive undrained soil under plane strain conditions. The shear strength reduction method in the two-dimensional finite-element limit analysis programme is used to obtain rigorous upper and lower bounds of the factor of safety (FoS) for various depth ratios (C/D) and centre-to-centre spacing ratios (S/D) between the tunnels. Since the undrained shear strength is not a function of the mean normal stress, stability results are independent of loading directions. Therefore, the stability (in collapse or blowout) for this problem is well expressed by using Broms and Bennermarks’ original stability number N = (σs + γH − σt)/Su. The variations of the FoS have been presented for different combinations of stability numbers (N) and geometries (C/D and S/D). The FoS and the stability number results are compared and validated by using the finite-difference method as well as other existing solutions available in the literature. The results from this study are summarised in stability charts for use by designers and practising engineers.

Reference Curves of Birth Weight, Length, ‎and Head Circumference for Gestational Age in Iranian Singleton Births

Background: Growth charts have been used to record and evaluate an infant’s growth condition at birth and during infancy. The current study was undertaken to explore the anthropometric indices of growth in Iranian newborn infants to draw growth charts and compare them with charts in use. Methods: Data of singleton births was extracted from the Iranian national data centre ministry of health database between March 2014 and 2015. Newborns with ill conditions, stillbirth, congenital anomalies such as neural tube defects (NTDs), and multiple births were excluded. Our study included 1277169 singleton live births. Growth curves were created for boys (51.7) and girls (48.2) for birth weight, length, and head circumference. Smoothening of the curves was accomplished by using gamlss package under R.3.0.1 software. Results: The average GA was 38.5 ± 1 weeks. The average birth weight was 3242 ± 422 gram and 3125 ± 422 gram for boys and girls respectively. Length of body at birth was 50 ± 2.2 cm in boys and 49.5 ± 1.2 cm in girls and as for head circumference, the average was 35 ± 1.4 cm and 34.2 ± 2.3 cm respectively for studied boys and girls. Female newborns had lower weight, length and head circumference in comparison to male newborns. Conclusions: we observed differences between age-gender specific growth chart in Iranian newborn infants with Fenton growth chart that may be attributed to ethnicity, regional and socioeconomic factors, mother-fetus health and nutrition status during pregnancy. © 2018, Author(s).

Near-miss density map for safe navigation of ships

The purpose of the present study was to identify ship near-miss areas and determine the relative densities of the areas. The findings were used to develop a near-miss density map for safe ship navigation and the prevention of collision between passing ships. This study used big data of merchant vessel and fishing boat location for 1 year in 2014. The databases were interpolated using a time unit of seconds to extract near-misses between ships based on data for exactly the same time. Furthermore, to determine near-misses, the distance and time to closest point of approach were calculated for different pairs of approaching ships. The near-miss density of each grid of the map was depicted by means of the RGB color code. The concept was validated by using it to depict the distributions of actual collision accident locations that occurred in the southern coastal sea of Korea between 1997 and 2016. The highest near-miss area was found to be in the approach of Busan Port, where actual collision accidents also occurred most frequently. The results showed that 73.3% of the near-misses in the study area involved fishing boats. In addition, out of the 25 collisions that actually occurred in the study area in 2014, 19 (76.0%) were related to fishing boats, and this was reflected by the map developed in the present study. The findings of the study can be used to develop a special near-miss density nautical chart for use as a navigation safety material by deck officers. Such chart would facilitate the exercise of precaution in passing through dangerous areas.

Limited Documentation and Treatment Quality of Glycemic Inpatient Care in Relation to Structural Deficits of Heterogeneous Insulin Charts at a Large University Hospital.

Insulin charts represent a key component in the inpatient glycemic management process. The aim was to evaluate the quality of structure, documentation, and treatment of diabetic inpatient care to design a new standardized insulin chart for a large university hospital setting. Historically grown blank insulin charts in use at 39 general wards were collected and evaluated for quality structure features. Documentation and treatment quality were evaluated in a consecutive snapshot audit of filled-in charts. The primary end point was the percentage of charts with any medication error. Overall, 20 different blank insulin charts with variable designs and significant structural deficits were identified. A medication error occurred in 55% of the 102 audited filled-in insulin charts, consisting of prescription and management errors in 48% and 16%, respectively. Charts of insulin-treated patients had more medication errors relative to patients treated with oral medication (P < 0.01). Chart design did support neither clinical authorization of individual insulin prescription (10%), nor insulin administration confirmed by nurses' signature (25%), nor treatment of hypoglycemia (0%), which resulted in a reduced documentation and treatment quality in clinical practice 7%, 30%, 25%, respectively. A multitude of charts with variable design characteristics and structural deficits were in use across the inpatient wards. More than half of the inpatients had a chart displaying a medication error. Lack of structure quality features of the charts had an impact on documentation and treatment quality. Based on identified deficits and international standards, a new insulin chart was developed to overcome these quality hurdles.

Upper-bound solutions for face stability of circular tunnels in undrained clays

The aim of this paper is to determine the critical supporting pressure on the circular face of an advancing tunnel in undrained clay in which undrained strength increases linearly with depth. Based on the kinematic approach of limit analysis, a continuous velocity field with a toric envelope is adopted to yield upper bounds of the face pressure for both collapse and blow-out. Combining with a closed-form expression describing the overall velocity field, an optimisation procedure is carried out to find the lowest upper-bound solutions. The calculated results are presented in terms of a dimensionless coefficient N (called the stability number) and then stability charts for use are produced. Alternatively, an approximation formula is given to estimate easily the collapse and blow-out pressure in practice.

Updated birth weight centiles for England and Wales

ObjectivesConstruct updated birth weight-for-gestational age centile charts for use in the UK and compare these to the currently used UK-WHO charts.DesignSecondary analysis of national birth data.ParticipantsCentiles were constructed using 1...

Validation and diagnostic accuracy of predictive curves for age-associated longitudinal cognitive decline in older adults.

The Mini-Mental State Examination continues to be used frequently to screen for cognitive impairment in older adults, but it remains unclear how to interpret changes in its score over time to distinguish age-associated cognitive decline from an early degenerative process. We aimed to generate cognitive charts for use in clinical practice for longitudinal evaluation of age-associated cognitive decline. We used data from the Canadian Study of Health and Aging from 7569 participants aged 65 years or older who completed a Mini-Mental State Examination at baseline, and at 5 and 10 years later to develop a linear regression model for the Mini-Mental State Examination score as a function of age and education. Based on this model, we generated cognitive charts designed to optimize accuracy for distinguishing participants with dementia from healthy controls. We validated our model using a separate data set of 6501 participants from the National Alzheimer's Coordinating Center's Uniform Data Set. For baseline measurement, the cognitive charts had a sensitivity of 80% (95% confidence interval [CI] 75% to 84%) and a specificity of 89% (95% CI 88% to 90%) for distinguishing healthy controls from participants with dementia. Similar sensitivities and specificities were observed for a decline over time greater than 1 percentile zone from the first measurement. Results in the validation sample were comparable, albeit with lower sensitivities. Negative predictive value was 99%. Our innovative model, which factors in age and education, showed validity and diagnostic accuracy for determining whether older patients show abnormal performance on serial Mini-Mental State Examination measurements. Similar to growth curves used in pediatrics, cognitive charts allow longitudinal cognitive evaluation and enable prompt initiation of investigation and treatment when appropriate.

Development of a safe operation capability chart as the design basis of a rudder area

Ship owners now demand a new design approach for the rudder that considers detailed design information such as maneuverability and environmental loads etc. on a quantified basis. In this paper, we developed the concept of a safe operation capability chart for the design of a rudder area. The chart can be used as the basis of design considering the maneuverability and environmental loads. To confirm the applicability of the safe operation capability chart for use as the basis of design, four different rudders are assumed in this work. First, it is determined whether or not it is appropriate to design a rudder by applying a conventional design approach based on IMO maneuvering tests. The proposed concept is reviewed for use as the basis of the design by investigating the effect of rudder area on capability charts that are plotted according to the rudder under various environmental conditions.

User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site audit study.

To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated. Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required. Two-phase audit. Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice,retrospective and prospective chart audits were conducted (Phase 2; 2012). Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%-14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart. User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.

INTERGROWTH‐21st: a new paradigm for fetal growth in the 21stcentury

Key contentThere are currently more than 100 different population‐based and customised charts in use, hence definitions of small‐for‐gestational‐age (SGA) are inconsistent.Over 130 countries have adopted the World Health Organization Child Growth Standards. These standards recognise that all children can achieve similar growth if environment, nutrition and health are optimal.The INTERGROWTH‐21stProject was a large‐scale, multicountry study that measured fetal growth of babies in utero and at birth in mothers in whom environmental, social, medical and pregnancy conditions were optimal.International standards for fetal measurement and the assessment of newborn size at birth will enable continuity of measurement from the pregnancy to childhood.Learning objectivesUnderstand that 97% of variation in fetal growth is caused by factors unrelated to ethnicity.When conditions for growth are optimal, fetal growth is strikingly similar around the world.Ethical issuesConsider poor fetal growth as a human rights issue: what is the legacy for individuals and societies where undernutrition has occurred in the first 1000 days of life?Recognise that, as obstetricians, we have a duty to help the most disadvantaged. The practice of ‘customising’ for ethnicity could normalise suboptimal growth.

Settlement behavior of embankment on geosynthetic-encased stone column installed soft ground – A numerical investigation

This paper presents the results of a numerical investigation into the settlement behavior of embankment constructed on geosynthetic-encased stone column installed in soft ground. A three-dimensional finite element model was employed to carry out a parametric study on a number of governing factors such as the thickness and consistency of soft ground, the geosynthetic encasement length and stiffness, the embankment fill height, and the area replacement ratio. It is shown among other things that unlike an isolated geosynthetic-encased stone column, full encasement of stone column is necessary to minimize the settlement for the embankment loading condition. Also revealed is that the efficiency of increasing encasement stiffness is construction condition dependent and is maximized for cases with which the stress intensity in the soft ground is larger. Based on the results of this investigation, design charts for use in estimating the maximum settlement and the stress concentration ratio during preliminary design are presented.

Undrained stability of dual square tunnels

In this paper, finite element limit analysis (FELA) and semi-analytical rigid block techniques are used to investigate the influence of tunnel spacing on the undrained stability of two unlined square tunnels constructed side by side. The tunnels, which are assumed to be straight and infinitely long, are modelled under conditions of plane strain. Upper and lower bounds on the stability of the tunnels are obtained using FELA; the numerical formulation of which is based upon the bounds theorems of classical plasticity. These bounds, which bracket the true collapse load from above and below, are found to be in good agreement with one another. Rigid block methods also provided an upper bound estimate on tunnel stability which was generally higher than, but still in good agreement with, the FELA upper bound. Failure mechanisms associated with the collapse of the dual tunnels were investigated, and for deeper tunnels, it was found that mechanisms extend much deeper below the tunnels than the collapse mechanisms associated with a single tunnel. Results from this study are summarised in dimensionless stability charts for use by practitioners.

PO-0669 New Born Observation Track And Trigger (nott) Chart – Burton Experience

<h3>Background</h3> Use of early warning system scores and track and trigger charts is widespread in adult and paediatric hospitalised patients. Its use in neonatal group is not well recognised. Lack of well established normal ranges for biophysical variables in preterm/term neonates illustrate difficulties in establishing a scoring system that can potentially be used on the neonatal units (NNU) and postnatal wards (PNW). We have recently developed NOTT chart for use in newborn babies on PNW. <h3>Aim</h3> To validate NOTT chart in order to enable early identification of neonates in need of urgent medical assessment and intervention. <h3>Methods</h3> A service evaluation was carried out to evaluate the efficacy of NOTT chart. All admissions from PNW to NNU (Feb–Aug 2013) were evaluated. Notes of all babies on PNW (2 weeks duration in Nov 2013) were also reviewed. <h3>Results</h3> There were 24 NNU admissions from PNW between Feb–Aug 2013. Sensitivity of NOTT chart’s ‘medium’ and ‘high’ score was 96% (22/23). Charts of 42 babies on PNW were examined in Nov 2013. 7/42 babies scored ‘medium’ or ‘high’ out of which, 3 were admitted to NNU. Specificity of NOTT chart was 90%. Positive and negative predictive value was 43% and 100% respectively. <h3>Conclusions</h3> NOTT is an effective screening tool to identify any deterioration in the condition of a new born so prompt and timely assessment and medical intervention could be carried out. It is a useful tool for information sharing and provides a one stop solution for unifying all neonatal observations on PNW.

A paediatric X-ray exposure chart.

The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.