Head End Research Articles

Development and validation of a nomogram for predicting the placement of nasointestinal tubes in critically ill patients based on abdominal radiography: A single-center, retrospective study

BackgroundEnteral nutrition administered via the nasointestinal tube (NET) is a prevalent nutritional modality among critically ill patients, and abdominal radiographs hold significant value in accurately ascertaining the precise positioning of the NET subsequent to its placement. Therefore, we propose an innovative approach to construct a clinical prediction model based on NET's configuration within the gastrointestinal tract in abdominal radiography. This model aims to enhance the accuracy of determining the position of NETs after their placement. MethodsPatients admitted to the intensive care unit of Zhejiang Provincial People's Hospital between October 2017 and October 2021 were included to constitute the training cohort for retrospective analysis, and nomogram was constructed. Consecutively enrolled patients admitted to the same hospital from October 2021 to October 2023 were included as the validation cohort. The training cohort underwent a univariate analysis initially, followed by a multivariate logistic regression approach to analyze and identify the most appropriate model. Subsequently, nomogram was generated along with receiver operator characteristic curves, calibration curves, and decision curves for both the training and validation cohorts to evaluate the predictive performance of the model. ResultsThe training and validation cohorts comprised 574 and 249 patients, respectively, with successful tube placement observed in 60.1 % and 76.3 % of patients, correspondingly. The predictors incorporated in the prediction maps encompass the “C-shape,” the height of “inverse C-shape,” showing the duodenojejunal flexure, and the location of the head end of the NET. The model demonstrated excellent predictive efficacy, achieving an AUC of 0.883 (95 % CI 0.855–0.911) and good calibration. Furthermore, when applied to the validation cohort, the nomogram exhibited strong discrimination with an AUC of 0.815 (95 % CI 0.750–0.880) and good calibration. ConclusionThe combination of abdominal radiography and NET's configuration within the gastrointestinal tract enables accurate determination of NET placement in critically ill patients.

Assessing Design of Drip Emitters by Evaluating Hydraulic and Manufacturing Performance of Online Drip Emitters

The efficiency of drip irrigation is closely influenced by the accuracy of its design, particularly the hydraulic and manufacturing performance of the emitters. This study investigates the hydraulic performance and flow variation of 8 litres per hour (lph) drip emitters. Discharge rates for 100 emitters were measured at a pressure of 1 kg/cm² to determine the manufacturer's coefficient of variation and the flow variation due to hydraulic factors. The relationship between pressure and discharge was modelled using power function regression, demonstrating a strong correlation between predicted and observed emitter discharge rates, with a root mean square error (RMSE) of 0.56 lph. A design chart was derived from this model, illustrating the relationship between input pressure at the head end and output pressure at the tail end of the system. The manufacturing coefficient of variation for the 100 emitters was found to be 0.0521, classifying the emitters as "good" according to manufacturing standards. The study provides important understandings for designers aiming to create efficient drip irrigation systems and effective water management strategies. By addressing both hydraulic and manufacturing variations, the study confirms that it is possible to achieve more uniform water distribution, enhance crop yield, and optimize resource utilization.

A New Method for Anti-Interference Measurement of Capacitance Parameters of Long-Distance Transmission Lines Based on Harmonic Components

In the context of strong electromagnetic interference environments, the measurement accuracy of the capacitance parameters of transmission lines under power frequency measurement methods is not high. In this paper, a capacitance parameter anti-interference measurement method for transmission lines based on harmonic components is proposed to overcome the impact of power frequency interference. When applying this method, it is first necessary to open-circuit the end of the line under test. Subsequently, apply voltage to the head end of the tested line through a step-up transformer. Due to the saturation of the transformer during no-load conditions, a large number of harmonics are generated, primarily third harmonic. The third harmonic components of voltage and current on the tested transmission line are extracted using the Fourier transform. The proposed method addresses the influence of line distribution effects by establishing a distributed parameter model for long-distance transmission lines. The relevant transmission matrix for the zero-sequence distributed parameters is obtained by combining Laplace transform and similarity transform to solve the transmission line equations. Using synchronous measurement data from the third harmonic components of voltage and current at both ends of the transmission line, combined with the transmission matrix, this method accurately measures the zero-sequence capacitance parameters. The PSCAD/EMTDC simulation results and field test outcomes have demonstrated the feasibility and accuracy of the proposed method for measuring line capacitance parameters under strong electromagnetic interference.

Head surface strain measurement based wireless bolt sensor with self temperature compensating

Bolt loosening detection is crucial for ensuring the safe operation of equipment. Loosened bolts are hard to detect, and if left undetected, it can lead to catastrophic failures, especially for numerous bolts in large-scale structures. Therefore, the development of distributed bolt monitoring method and related sensors is highly necessary. In this paper, a novel bolt preload sensor with self-temperature compensation is proposed, based on the strain distribution of the bolt head end face. This study enhances previous research by conducting a detailed analysis of strain distribution at the edge of the bolt head surface. The finite element analysis results show that the bolt preload has almost no effect on the circumferential strain in the edge region of bolt head surface. Based on this feature, the strain gauge is applied circumferentially along the edge of the bolt head face as a temperature compensation gauge. In this way, the measuring strain gauge and the temperature compensation gauge can be integrated on the surface of the bolt head, thus achieving self-temperature compensation for the sensor. An experimental device has been established and the experimental results show that the designed sensor has excellent linearity to the bolt preload and effective temperature compensation. For the monitoring of numerous bolts with a wide distribution, a wireless sensing network utilizing the proposed sensor has been designed. The proposed wireless bolt sensor is easy to install and replace, without redesigning or changing the existing structure, thus providing a simple and effective way to monitor large number of bolts with wide distribution.

Research on the Mechanical Properties and Structural Optimization of Pipe String Joint under Deep Well Fracturing Operation

In order to reduce the failure accidents caused by the insufficient strength of fracturing string joints, theoretical calculation and string design methods were adopted to conduct finite element calculations on commonly used long circular threads. The distribution laws of stress and contact pressure of long round threads were obtained, a non-standard special thread was designed, and a finite element model of the joint of the casing was established. Considering different make-up torques, tensile loads, and tensile torque loads within a certain range, the stress variation law of the special casing threaded joint under this design size was analyzed. Finally, the stress and contact pressure variation law on the threaded tooth was analyzed under different structures, working conditions, and wall thickness parameters. The thread strength and sealing function were compared under various parameters. The results showed that the smaller the wall thickness of the joints, the greater the contact pressure at the threaded tooth. Among them, the contact pressure of the external threaded tooth is too high, and is prone to the sticking phenomenon. The distribution of contact pressure in the middle section is relatively reasonable. Compared with the original structure, the new structure significantly reduces the contact pressure at the head and tail ends of the threaded connection, reducing the risk of sticking.

Simulated impact of lift car sizes on transport of critical care patients: Informing the design of the New Dunedin Hospital.

The New Dunedin Hospital (NDH) is New Zealand's largest health infrastructure build. Here we describe the use of a simple simulation-based hospital design exercise to inform the appropriate lift car size for critical care intrahospital transfers in the NDH. The intensive care unit (ICU) user group tested a series of entries and exits of simulated complex patient transfers in mocked-up lift cars of three different dimensions. Time taken to enter and exit the lift were recorded, reflecting the relative difficulty of transfer. Qualitative assessments were made of ease and perceived safety of transfer. These simulations demonstrated that recommended standard patient lift cars, often proposed for critical care transfers, could not physically accommodate all complex ICU transfers. A size of 1800 mm wide (W) × 3000 mm deep (D) had the physical capacity to permit all simulated ICU transfers, but with staff and patient risk. As lift car size increased to 2200 mm W × 3300 mm D, the simulation demonstrated reduced transfer times, smoother entry and exit, improved access to the head end of the bed, and reduced risk of disconnection or dislodgement of lines and airway support. The resultant clinical recommendations for the dimensions of a critical care lift car surpass current international health architecture guidelines and may help to inform future updates. The NDH project benefited from an objective assessment of risk, in language familiar to clinicians and healthcare architects. The outcome was an upsizing of the two ICU-capable lifts.

Performance evaluation of the Bilate and Furfuro irrigation schemes in Silti Zone, southern Ethiopia

Many irrigation schemes are performing poorly for a number of reasons, and this should be improved to increase the efficiency and productivity of the schemes. This study attempted to determine the performance of the Bilate and Furfuro irrigation schemes in Silti Zone, southern Ethiopia. For field data measurements, three farmers’ fields were selected at the head, middle, and tail end of each scheme. Average conveyance efficiencies were 53% and 56.1%, average field application efficiencies were 55.9% and 58.0%, average water storage efficiencies were 53% and 46.5%, irrigation uniformity was 91.03% and 92.9%, and overall irrigation efficiency was 28% and 32% for Bilate and Furfuro schemes respectively. This implied that the two schemes were performing inefficiently and inadequately, but water was distributed uniformly. The reason might be most canal sections had unreasonable losses of water in two schemes. Additionally, relative water supply was 0.68 and 0.79, relative irrigation supply was 0.61 and 0.77, output per unit irrigated area was 4140.4 and 1781.5 ($/ha), output per unit command area was 4510.3 and 1968.5 ($/ha), output per unit irrigation supply was 0.94 and 0.28 ($/m3), output per unit water consumed was 0.99 and 0.39 ($/m3), sustainability of irrigation area was 1.05 and 1.02, and irritation ratio was 1.11 and 1.09 for Bilate and Furfuro schemes respectively. This revealed that the applied water was not satisfied the crop water demand, but their irrigated lands were expanded for two irrigation schemes. Furfuro scheme was better than Bilate in terms of relative water supply and relative irrigation supply, but their results obtained were below acceptable values. However, Bilate scheme had significantly better land and water productivity than Furfuro scheme. This may be use high value crops, better agricultural inputs, and removal of grass cover and sedimentation from canal systems. Hence, Bilate irrigation scheme was better performing than Furfuro scheme. Therefore, adopt the best practices learned from Bilate irrigation scheme for the Furfuro scheme.

Headed coupling behavior of large diameter Cu-Al-Mn shape memory alloy bars: Mechanical testing and microstructural analyses

Cu-Al-Mn (CAM) superelastic alloy bars (SEAs) have received increasing attention in bridge applications. To take full advantage of their strain recovery and energy dissipation capacity, CAM SEAs are usually only applied in the plastic hinge regions of columns as part of the longitudinal reinforcement and coupled with steel rebar through mechanical splices. In this study, the feasibility of using headed coupling to connect large diameter CAM SEAs with steel rebar was investigated. Five large diameter CAM SEAs with headed ends were prepared: one 30 mm diameter and four 20 mm diameter samples. First, mechanical tests were performed on the five headed samples where each sample was coupled with one steel rebar at each end. Monotonic, incremental and constant strain cyclic loading was applied to simulate earthquake loading. The key mechanical properties were extracted and discussed. Second, microstructural analyses including electron backscatter diffraction (EBSD), metallographic imaging, Vickers hardness testing and fractographic evaluation were performed. The crystal orientation, phase composition and fracture surfaces were investigated to understand the effect of heading process on the stress induced martensitic transformation (SIMT), phase composition and failure of the headed CAM SEAs. It was found that the heading process only affects the near end portion of the specimen and it has no influence in the middle portion of the bars. Therefore, the strain recovery capacity of the CAM SEAs after heading was not reduced. Heading process led to high density of bainite phase precipitation at the end portions, which strengthened the sample. In order to uniformly strengthen the headed end of large diameter CAM SEAs, the key is to ensure a consistent cooling rate in the central and peripheral regions of the headed end after the heading process.

Research on the Prevention and Control Technology of Low Oxygen in The Upper Corner of Fully Mechanized Coal Mining Face in Daliuta Coal Mine

In response to the problem of low oxygen in the upper corner of the return air of the 52506 fully mechanized mining face in Daliuta Coal Mine, the impact of atmospheric pressure and temperature changes on the low oxygen in the upper corner of the 52506 fully mechanized coal mining face is analyzed, and the source and cause of the low oxygen gas in the upper corner of the 52506 fully mechanized coal mining face are analyzed from multiple perspectives. A comprehensive treatment method is adopted, including installing windshields and air guide boards at the head and tail ends, joint sealing and leak-repairing at the ground and underground levels, sealing the adjacent goaf communication alleys, pressure ventilation, negative pressure suction, monitoring and control management, etc. This method solves the problem of low oxygen in the upper corner of the 52506 fully mechanized coal mining face.

Optimality and water conservation under non-system and system tank commands of Andhra Pradesh, India

Abstract Indian agriculture relies on irrigation. India's net irrigated area has tripled in 60 years, although tank-irrigated regions suffered a large decline. This study examines the potential for improving tank irrigation performance through linear programming by developing individual optimal plans for two different tank irrigation systems (non-system and system tank) in the Chittoor and Srikakulam districts of Andhra Pradesh, India. The optimal plans under non-system tanks allocated less land under paddy while improving groundnut areas to optimally reorganize resources among head, middle, and tail ends. Net returns were maximized to ₹ 2.63, ₹ 2.52, and ₹ 1.92 lakhs. The system tank optimal plans advised less water-intensive crops like pulses and sesame over sugarcane with maximized net returns of ₹ 5.35, ₹ 2.61, and ₹ 1.71 lakhs. Both physical (kg/m3) and economic water productivity (₹/m3) were highest among optimal crop mix under non-system and system tank command farms. Participatory water management, adoption of less water-intensive crops, and promotion of pressurized technologies were highly recommended in the study area and similar agro-climatic conditions

Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures

BackgroundThis study aimed to investigate the relationship between femoral neck fractures and sarcopenia.MethodsThis was a retrospective analysis of 92 patients with femoral neck fractures, from September 2017 to March 2020, who were classified into high ambulatory status (HG) and low ambulatory status (LG) groups. Ambulatory status was assessed before surgery, one week after surgery, at discharge, and during the final follow-up. To evaluate sarcopenia, muscle mass and fatty degeneration of the muscles were measured using preoperative CT. An axial slice of the superior end of the L5 vertebra was used to evaluate the paraspinal and psoas muscles, a slice of the superior end of the femoral head for the gluteus maximus muscle, and a slice of the inferior end of the sacroiliac joint for the gluteus medius muscle. The degeneration of the muscles was evaluated according to the Goutallier classification.ResultsThe cross-sectional area of the gluteus medius and paraspinal muscles was significantly correlated with ambulatory status before the injury, at discharge, and during the final follow-up.ConclusionsMeasurement of the gluteus medius and paraspinal muscles has the potential to evaluate sarcopenia and predict ambulatory status after femoral neck fractures.

Designing 2D stripe winding network through crown-ether intermediate Ullmann coupling on Cu(111) surface.

Chemical synthesis typically yields the most thermodynamically stable ordered arrangement, a principle also governing surface synthesis on an atomically level two-dimensional (2D) surface, fostering the creation of structured 2D formations. The linear connection arising from energetically stable chemical bonding precludes the generation of a 2D random network comprised of one-dimensional (1D) convoluted stripes through on-surface synthesis. Nonetheless, we underscored that on-surface synthesis possesses the capability not solely to fashion a 2D ordered linear network but also to fabricate a winding 2D network employing a precursor with a soft ring and intermediate state bonding within the Ullmann reaction. Here, on-surface synthesis was exhibited on Cu(111) employing a 2D self-assembled monolayer array of 4,4',5,5'-tetrabromodibenzo[18]crown-6 ether (BrCR) precursors. These precursors were purposefully structured, with a crown ether ring at the core and Br atoms positioned at the head and tail ends, facilitating preferential connections along the elongated axis to foster a 1D stripe configuration. We illustrate how adjustments in the quantities of the intermediate state, serving as a primary linkage, can yield a labyrinthine, convoluted winding 2D network of stripes. The progression of growth, underlying mechanisms, and electronic structures were scrutinized using an ultrahigh vacuum low-temperature scanning tunneling microscopy and spectroscopy (STM/STS) setup combined with density functional theory (DFT) calculations. This experimental evidence opens a novel functionality in leveraging on-surface synthesis for the formation of a 2D random network. This discovery holds promise as a pioneering constituent in the construction of a ring host supramolecule, augmenting its capability to ensnare guest atoms, molecules, or ions.

Impact of posterior wall gastrojejunostomy versus anterior wall gastrojejunostomy in pancreaticoduodenectomy on delayed gastric emptying and enhanced recovery: a prospective study

Background Pancreaticoduodenectomy (Whipple operation) is considered the main surgical management for duodenal, pancreatic head, and lower end common bile duct neoplasm. Gastrojejunostomy orientation has a direct impact on enteral feeding and delayed gastric emptying (DGE). Aim The primary outcomes were reviewing the effect of changing the orientation of gastrojejunostomy either anterior wall vertical gastrojejunostomy versus posterior wall vertical gastrojejunostomy on DGE, early enteral feeding, leakage, and overall enhanced recovery with early start of chemotherapy. Patients and methods A prospective randomized trial 55 patients total number of patients after substraction of lost follow up was 50 patients and were divided into two group; group A: 27 patients underwent posterior wall gastrojejunostomy and group B: 23 patients underwent anterior wall gastrojejunostomy both techniques done in antecolic vertical manner. Results Operative time, postoperative bleeding, and leakage was not significantly different between the two groups. The total incidence of DGE was significantly lower in group A (posterior wall vertical) than group B (anterior wall vertical), regarding grades of DGE grade a was significantly lower in group A while the incidence in grades B and C was not significantly different regarding the number of patients. Ryle removal and starting oral intake was earlier and statistically significant in posterior wall vertical gastrojejunostomy when compared to anterior wall vertical gastrojejunostomy. Readmission, the actual use of prokinetics and need for nutritional support was higher in group B (anterior wall vertical gastrojejunostomy) than group A (posterior wall vertical gastrojejunostomy) but was not statistically significant. Conclusions Posterior wall vertical gastrojejunostomy has a better overall significant better outcome regarding early enteral feeding and DGE over anterior wall vertical gastrojejunostomy group also has better enhanced recovery and earlier time of starting chemotherapy. This topic should be evaluated in depth in a large-volume studies.

Fault diagnosis for spent fuel shearing machines based on Bayesian optimization and CBAM-ResNet

Spent fuel shearing machines in nuclear power plants are important equipment for the head end of spent fuel reprocessing in power reactors. Condition monitoring and fault diagnosis play important roles in ensuring the safe operation of spent fuel shearing machines, avoiding serious accidents, and reducing their maintenance time and cost. Existing research on fault diagnosis of spent fuel shearing machines has some shortcomings: (a) the current research on fault diagnosis of shearing machines is small and diagnostic accuracy is not high. The research methodology of shearing machines needs to be updated; (b) the high difficulty in obtaining fault data and the often limited and highly informative fault data for shearing machines lead to low diagnostic performance. To solve these problems, this study constructs a residual network (ResNet) model based on Bayesian optimization (BO) and convolutional block attention module (CBAM). First, dual-channel difference method is introduced into the preprocessing of noise signals, and two data enhancements were applied to the Mel spectrograms used as inputs to the model. Second, the attention mechanism CBAM is introduced to improve the ResNet to enhance the deep feature extraction ability of the network, and the BO algorithm is used to train the hyperparameters, such as the optimizer, and retrain the network model after obtaining the optimal hyperparameters. Finally, the feasibility and effectiveness of the proposed model are verified through experiments on the noise signals of spent fuel shearing machines. The experimental results show that the diagnostic accuracy of the constructed model is 93.67%, which is a significant improvement over the other methods.

A deep learning-based approach for the inverse design of the Helmholtz resonators

This article discusses the use of artificial neural networks in the design of Helmholtz resonators. A large database is constructed analytically by using the classical approach for computing the transmission loss and resonance frequencies of the Helmholtz resonators. In DNN, four geometric parameters, neck radius (rn), corrected neck length (ln) (derived from neck length (hn)), cavity radius (rc), and cavity height (hn) of the Helmholtz resonator, are the final output of the designed model which are mapped with the transmission loss and resonance frequency of the Helmholtz Resonators through our proposed neural network. A Feed-forward deep neural network (DNN) based on pre-transfer learning approach is used to map feature variables to target variables. The training follows the three major steps i.e., (a) Generalised pre-training in unsupervised manner, (b) Decoder pruning and regressor head training and (c) End to End regressor training using full backpropagation. This modularized approach removes the chances of overfitting, by effectively tuning the weights at each layer of the network. Each step focuses on creating a more structured and organized model. The best combination of the weight and biases is used for the prediction of the geometric parameters. Also, the finite element study of the transmission loss and resonance frequency supports the predicted geometric parameter of the randomly chosen sample for testing with the true value of the sample. It has been found that the accuracy of the model can be improved by training in a modular way. The approach discussed in this article can be useful to bypass the complex wave analysis approach for designing the Helmholtz resonators.

Fiber movement during twisting in air vortex spinning

In order to clarify the twisting mechanism of the air vortex spinning machine, this paper investigates the motion law of air vortex spinning fiber from the guided access into the twisting chamber during the whole process. While considering the bi-directional coupling effects of the airflow and fiber, the airflow–fiber fluid–solid coupling solution model of the guiding parts is established, and the fluid–solid bi-directional coupling solution platform is built based on ANSYS Workbench software. The movement trajectories of fibers in the process of single and double fibers entering the twisting zone from the guiding channel to the hollow spindle guiding channel were obtained, respectively. Through the fluid–solid coupling analysis, (1) under the action of airflow, the fiber movement is complex and variable, while the movement of the fiber affects the distribution of the surrounding airflow velocity and pressure. (2) Due to the asymmetric structure of the guiding channel, the airflow distribution on both sides of the fiber in motion is uneven, so that the fiber as a whole is wavy forward, and from time to time collisions occur with the tube wall. (3) The fibers are sucked into the twisting chamber under the effect of pressure difference, and the fibers are twisted under the combined effect of axial airflow and tangential airflow. The head end of the fiber enters the guided access in the middle of the hollow spindle under the guidance of the guiding pins. (4) In double fiber movement, there will be mutual adsorption, fibers becoming closer together, contact, stagger, separation and other phenomena that also affect the fiber in the airflow under the action of the twisting winding movement process.

Impurity distribution in preparation of high-purity aluminum by vacuum zone melting

A novel vacuum zone melting process for preparing high-purity Al was proposed. The axial segregation of impurities was investigated by determining the equilibrium distribution coefficient. Theoretical and experimental results showed that impurities (Cu, Si, and Fe) with an equilibrium distribution coefficient k0<1 accumulated in the tail of the Al ingot, while Ti (k0 >1) accumulated at the head end of the ingot. When the molten area moving at 1.5 mm/min and zone melting was performed 15 times, the removal rate of the impurities and the purity of Al were the highest. In the middle of the Al ingot, i.e. 140 mm away from the head end of the sample, the removal rates of Cu, Fe, and Si were higher than 90%, that of Ti was higher than 75%, and the Al content was higher than 99.999%. The purity of the Al samples met the requirements of the commercial 99.999% (5N) high-purity Al standard.

Morphometric characteristics of the nematode Oesophagostomum venulosum (Nematoda, Strongylida) isolated from the domestic goat

The nematodes of the genus Oesophagostomum Molin, 1861 parasitize in the large intestine of ruminants and are widely represented in the terrestrial ecosystems of many countries of the world. One of the most common species of this genus in small ruminants is Oesophagostomum venulosum Rudolphi, 1809. The validity of this species was established using morphological and molecular genetic methods, the importance of which is still relevant. The aim of our research was to determine the morphological and metric characteristics of O. venulosum nematodes isolated from domestic goats in Ukraine. The differential parameters of mature males and females of nematodes of this species are described and illustrated, and the obtained data is analyzed in the context of the findings of other authors. The taxonomic morphological characters of O. venulosum include the presence of a pronounced cuticular vesicle at the head end, inner and external corona radiata, cervical papillae located behind the esophagus; in males, the presence of prebursal papillae in front of the tail bursa and features of its structure, thin and tubular spicules and features of the structure of their proximal and distal ends; in females, features of the structure of the tail end, vulva and its location. 35 morphometric indicators were determined and proposed to be used in the identification of O. venulosum in males, and 29 indicators in females. Of these, 20 parameters characterize the general body structure (the length and width of the nematode, the dimensions of the mouth capsule, cervical vesicle, esophagus, the length of the inner and outer radial crowns, the location of the nerve ring and cervical papillae, as well as their sizes). In male nematodes of this species, 15 indicators characterize the metric parameters of the reproductive system (the size of the spicules in their various parts, gubernaculum, genital cone, genital papillae and their location, the width of the copulatory bursa). In females, 7 indicators are described that characterize the length of the vagina, the ovipositor, the location of the vulva and anus, the width of the body in the area of the vulva and anus, as well as two metric parameters of eggs. The identified and described morphometric characters of O. venulosum males and females based on microscopic studies can be an economical and effective method for researchers to accurately identify nematodes of this species. The information obtained in this study can contribute to the timely planning of control and prevention strategies for the parasitism of these nematodes on goat farms.

A Radiostereometric Analysis of Tendon Migration After Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw Versus Single Suture Anchor Fixation.

Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques. To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis. Cohort study; Level of evidence, 2. Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up. Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively (P < .0001). PROMs did not differ among groups at final follow-up. Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.

Role of basic infection control practices to curtail the outbreak of ventilator-associated pneumonia caused by Klebsiella pneumoniae in a tertiary care hospital’s trauma intensive care unit

Abstract Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), with high mortality and morbidity rates. Multidrug-resistant pathogens such as Klebsiella pneumoniae and Acinetobacter spp. generally cause VAP. Following an outbreak of VAP due to Klebsiella pneumonia in the trauma ICU (TICU), aggressive infection control practices and effective interventions were instituted to reduce the infection. We summarize the timely implementation and changes in infection control practices that helped reduce VAP incidence in an ICU. Materials and Methods: An intervention was done in the form of the implementation of infection control practices, training of healthcare workers (HCWs), and auditing of practices. Data were collected, and VAP rates were calculated pre- and postintervention. Results: Twenty-four VAP cases/1000 ventilator days due to multidrug-resistant Klebsiella pneumoniae were identified in April–May 2019. After the intervention in the form of training and auditing, there was a change in the behavior of healthcare workers. The hand hygiene compliance rate improved from 33% to 74%. Overall bundle adherence rate in the study period was 62.5%, with semirecumbent position (head end elevation) achieved in 95%, administration of deep vein thrombosis prophylaxis in 56%, peptic ulcer prophylaxis in more than 90% of patients, and daily oral care was achieved in 96% patients. Their VAP rate decreased to 8 cases/1000 ventilator days in June and July 2019 from 24/1000 ventilator days in April–May 2019. The difference was statistically significant (P &lt; 0.05). Conclusions: The VAP rates in TICUs were reduced by strengthening basic infection control practices.