Index Criteria Research Articles

Predictive ability and prognostic correlation of global longitudinal strain in patients with negative dipyridamole stress echocardiography by wall motion criteria

Abstract Background Dipyridamole stress echocardiography (DSE) is an established technique to detect coronary artery disease (CAD) and for risk stratification. Speckle Tracking Echocardiography (STE), as an objective and quantitative evaluation of ventricular function, may add incremental value to conventional stress echo analysis. Purpose To assess the prognostic value of rest (Rest-GLS) and peak (Peak-GLS) stress global longitudinal strain (GLS) in patients with suspected CAD and negative DSE according to wall motion index (WMI) criteria. Methods We retrospectively enrolled patients who underwent DSE at our centre for suspected CAD, with normal WMI. Strain Reserve was calculated as Rest GLS – Peak-GLS (Delta-GLS). We also collected data regarding other conventional parameters such as coronary flow reserve (CFR) of left anterior descending (LAD), left ventricle contractile reserve (LVCR), delta left ventricular ejection fraction (Delta-LVEF), heart rate response (HRR). Our primary endpoint was a composite of all-cause death and coronary revascularization. Receiver operating characteristic (ROC) curves were used to compare the predictive ability of the parameters. Adjusted logistic regression analyses were used to assess associations, also modelled as a restricted cubic spline. Results A total of 355 patients were included in the analysis (median age 68.2, IQR 58.2-75.2, 38.0% female). At follow-up, 58 patients met the primary endpoint. Figure 1 shows the ROC curves of different DSE parameters. Delta-GLS and Peak-GLS showed high predictive ability of composite endpoint events (area under the curve [AUC] 0.87, 95% Confidence Interval [CI] 0.82-0.92, AUC, 0.85, 95% CI 0.79-0.91, respectively), which was significantly higher compared with other DSE parameters, included Basal-GLS (P for difference for all < 0.001). After adjustments for age, previous CAD, sex, and diabetes, reducing values of Rest-GLS, Peak-GLS and Delta-GLS were significantly associated with higher odds of experiencing composite endpoint events (Basal-GLS, odds ratio [OR] 1.13, 95% CI 1.04-1.24; Peak-GLS, OR 1.45, 95% CI 1.32-1.63; Delta-GLS, OR 1.73, 95% CI 1.50-2.04). Plotting the results of the logistic regression analysis on a restricted cubic spline, reducing values of Peak-GLS and Delta-GLS showed a linear increase for the risk of adverse events, while Rest-GLS showed a plateau for lower values. Conclusion The use of GLS parameters in DSE can help to better stratify the risk for the patients since they are associated with adverse cardiovascular events.Figure 1Figure 2

A comparative analysis of the evaluation system for comprehensive reform of agricultural water prices in China

Water is a fundamental natural resource that affects human and social development, and also plays an important role in modern agricultural production and food security. In China, agricultural water consumption accounts for the majority of the total water consumption. For a long time, China has not fully implemented water pricing and payment for agricultural water, and the lower agricultural water cost have led to the waste of water resource and the rapid conversion of agricultural water to other industries. In order to avoid agricultural water waste and achieve the goal of agricultural sustainable development, the Chinese government has launched a comprehensive reform of agricultural water prices nationwide since 2016. According to the plan, nowadays, the reform will faces overall evaluation and acceptance in 2024 and 2025. However, there is a lack of a relatively unified and flexible nationwide evaluation index system and acceptance measures. In this study, a comparative research of the evaluation system for comprehensive reform of agricultural water prices was developed. Based on existing evaluation and acceptance measures issued by four typical provincial regions, this study compared and analyzed the compliance and similarities and differences of these acceptance measures with national reform policies and requirements. From the aspects of evaluation procedure and index system, a systematic comparative analysis was conducted on the integrity and differences in the four regions. At the same time, suggestions were given for policy-making of national evaluation process and standard. The comparative analysis results showed that the evaluation indices in the four provincial regions have met all the key points of national reform policies and have a complete system, but there were significant differences in the structure of the evaluation index system in different provincial regions. It is recommended to establish a simple, relatively unified and practical national evaluation and acceptance system as soon as possible. In addition, evaluation criteria for individual specific indices should be determined by region based on the differences in economic capacity and agricultural water conservancy facilities conditions.

An evaluation rule to manage productivity properties performance of male date palms

ABSTRACT Male palm trees almost prominently display minute morphological variations; however, date palm growers rely on readily available pollen from unproven male genotypes without giving correct type selection any thought, which may result in low productivity and/or poor fruit quality. This study sought to develop an evaluation rule by calculating an evaluation index for managing the productivity characteristics performance of nine male date palms, which were examined for their pollen productivity, nutritional status and morphological traits from their leaves, pinnae and spathes. The findings showed that the evaluation rule for a male date palm should depend on pollen grains productivity and germination percentage traits with a weight of 5, spathe morphological traits with a weight of 4, pinnae morphological traits with a weight of 3, leaf morphological traits with a weight of 2 and leaf nutritional status with a weight of 1. The best productivity characteristics performance of male date palms was male No. 8 ‘M8’ due to its high evaluation index. The proposed evaluation index criterion will contribute to better information and analytical support for management of the date palm industry to maximise the effectiveness of germplasm conservation and exploitation, as well as procedural and methodological aspects of the analysis.

Soil Erosion Susceptibility Prediction Using GIS-Based Multicriteria Analysis and Worldview-3 Satellite Images

Soil erosion has been identified as a major threat to existing soil deposits, which negatively affects ecosystem sustainability, agricultural production and clean water supply. This study covered the eastern part of Kaštela Bay with the aim of developing a model of susceptibility to soil erosion by applying the GIS-based multicriteria analysis, based on nine determinant criteria categorized by the Jenks method in five classes. The largest representation of soil erosion susceptibility was detected on the slopes of the Kozjak and Mosor massifs. According to the calculated weighting coefficients using the analytic hierarchy process (AHP), the slope was the most impactful criterion with 29.9 % importance. It was followed by hydrological criteria of topographic wetness index, standardized precipitation index and LS-factor, with 13.1 % importance each. After the development of the model, zones of very high and high susceptibility to soil erosion were delineated, with a combined coverage of 33.34 % of the study area. These areas were identified as a potential threat from the future occurrence of negative effects of soil erosion, which should be addressed in the future by land policy managers and government managers.

Frailty Status, Not Just Age, is Associated With Postoperative Opioid Consumption: A Retrospective, Population-based Analysis

Objective: To assess the relationship between postoperative opioid consumption and frailty status. Background: Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty. Methods: We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within 30 days of surgery in oral morphine equivalents (OME). Our primary exposure was frailty status defined by the modified frailty index (mFi-5) criteria. Other covariates included patient demographic and clinical attributes, procedural factors, discharge opioid prescription size, and postoperative complications. Linear regression was performed to assess the association of frailty status and opioid consumption, stratified by age. Results: In this cohort of 34,854 patients, 10,596 had an mFi-5 score of ≤1 and 3,635 had a score of >1. A score of >1 was associated with increased patient-reported opioid consumption (OMEs 3.3 greater; 95% CI = 1.5–5.1). This held true for individuals over 65 (OMEs 2.7 greater; 95% CI = 0.2–5.1). Frailty status, regardless of score, was negatively associated with an opioid prescription at discharge. Conclusions: Frailty status is associated with increased opioid consumption after common operations. Future prescribing guidelines and outcomes analyses should consider this marker when reviewing opioid consumption data and related adverse outcomes.

Testing the validity and reliability of the Korean nursing surveillance scale: a methodological study

BackgroundBecause of the importance of nursing surveillance, there is a need to develop a scale to measure nursing surveillance that reflects the roles of nurses in South Korea. This study aimed to develop a scale to measure surveillance by Korean nurses and to test its reliability and validity.MethodsIn the development phase, a literature review was conducted to verify the attributes of nursing surveillance, and preliminary items were developed based on the surveillance activities in the Nursing Intervention Classification (NIC) and the interviews of Korean nurses and modified through content validation and a pilot study. In the psychometric testing phase, two surveys were conducted with Korean nurses working in acute hospitals, using the preliminary scale in exploratory factor analysis (EFA, n = 220) and confirmatory factor analysis (CFA, n = 219). Data were analyzed through EFA, CFA, correlation, and reliability analyses to verify convergent validity, discriminant validity, criterion validity, and reliability. To verify the validity of the preliminary scale, the exploratory factor analysis and confirmatory factor analysis convergent validity, discriminant validity, criterion validity, and reliability were performed.ResultsIn the EFA, 16 items were grouped into four factors, accounting for 70.1% of the cumulative variance. In the CFA, the model exceeded the criteria for all fit indices (χ2 = 155.62 [df = 94, p < .001], CMIN = 1.65, SRMR = .048, RMSEA = .055, GFI = .921, NFI = .916, TLI = .955, CFI = .964) and was acceptable. The convergent validity, discriminant validity, criterion validity, and reliability were verified. The final Korean nursing surveillance scale consists of four factors: ‘anticipation of problems and decision-making’ with six items; ‘systematic assessment’ with five items; ‘recognition of patterns’ with three items; and ‘identification of the patient’s self-care and coping strategies’ with two items.ConclusionThe Korean nursing surveillance scale developed in this study comprised questions that included NIC’s surveillance activities and empirical data from Korean nurses; based on the attributes of nursing monitoring derived from concept analysis, its validity and reliability were verified. This study can provide precedent to motivate the development of nursing surveillance scales in other countries, and ultimately stimulate studies on nursing surveillance, which is essential for patient safety.

Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning.

Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach. Using Organ Procurement and Transplantation Network-United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5mg/dL. Significant cluster characteristics were determined, and outcomes were compared. The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7-3.3) mg/dL. Cluster analysis was performed on 12356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%). In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.

Online Tree-Structure-Constrained RPCA for Background Subtraction of X-ray Coronary Angiography Images

Background and objectiveBackground subtraction of X-ray coronary angiograms (XCA) can significantly improve the diagnosis and treatment of coronary vessel diseases. The XCA background is complex and dynamic due to structures with different intensities and independent motion patterns, making XCA background subtraction challenging. MethodsThe current work proposes an online tree-structure-constrained robust PCA (OTS-RPCA) method to subtract the XCA background. A morphological closing operation is used as a pre-processing step to remove large-scale structures like the spine, chest and diaphragm. In the following, the XCA sequence is decomposed into three different subspaces: low-rank background, residual dynamic background and vascular foreground. A tree-structured norm is introduced and applied to the vascular submatrix to guarantee the vessel spatial coherency. Moreover, the residual dynamic background is separately extracted to remove noise and motion artifacts from the vascular foreground. The proposed algorithm also employs an adaptive regularization coefficient that tracks the vessel area changes in the XCA frames. ResultsThe proposed method is evaluated on two datasets of real clinical and synthetic low-contrast XCA sequences of 38 patients using the global and local contrast-to-noise ratio (CNR) and structural similarity index (SSIM) criteria. For the real XCA dataset, the average values of global CNR, local CNR and SSIM are 6.27, 3.07 and 0.97, while these values over the synthetic low-contrast dataset are obtained as 5.15, 2.69 and 0.94, respectively. The implemented quantitative and qualitative experiments verify the superiority of the proposed method over seven selected state-of-the-art methods in increasing the coronary vessel contrast and preserving the vessel structure. ConclusionsThe proposed OTS-RPCA background subtraction method accurately subtracts backgrounds from XCA images. Our method might provide the basis for reducing the contrast agent dose and the number of needed injections in coronary interventions.

Development of an algorithm for proton dose calculation in magnetic fields.

The advantages of proton therapy can be further enhanced with online magnetic resonance imaging (MRI) guidance. One of the challenges in the realization of MRI-guided proton therapy (MRPT) is accurately calculating the radiation dose in the presence of magnetic fields. This study aims to develop an efficient and accurate proton dose calculation algorithm adapted to the presence of magnetic fields. An analytical-numerical radiation dose calculation algorithm, Proton and Ion Dose Engine (PRIDE), was developed. The algorithm combines the pencil beam algorithm (PBA) with a novel iterative voxel-based ray-tracing algorithm. The new ray-tracing method uses fewer assumptions and ensures broader applicability for proton beam trajectory prediction in magnetic fields, and has been compared to Wolf's method and Schellhammer's method. The accuracy of PRIDE algorithm was validated on three phantoms and two practical plans (one single-field water plan and one prostate tumor plan) in different magnetic field strengths up to 3.0 T. The validation was performed by comparing the results against the Monte Carlo (MC) simulations, using the global gamma index criteria of 2%/2mm and 3%/3mm with a 10% threshold. PRIDE showed good agreement with MC in homogeneous and slab heterogeneous phantom, achieving gamma passing rates (%GPs) above 99% for 2%/2mm criteria when magnetic field strength is not greater than 1.5 T. Although the agreement decreased for scenarios involving high proton energy (240 MeV) and strong magnetic field (3.0 T), the 2%/2mm %GPs still remained above 98%. In lateral heterogeneous phantom, the accuracy of PRIDE decreased due to the PBA's limitation. For the two practical plans in different magnetic fields, %GPs exceeded 98% and 99% for 2%/2mm and 3%/3mm criteria, respectively. PRIDE can perform efficient and accurate proton dose calculation in magnetic fields up to 3.0 T, and is expected to work as a useful tool for proton dose calculation in MRPT.

Implementation of Accounting Information Systems in Village Fund Management Accountability

This study aims to examine the effect of accounting information systems on accountability for village fund management in Boyolali Regency with control variables of village development index, village fund ceiling, and population. The study was conducted in 40 villages in Boyolali Regency with the criteria of village development index at the developing village stage. Data collection was collected by filling out questionnaires and secondary data for control variables taken from the official government website. The results of this study indicate that accounting information systems have an effect on accountability for village fund management in Boyolali Regency. The control variable of population has a positive effect on accountability for village fund management. The village development index and village fund allocation have a negative effect on accountability for village fund management.

Assessing Surface Guided Radiation Therapy Benefits for Paediatric Cancer Patients: Dosimetric Implications of Intrafractional Motion - An Institutional Review

&amp;lt;i&amp;gt;Introduction/Background&amp;lt;/i&amp;gt;: SGRT, a real-time imaging technique, offers continuous monitoring and motion control during &amp;lt;i&amp;gt;treatment&amp;lt;/i&amp;gt;. The investigation aims to assess potential dosimetric alterations in target coverage due to intrafractional motion, considering its impact on patient safety and treatment efficiency. &amp;lt;i&amp;gt;Materials and Methods&amp;lt;/i&amp;gt;: A retrospective chart review was conducted to assess intrafractional shifts in 18 paediatric cancer patients. Patient setup employed SGRT using AlignRT (Vision RT Ltd., UK), and the PTV was aligned with CBCT. The study introduced induced shifts of 3 mm, 5 mm, and 7 mm during treatment delivery, assessing their impact on portal dosimetry results for both treatment fields. The gamma index criteria (3%, 3 mm) were employed to evaluate dosimetric accuracy. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: A total of 18 patients were included, and induced shifts were analyzed for their impact on the planned gamma index values. Significant differences were observed between the Planned Gamma Index and induced shifts of 3 mm, 5 mm, and 7 mm for both treatment fields, highlighting the dosimetric implications of intrafractional motion in paediatric cases. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Surface Guided Radiation Therapy (SGRT) is concluded to offer a comprehensive array of benefits for paediatric cases. The dosimetric implications of induced shifts underscore the importance of SGRT in ensuring accurate and safe treatment for paediatric cancer patients.

Geological, Tectonic, and Lithological Evaluation Approach of the Fault Hydraulic Conductive Property.

The hydraulic characteristics of faults are of great significance for groundwater transport. Many groundwater inrush disasters are caused by hydraulically conductive faults. However, the hydraulic conductive property of a fault is complex and varies in different parts, and evaluation in coal mines has always been a hard challenge for hydrogeologists. An evaluation model proposed by Li et al. partially solves the above-mentioned problem [Li L. N.Nat. Resour. Res.2022, 31, 849-865]. However, this model has two shortcomings: (1) They focused only on small faults and did not have a specific method for large faults with a drop of more than 100 m. (2) The problem of differences between different locations of the same fault is not solved. This paper presents a method to estimate the fault hydraulic conductive property using abundant geological exploration data without hydrologic tests. First, the influence of fault rocks, water pressure, and geostress on the fault hydraulic conductive property was analyzed. Moreover, four evaluation indices, namely, the fault shaliness index (FSI), mudstone deformation index (MDI), fault rock plugging index (FRPI), and water pressure index (WPI), were proposed, and evaluation criteria were established to divide the fault hydraulic conductive property into five grades. This method was applied in Shandong Province and verified by hydrochemical experiments, surface boreholes, injection tests, and geophysical data. Furthermore, the method may be transferable to other coal mines with similar geological and hydrogeological characteristics.

HIV, malnutrition, and noncommunicable disease epidemics among tuberculosis-affected households in east and southern Africa: A cross-sectional analysis of the ERASE-TB cohort.

As a result of shared social and structural risk factors, people in households affected by tuberculosis may have an increased risk of chronic conditions; at the same time, tuberculosis screening may be an opportunity for interventions. We sought to describe the prevalence of HIV, nutritional disorders, and noncommunicable diseases (NCDs) among members of tuberculosis-affected households in 3 African countries. A part of a multicountry cohort study, we screened for tuberculosis, HIV, nutritional disorders (underweight, anaemia, overweight/obesity), and NCDs (diabetes, hypertension, and chronic lung disease) among members of tuberculosis-affected households aged ≥10 years in Mozambique, Tanzania, and Zimbabwe. We describe the prevalence of these conditions, their co-occurence within individuals (multimorbidity) and household-level clustering. Of 2,109 household contacts recruited, 93% (n = 1,958, from 786 households) had complete data and were included in the analysis. Sixty-two percent were female, median age was 27 years, and 0.7% (n = 14) were diagnosed with co-prevalent tuberculosis. Six percent of household members (n = 120) had previous tuberculosis, 15% (n = 294) were living with HIV, 10% (n = 194) had chronic lung disease, and 18% (n = 347) were anaemic. Nine percent of adults (n = 127) had diabetes by HbA1c criteria, 32% (n = 439) had hypertension. By body mass index criteria, 18% household members (n = 341) were underweight while 29% (n = 549) were overweight or obese. Almost half the household members (n = 658) had at least 1 modifiable tuberculosis risk factor. Sixty-one percent of adults (n = 822) had at least 1 chronic condition, 1 in 4 had multimorbidity. While most people with HIV knew their status and were on treatment, people with NCDs were usually undiagnosed and untreated. Limitations of this study include use of point-of-care HbA1c for definition of diabetes and definition of hypertension based on single-day measurements. Households affected by tuberculosis also face multiple other health challenges. Integrated approaches to tuberculosis screening may represent an opportunity for identification and treatment, including prioritisation of individuals at highest risk for tuberculosis to receive preventive therapy.

A novel radiological index uses the inner canal diameter and the Citak classification index to predict risk factor for aseptic loosening following hinged total knee arthroplasty.

It remains unclear if distal femoral morphology should be a key consideration when selecting the implant or fixation strategy. A novel radiological index has been proposed to classify patients' distal femoral morphology. This study aims to evaluate the validity of this classification system in a cohort of patients undergoing hinged Total Knee Arthroplasty (TKA), and to determine if distal femoral morphology is a risk factor for aseptic loosening or all cause revision following hinged TKA. This study was a retrospective analysis of our institutional database. Fifty-nine patients having undergone hinged TKA with adequate radiographs for examination were eligible for inclusion. Radiographic measurements were performed using the Citak radiological index criteria. The proportion of aseptic loosening and all-cause revisions were compared between the different classification groups. The analysis included 41 females (69.5%) and 18 males (30.5%). The mean age of the participants was 71.2 years (SD = 12.6). For inner canal diameter patients were classified as: Type A (31/59, 53%), Type B (19/59, 32%), and Type C (9/59, 15%). For the Index Classification Group, patients were classified as: Group A (26/59, 44%), Group B (20/59, 34%), and Group C (13/59, 22%). There was no significant difference in overall revision rate between the three groups (χ2 = 3.25, P = .197 from a Chi-square test). There was a significantly higher rate of aseptic loosening in Group C compared to Groups A and B, with no significant difference between Groups A and B in terms of aseptic loosening rates (χ2 = 8.72, P = .013 from a Chi-square test). Distal femoral morphology plays an important role in the risk of aseptic loosening following hinged knee replacement, and should be considered when deciding implant type and fixation in these patients.

Using a negative spatial auto-correlation index to evaluate and improve intrinsic tag map’s multi-scale visualization capabilities

ABSTRACT The popularity of tag clouds has sparked significant interest in the geographic research community, leading to the development of map-based adaptations known as intrinsic tag maps. However, existing methodologies for tag maps primarily focus on tag layout at specific scales, which may result in large empty areas or close proximity between tags when navigating across multiple scales. This issue arises because initial tag layouts may not ensure an even distribution of tags with varying sizes across the region. To address this problem, we incorporate the negative spatial auto-correlation index into tag maps to assess the uniformity of tag size distribution. Subsequently, we integrate this index into a TIN-based intrinsic tag map layout approach to enhance its ability to support multi-scale visualization. This enhancement involves iteratively filtering out candidate tags and selecting optimal tags that meet the defined index criteria. Experimental findings from two representative areas (the USA and Italy) demonstrate the efficacy of our approach in enhancing multi-scale visualization capabilities, albeit with trade-offs in compactness and time efficiency. Specifically, when retaining the same number of tags in the layout, our approach achieves higher compactness but requires more time. Conversely, when reducing the number of tags in the layout, our approach exhibits reduced time requirements but lower compactness. Furthermore, we discuss the effectiveness of various applied strategies aligned with existing approaches to generate diverse intrinsic tag maps tailored to user preferences. Additional details and resources can be found on our project website: https://github.com/TrentonWei/Multi-scale-TagMap.

Open Reduction and Fixation of Late-Presenting Pediatric Supracondylar Humeral Fractures: A Prospective Study.

Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures. This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria. All fractures (100%) united within 3-5.5weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome. Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Oximetry and carbon dioxide screening for ventilatory requirements in children with spinal muscular atrophy type 1-3

IntroductionDespite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO2) for sleep disordered breathing (SDB). AimTo determine the utility of pulse oximetry and TcCO2 as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1–3. MethodsA prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT naïve children with SMA. Pulse oximetry and TcCO2 were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: ≤3 months of age [mo] AHI≥10 events/hour; >3mo AHI ≥5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO2 variables, and diagnostic statistics were calculated. ResultsForty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index ≥4 % (ODI4) ≥20events/hour had sensitivity 82.6 % (95 % CI 61.2–95.0) and specificity of 58.3 % (95 % CI 36.6–77.9). TcCO2 alone and combinations of oximetry/TcCO2 had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry±TcCO2 had low diagnostic ability. ConclusionODI4 ≥20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO2 monitoring were useful screening tests in the children treated with DMT.

Short-term heart rate variability: A potential approach to frailty assessment in older adults.

This study aimed to evaluate cardiac autonomic modulation using short-term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre-frail (n = 70), and non-frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5-min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre-frail and non-frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre-frail and non-frail subjects (P < 0.05). Measures of sympatho-vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre-frail and non-frail individuals, although maintaining a balanced sympatho-vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty.

A Comparative Study Between Conventional Outrigger System and Hybrid Outrigger System considering Performance Index Criterion

Outriggers are regarded as a structural component which can effectively lessen the reactions generated by lateral loads in tall buildings. Depending on the connectivity between the core and the peripheral columns, the outrigger system can be divided into virtual outrigger system and conventional outrigger system (COS). The hybrid outrigger system (HOS) has one conventional outrigger and one virtual outrigger at two distinct floor levels. This study gives a comparison of optimal position and performance between COS and HOS based on formulated performance index criterion (PIC) for building heights of 140, 210, 280 and 350 m by considering variations in stiffness of the outrigger belt wall and beam, the stiffness of the building's core, the height of the structure and the length of the outrigger arm under static wind and equivalent static earthquake load. The outrigger behaviour assessed using PIC takes into account the combined response of displacement at top, absolute maximum inter storey drift ratio and acceleration response at the roof. Based on PIC, performance of both COS and HOS at their evaluated optimal position are compared, and is found that HOS are less effective than COS. Therefore, to enhance the performance of HOS to be in par with COS, an optimization study is performed by increasing the axial stiffness of column, stiffness of outrigger, and stiffness of slab while maintaining the increase in total concrete volume of the structure a minimum. From the findings, PIC values of HOS (PICHOS) for 40 to 100 storeys exhibits an increase of 10 to 1.1, 20.2 to 2.2 and 12.5 to 1.9% for variation in core thickness, length of outrigger arm, and outrigger thickness, respectively, compared to PIC values of COS (PICCOS). For PICHOS to be comparable with PICCOS, increase in the total concrete volume of HOS reduces from 1.4–16.5 to 0.6–2.5% as the model's height increases from 40 to 100 storeys, respectively, suggesting that the HOS with marginal increase in total concrete volume can perform effectively for taller structures.

Assessing the Validity of the Centers for Medicare & Medicaid Services Measure in Identifying Potentially Preventable Emergency Department Visits by Patients With Cancer.

The Centers for Medicare & Medicaid Services (CMS) implemented chemotherapy measures (OP-35) to reduce potentially preventable emergency department visits (PPEDVs) and hospitalizations. This study evaluated the validity of the OP-35 measure in identifying PPEDVs among patients with cancer. This is a cross-sectional study, which used data from the 2012-2022 National Hospital Ambulatory Medical Care Survey. ED visits are assessed and compared on the basis of three measures: immediacy using Emergency Severity Index (ESI), disposition (discharge v hospitalization), and OP-35 criteria. Between 2012 and 2022, a weighted sample of 46,723,524 ED visits were made by patients with cancer. Among reported ESI cases, 25.2% (8,346,443) was high urgency. In addition, 30.3% (14,135,496) of ED visits among patients with cancer led to hospitalizations. Using the OP-35 measure, it was found that 20.85% (9,743,977) was PPEDVs. A 21.9% (10,232,102) discrepancy between discharge diagnosis (CMS billing codes) and chief complaints was identified. Further analysis showed that 19.2% (1,872,556) of potentially preventable ED visits (CMS OP-35) were high urgency and 32.6% (3,181,280) resulted in hospitalization. The CMS approach to identifying PPEDVs has limitations. First, it may overcount preventable visits by including high-urgency or hospitalization-requiring cases. Second, relying on final diagnoses for retrospective preventability judgment can be misleading as they may not reflect the initial reason for the visit. In addition, differentiating causes for ED visits in patients with cancer undergoing various treatments is challenging as the approach does not distinguish between chemotherapy-related complications and others. Identification inconsistencies arise because of varying coding practices and chosen preventable conditions, lacking consensus and alignment with specific hospital or patient needs. Finally, the model fails to consider crucial nonclinical factors like social support, economic barriers, and alternative care access, potentially unfairly penalizing hospitals serving underserved populations.