Probabilistic Fracture Research Articles

Association of secondhand smoke with fracture risk in community-dwelling nonsmoking adults in Korea.

Although the detrimental effects of active smoking on bone health have been widely recognized, the impact of secondhand smoke exposure on fracture risk in non-smokers remains less understood. A total of 4843 nonsmokers aged 40-69yr, who participated in the Korean Genome and Epidemiology Study from 2001 to 2018, were analyzed. The participants were categorized into two groups based on their exposure status to secondhand smoke: currently exposed and unexposed. The exposure group was subsequently divided into two subgroups based on the median weekly exposure time (high vs low). The incidence of new fractures was determined using self-reported questionnaires. The identified fractures were categorized according to the fracture site: overall, vertebral, hip, non-vertebral, and non-vertebral non-hip fractures. The mean age of the participants was 52.4yr (84.1% women). Exposure to secondhand smoke was associated with an increased risk of fracture (adjusted hazard ratio [aHR]: 1.27, P =0.028) after adjusting for multiple covariates including age, sex, BMI, household income, bone density of mid-shaft tibia, C-reactive protein, alcohol consumption, and fracture history. Secondhand smoke remained as a significant risk factor for fracture, independent of the major osteoporotic fracture probabilities estimated using a fracture risk assessment tool (aHR: 1.24, P =0.038). The high exposure group had higher risk of fracture than that of the unexposed group (aHR: 1.33, P =0.025), whereas the fracture risk did not differ significantly between low exposure and unexposed groups (aHR: 1.18, P =0.253), suggesting a potential dose-response relationship. Secondhand smoke showed robust association with increased risk of non-vertebral (aHR: 1.37, P =0.008) or non-vertebral non-hip fractures (aHR: 1.36, P =0.013), while its association with vertebral fracture was attenuated (aHR: 1.03, P =0.908). Secondhand smoke was associated with an elevated risk of fracture in nonsmokers, independent of clinical risk factors.

Fracture probability of PV mono-Si wafers in diamond wire slicing due to coupling of capillary adhesion bending stress and sawing stress

Fracture probability of PV mono-Si wafers in diamond wire slicing due to coupling of capillary adhesion bending stress and sawing stress

Ultrasonic fatigue of unfilled and carbon nanotube (CNT) reinforced polyetheretherketone (PEEK)

Fatigue properties of polyetheretherketone (PEEK) and multiwall carbon nanotube (CNT) reinforced PEEK were investigated with the ultrasonic fatigue testing method. Lifetimes were measured in the high and very high cycle fatigue regime at resonance frequency 19 kHz and load ratio R = -1. Pulse-pause loading served to avoid specimen self-heating and led to effective cycling frequencies in the range from several hundred Hz to about two kHz. Stress amplitude for 50 % fracture probability at 109 cycles is 21.2 ± 4.3 MPa for unreinforced PEEK (22 % of its tensile strength) and 33.5 ± 3.5 MPa for CNT reinforced PEEK (33 % of its tensile strength). Servohydraulic fatigue tests at 22 Hz with CNT reinforced PEEK delivered fatigue lifetimes comparable to ultrasonic tests, i.e. no frequency effect and no influence of load versus displacement control was observed. Keeping specimen temperature far below the glass transition temperature, ultrasonic fatigue testing of a high temperature resistant plastic was successfully implemented.

Study on the Relationship between Crack Initiation and Crack Bifurcation in Walnut Shells Based on Energy

Clarifying the dissipated energy required for crack expansion is an effective way to control material crushing. Therefore, based on the material fracture probability model and fractal theory, the energy range required for crack extension was determined, and the morphology of the cracks was quantified. This study investigates the influence of walnut size on crack propagation characteristics; this includes its effects on the crack initiation threshold energy, representing resistance to crack initiation, and the crack bifurcation threshold energy, representing resistance to crack bifurcation. The results show that crack extension has a well-defined threshold energy below which cracks do not initiate or bifurcate. The size of walnuts significantly impacts crack propagation characteristics, showing that both crack initiation threshold energy and crack bifurcation threshold energy decrease with increasing walnut sizes. In addition, there is a positive correlation function between the crack initiation threshold energy and the crack bifurcation threshold energy. The experimental results can offer fresh insights into material fracture prediction and serve as a reference for numerical simulations.

Regional CT value in prediction of proximal femoral fracture

To investigate CT values of cancellous bone in femoral neck in adults over 60 years with proximal femoral fractures. From January 2020 to December 2020, a retrospective analysis was performed on 280 subjects aged 60 years or older who underwent bilateral hip CT examination, including 85 males and 195 females, 120 on the left side and 160 on the right side, aged 75 (66, 82) years old. One hundred thirty-six patients with proximal femoral fractures were included in study group and 144 patients without fractures were included in control group. GEOptima CT was used to scan and reconstruct horizontal, coronal and sagittal layers of proximal femur. CT values of cancellous bone in femoral neck were measured and compared between two groups. The relationship between CT values of cancellous bone of femoral neck and proximal femoral fracture was analyzed statistically. In terms of age, fracture group aged 79(73.3, 85.0) years old, non-fracture group aged 69.5 (64.0, 78.8) years old, and had significant difference in age between two groups (P<0.05). In terms of CT value, regional CT value in fracture group was 8.62(-3.62, 27.15) HU, which was lower than that in non-fracture group 34.31(-5.93, 71.74) HU(P<0.05). CT value on coronal view in fracture group was -8.48(-30.96, 17.46) HU, which was lower than that in non-fracture group 40.49(5.55, 80.71) HU (P<0.05). CT value on sagittal view in fracture group was -31.28(-54.91, -5.11) HU, which was lower than that in non-fracture group 7.74(-20.12, 44.54) HU (P<0.05). CT values on horizontal view in fracture group was 0.17(-23.13, 24.60) HU, which was lower than that in non-fracture group 46.40(10.42, 85.18) HU(P<0.05). The mean regional CT values among three planes in the fracture group were lower than those in the non-fracture group. Logistic regression analysis showed coronal CT value was influencing factors of proximal femoral fracture, and it could be written into regression equations that predict probability of fracture. In adults aged over 60 years old, CT values of cancellous bone of femoral neck decreased with increasing age. The smaller CT value of cancellous bone of femoral neck, the greater risk of proximal femoral fracture.

Fracture prediction in rheumatoid arthritis: validation of FRAX with bone mineral density for incident major osteoporotic fractures

Abstract Objectives FRAX uses clinical risk factors, with or without BMD, to calculate 10-year fracture risk. RA is a risk factor for osteoporotic fracture and a FRAX input variable. FRAX predates the current era of RA treatment. We examined how well FRAX predicts fracture in contemporary RA patients. Methods Administrative data from patients receiving BMD testing were linked to the Manitoba Population Health Research Data Repository. Observed cumulative 10-year major osteoporotic fracture (MOF) probability was compared with FRAX-predicted 10-year MOF probability with BMD for assessing calibration. MOF risk stratification was assessed using Cox regression. Results RA patients (n = 2099, 208 with incident MOF) and non-RA patients (n = 2099, with 165 incident MOF) were identified. For RA patients, FRAX-predicted 10-year risk was 13.2% and observed 10-year MOF risk was 13.2% (95% CI 11.6, 15.1). The slope of the calibration plot was 0.67 (95% CI 0.53, 0.81) in those with RA vs 0.98 (95% CI 0.61, 1.34) in non-RA patients. Risk was overestimated in RA patients with high FRAX scores (&amp;gt;20%), but FRAX was well calibrated in other groups. FRAX stratified risk in those with and without RA [hazard ratio (HR) 1.52 (95% CI 1.25, 1.72) vs 2.00 (95% CI 1.73, 2.31)], with slightly better performance in the latter (P for interaction = 0.004). Conclusions FRAX predicts fracture risk in contemporary RA patients but may slightly overestimate risk in those already at high predicted risk. Thus the current FRAX tool continues to be appropriate for fracture risk assessment in RA patients.

Sarcopenia in Egypt: epidemiology of sarcopenia risk among older adults presenting with fragility fractures—an initiative by the Egyptian Academy of Bone Health

Purpose(1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture.ResultsTwo hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p < 0.05) between the functional disability score and the SARC-F score. This was persistent when assessed in relation to fall risk.ConclusionThis study highlighted the high sarcopenia risk in the patients presenting with fragility fractures. Identification of patients at increased risk of sarcopenia should be a component of the standard practice.

Probabilistic analysis of operational ice damage for Polar class vessels using full-scale data

To ensure the safety of maritime operations in polar waters, the IMO enforced the International Code for Ships Operating in Polar Waters (Polar Code) in 2017. To address ice navigation related risks, the Polar Code refers to a set of guidelines known as the Polar Operational Limit Assessment Risk Indexing System (POLARIS). Following POLARIS, operational limits for ice navigation are defined based on the Risk Index Outcome (RIO) value, which takes into account the prevailing ice conditions and the ice class of a ship.Recent studies indicate that the POLARIS guidelines are well-founded. However, no direct relationship between RIO values and the probability of an ice-induced hull structural damage has been established. To enable a more accurate analysis of ice navigation risks, this article addresses this issue by (i) relating measured ice-induced loads to RIO values corresponding to the ice conditions in which the loads were measured, (ii) calculating the load limits for plastic deformation and rupture of the ice belt of hull structures representing different ice classes, and (iii) defining the probability of structural damage for different load limits. The study utilizes long-term full-scale ice load measurements carried out onboard Polar Supply and Research Vessel (PSRV) S.A. Agulhas II in the Antarctic Ocean. The load limits were calculated for ice class standards, PC3, PC4, PC5, PC6, and PC7 in accordance with the Unified Requirements of the International Association of Classification Societies (IACS).On a general level, the results are consistent with earlier findings indicating that the POLARIS guidelines are well-founded. If a ship operates mainly at ‘normal operation’ level, the probability for fracture at hull are at probability levels of 10-3 and 10-4 for ice classes PC3 to PC5. The probability levels for PC6 and PC7 are higher that is possibly a result from conservative load probability distributions. When the portion of operations at ‘special consideration’ level becomes significant, the probability of fracture at the hull increases significantly. However, large ice thicknesses and the largest load magnitudes may be associated with positive RIO values. Some inconsistencies are recognized, and the uncertainty and limitations of the analysis are discussed.

Dual Energy X-ray Absorptiometry: Radiographer'S Role in Assessing Fracture Risk Assessment Tool (FRAX) Questionnaire Variables

Background: The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® anamnestic questionnaire by the radiographer without impact on the clinical workflow.Methodology: We evaluated the accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm before and after specific training. A total of 100 women were enrolled in the study. The radiographer preliminarily administered the FRAX® questionnaire to all subjects before the execution of the DXA examination. After the end of the examination, a radiologist administered the questionnaire to the patient. Women were divided into two groups: group A (pre-training) and group B (post-training). The radiographer in group A completed the FRAX® questionnaire for the patients before training. For group B, the same radiographer completed the FRAX® questionnaire after training. The results of the FRAX® questionnaire completed by radiographer were compared with that completed by the referring physician.Results: Before training, radiographer's accuracy ranged from 92% (question 7, alcohol consumption) to 36% (question 6, secondary osteoporosis). After training, accuracy values improved substantially, ranging from 100% to 92%. Analysis of the absolute values of FRAX® showed that in the pre-training group data tended to be overestimated by the radiographer, with both major and fractures probabilities being significantly higher when assessed by the radiographer (12% and 5.8%, respectively). After the training, there was a marked decrease in the variation between the FRAX® data calculated by the radiographer and the radiologist.Conclusions: The accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm is significantly improved after a specific training period. This study demonstrates the importance of dedicated training radiographers on the FRAX® algorithm.

Effects of Running in Minimal, Maximal and Conventional Footwear on Tibial Stress Fracture Probability: An Examination Using Finite Element and Probabilistic Analyses

This study examined the effects of minimal, maximal and conventional running footwear on tibial strains and stress fracture probability using finite element and probabilistic analyses. The current investigation examined fifteen males running in three footwear conditions (minimal, maximal and conventional). Kinematic data were collected during overground running at 4.0 m/s using an eight-camera motion-capture system and ground reaction forces using a force plate. Tibial strains were quantified using finite element modelling and stress fracture probability calculated via probabilistic modelling over 100 days of running. Ninetieth percentile tibial strains were significantly greater in minimal (4681.13 με) (p &lt; 0.001) and conventional (4498.84 με) (p = 0.007) footwear compared to maximal (4069.65 με). Furthermore, tibial stress fracture probability was significantly greater in minimal footwear (0.22) (p = 0.047) compared to maximal (0.15). The observations from this investigation show that compared to minimal footwear, maximal running shoes appear to be effective in attenuating runners’ likelihood of developing a tibial stress fracture.

Research on Material Selection Method and Brittle Fracture Mechanism of High-Pressure Pipeline

Aiming at the problem of the brittle fracture of pressure pipeline, the elastic constraint structure is described by using members and engineering building structures, and the concept of elastic constraint is proposed. Through the stress field analysis of the pressure pipeline under internal pressure, it is found that the pressure pipeline under internal pressure is an elastic constraint structure. The elastic constraint effect is applied to the pressure pipeline to explore the influence of elastic constraint effect on the brittle fracture of pressure pipeline. The critical wall thickness and limit load of different materials are calculated by the limit bearing formula. Through simulation analysis of materials with different yield ratios and pipelines with different wall thicknesses of the same material (yield ratio is the ratio of yield strength to tensile strength), it was found that pressure pipelines made of the same material have an increased load-bearing capacity as the wall thickness increases, but their own elastic constraint effects are becoming more obvious, and the probability of the brittle fracture of the pipeline is higher. When the wall thickness of pressure pipelines made of materials with different yield ratios is certain, the lower the yield ratio is, the more likely the pipeline is to generate plastic deformation and the larger the deformation capacity is; the higher the yield ratio, the poorer the plastic deformation capacity of the pipeline and the smaller the deformation capacity. Pipelines with large yield ratio are more sensitive to the brittle fracture than those with small yield ratio.

Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions

Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm.

Effect of BMI-Discordant Abdominal Tissue Thickness on Fracture Probability: A Registry-Based Study.

FRAX, which is used to assess fracture probability, considers body mass index (BMI), but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by dual-energy X-ray absorptiometry (DXA) and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (<-2 cm, -2 to -1 cm) to higher (1-2 cm, >+2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR = 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects before age 65 years (HR = 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes, there was also increased risk for those in the lowest ATI category (HR = 1.73, 95% CI 1.12-2.65 for MOF; 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not found in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Classification of Osteoporosis.

Osteoporosis is defined by low bone quality, strength and increased fracture risk. Primary and secondary osteoporosis are the two forms of osteoporosis classified on the basis of factors affecting the metabolism of bone. Primary osteoporosis develops as a result of aging or menopause-related bone demineralization. Type I/postmenopausal and type II/senile osteoporosis are two subtypes of primary osteoporosis. Secondary osteoporosis is due to pathological conditions and medications other than aging and menopause that lead to deprivation of bone mass and elevated fracture risk. Classification of osteoporosis based on BMD testing with DEXA devised by the World Health Organization utilizes T-score in BMD reporting of women in menopausal transition or postmenopause and men ≥ 50 years. Z-scores are preferred, while BMD reporting in premenopausal women, adults < 50 years of age, and children. BMD alone is not diagnostic of osteoporosis in men < 50 years. The Fracture Risk Assessment Tool Model (FRAX) is a software algorithm that incorporates significant predictors of fracture risk and BMD in individuals to predict the risk of fracture. FRAX predicts the "10-year probability of a major fracture (hip, clinical spine, humerus, or wrist fracture) and the 10-year probability of a hip fracture".

Effect of Race/Ethnicity on United States FRAX Calculations and Treatment Qualification: A Registry-Based Study.

Since 2008. the United States has had four race/ethnic fracture risk assessment tool (FRAX) calculators: White ("Caucasian"), Black, Asian, and Hispanic. The American Society for Bone and Mineral Research Task Force on Clinical Algorithms for Fracture Risk has been examining the implications of retaining race/ethnicity in the US FRAX calculators. To inform the Task Force, we computed FRAX scores according to each US calculator in 114,942 White, 485 Black, and 2816 Asian women (self-reported race/ethnicity) aged 50 years and older. We estimated treatment qualification based upon FRAX thresholds (3% for hip fracture, 20% for major osteoporotic fracture [MOF]). Finally, we examined measures for a hypothetical population-based FRAX calculator derived as the weighted mean for the US population based upon US Census Bureau statistics. With identical inputs, the highest FRAX measurements were found with the White FRAX calculator, lowest measurements with the Black calculator, and intermediate measurements for the Asian and Hispanic calculators. The percentage of women with FRAX scores exceeding the hip fracture treatment threshold was 32.0% for White, 1.9% for Black, and 19.7% for Asian women; the MOF treatment threshold was exceeded for 14.9% of White, 0.0% of Black, and 3.5% of Asian women. Disparities in treatment qualification were reduced after considering additional criteria (fracture history and dual-energy X-ray absorptiometry [DXA] T-score -2.5 or lower). When fracture risk was recalculated for non-White women using the White FRAX calculator, mean values for Asian women slightly exceeded those for White women but for Black women remained substantially below those for White women. When using a single population-based FRAX calculator, the mean probability of fracture and treatment qualification increased for non-White women across the age range. In summary, use of a single population-based FRAX calculator, rather than existing US race/ethnic FRAX calculators, will reduce differences in treatment qualification and may ultimately enhance equity and access to osteoporosis treatment. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

A new FRAX model for Brazil

SummaryFracture probabilities derived from the original FRAX model for Brazil were compared to those from an updated model based on more recent regional estimates of the incidence of hip fracture. Fracture probabilities were consistently lower in the updated FRAX model. Despite large differences between models, differences in the rank order of fracture probabilities were minimal.ObjectiveRecent epidemiological data indicate that the risk of hip fracture in Brazil is lower than that used to create the original FRAX model. This paper describes the epidemiology of hip fracture in Brazil and the synthesis of an updated FRAX model with the aim of comparing this new model with the original model.MethodsHip fracture rates from three cities in three regions were combined, weighted by the population of each region. For other major fractures, incidence rates for Brazil were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Mortality estimates were taken from the UN.ResultsCompared to the original FRAX model, the updated model gave lower 10-year fracture probabilities in men and women at all ages. Notwithstanding, there was a very close correlation in fracture probabilities between the original and updated models (r > 0.99) so that the revisions had little impact on the rank order of risk.ConclusionThe disparities between the original and updated FRAX models indicate the importance of updating country-specific FRAX models with the advent of significant changes in fracture epidemiology.

Stress Analysis of Graphite Anode under Various Binder Conditions in a Multiparticle Model through Multiscale Simulation and Experimental Verification

Quantifying and analyzing the stress of the battery system at different levels are important for ensuring battery stability and performance. Herein, a three‐dimensional multiparticle model to evaluate the stress generated within the active material particles of battery due to the particle–particle and particle–binder interactions is developed. Variations in binder conditions, such as binder distribution, thickness, and radius, as well as Young's modulus, are introduced to investigate their effects on the mechanical stress of graphite particles in the battery. Herein, it is demonstrated that larger binder distributions, lower thicknesses, and smaller Young's moduli and radii reduce the maximum particle stress of graphite. Moreover, smaller binder distributions and Young's moduli along with larger thicknesses and radii reduce the maximum and average binder stress values. The interfaces between the particle–particle and particle–current collector are the typical maximum stress locations. The average stress data obtained are applied at the electrode level for comparison with the experimental stress value. The experimental and the model average stresses are comparable, indicating the credibility of our model. These findings have considerable implications for minimizing the mechanical stress and probability of electrode fracture in the battery electrode operation and fabrication processes.

Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse.

Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recent systematic literature review (searched in Cochran, Embase, PubMed and Sociological Abstracts), Güvensel questioned the diagnostic accuracy of rib fractures to be caused by abuse, due to lack of sufficient scientific evidence. Further, there is currently a world-wide disagreement between physicians considering themselves child abuse specialized, and physicians that explore non-abuse-related symptoms that may mimic physical abuse, which, it is hoped, will significantly reduce current unjustified child abuse diagnoses. In an attempt to help resolving this disagreement, we hypothesize that the probability of physical child abuse-related infant rib fractures is significantly lower than the probability of all other possible non-abuse-related causes of occult asymptomatic infant rib fractures, e.g., from birth trauma, prematurity, osteogenesis imperfecta, hypermobile Ehlers-Danlos Syndrome, severe chronic placental pathology (e.g., massive perivillous fibrin depositions and severe chronic histiocytic intervillositis), and vitamin-D deficiency. As method, we attempted to assess the incidence of these various causes of infant rib fractures, in the Netherlands and the USA. The results are that the estimated Dutch and USA physical abuse-related infant rib fracture incidences are at least about 250 and 45 times lower than the sum of all the non-abuse-related estimates. Because these latter rib fractures are occult and asymptomatic, it is likely that (many) more could be out there. In conclusion, occult asymptomatic rib fractures develop perinatally, virtually always as birth trauma, in infants with sufficiently weak bones due to vitamin D deficiency, transmitted by their vitamin D deficient pregnant mothers. This group also includes cortical rib cracks due to deformation forces, with an estimated 186/100,000 incidence. And, despite obvious uncertainties in all estimated incidences, we provided strong evidence that our hypothesis has relevance, implying that the abundant occult asymptomatic rib fractures, when found in infants, should not be used to assess potential physical child abuse.

Fragility Fracture of Pelvis Prediction from Computed Tomography Using Boring Survey and Convolutional Neural Network

Fragility fracture of pelvis (FFP) is increasingly affecting elderly population. Although computed tomography (CT) imaging is considered superior to conventional radiographic image for diagnosing FFP, clinicians face challenges in recognizing pelvic fractures owing to imaging contrast or feature size. This study proposes a method that combines boring survey based FFP candidate extraction from CT images and a newly developed convolutional neural network model. In addition, the proposed method also visualizes the probability of fracture on 3D bone surface data. The accuracy, precision, and recall of the proposed method were found to be 79.7%, 60.0%, and 80.6%, respectively. Furthermore, the 3D view of fracture probability on the pelvic bone surface allows for qualitative assessment and can support physicians to diagnose FFP. The findings indicate that the proposed method has potential for predicting FFP.

Estimation of Fracture Size and Probability Density Function by Setting Scanlines in Rectangular Sampling Window

Abstract Rock masses are very important materials in geotechnical engineering. In engineering rock mass, fracture is the relatively weak part of mechanical strength in rock mass and is the most important factor controlling the deformation, damage, and permeability of rock mass. Therefore, investigating fractures is very important for characterizing rock mass. This paper proposed a new approach by using uniformly equidistant orthogonal scanlines. Within the study context, the solution formula of fracture size is derived by establishing the space intersection model of arbitrary fracture and scanline, rectangular window, and a rectangular box with a rectangular window. Then, fractures were randomly generated in a certain size cube and compared with the traditional Kulatilake trace length integral evaluation method. The study results have shown that the proposed method is more reasonable and accurate. Then, this method was applied to an adit of Songta Hydropower Station. Finally, a new fracture diameter probability density estimation method was proposed, the fracture diameter of the normal distribution was verified, and the parameters of the probability density function obtained by the scanlines method were in agreement with the initial set parameters. In summary, the proposed scanlines method can well estimate the mean value of the fracture diameter and the probability density function of the fracture size.