Proper Selection Research Articles

Computed Tomography Overuse in Pediatric Minor Head Trauma: Insights from a Single-Center Experience.

Minor head trauma is a common reason for emergency department visits in children, but many of these cases are not clinically significant. Despite established criteria for selecting patients who require computed tomography (CT), concerns about overuse of CT persist. This study aimed to determine the frequency of clinically important traumatic brain injury by retrospectively evaluating cranial CT scans in children categorized as very low risk for such injuries based on PECARN prediction rules. Cranial CT scans of 941 minor head trauma cases were assessed for the presence, type, and number of calvarial bone fractures. Concomitant bleeding and treatment approaches were also recorded. Among 881 patients (93.6%), cranial CT scans did not reveal any lesions apart from soft tissue edema. None of the cases had clinically important traumatic brain injury or required neurosurgical intervention. The study demonstrated that 93.6% of cranial CT scans for pediatric minor head trauma were negative, indicating a concerningly high rate of CT overuse. Although prediction rules exist, their application in clinical practice is not always optimal. Given the principle of "first, do no harm," proper patient selection is crucial to avoid unnecessary exposure to ionizing radiation.

Environmentally Sustainable Endoscopy Practices

AbstractClimate change affects each and every one of us and has far reaching consequences. As healthcare providers and responsible citizens, it is our duty to make our practices environmentally sustainable. Endoscopy practice involves frequent use of single-use items, resource-heavy decontamination practices, water consumption, patient and staff travel as well as high electricity consumption. The present review highlights the measures that can be taken to reduce the carbon footprint of endoscopy practice. Proper waste management, judicious use of electricity, proper selection of cases for anesthesia and biopsy, and appropriate use of noninvasive tests in practice are discussed in the review.

Optimization of Bolted Joints: A Literature Review

Bolted joints are widely used in the aerospace and automotive industries due to their ease of assembly, disassembly and design flexibility. Optimizing threaded fasteners is essential to achieve uniform load distribution and minimize the number of bolts required, thereby reducing system cost and weight. This review paper aims at summarizing the five optimization techniques available in the literature, including bolt layout, tightening strategies, tightening sequences, bolt size, and stresses. The purpose is to emphasize the importance of optimizing bolted joints via the proper selection of materials, geometry, patterns, and bolt sizes, to obtain efficient joints with low assembly time while maintaining strength.

The role of the phase-change material properties, porosity constant, and their combination for melting problems using the enthalpy-porosity scheme

This study investigates the effects of consistently altering the PCM thermophysical properties, the porosity constant, and their combination on the accuracy of melting models. To the best of the authors’ knowledge, this is the first systematic evaluation of this coupled effect, which challenges a common literature practice: to validate the model and use it with another PCM or in a completely different scenario. To this end, a mathematical model is formulated and numerically solved with Ansys® Fluent, being validated with two experimental datasets, comprising distinct geometries and PCM properties. Initially, the discussion centers on the alteration of the porosity constant, revealing its sensitivity in both isothermal and non-isothermal PCMs, with a more pronounced influence in materials exhibiting a mushy region. Subsequently, the effect of altering the parameters included in the Boussinesq approximation was assessed, being shown that a proper selection of the coefficient of thermal expansion is more critical than that of density, altering the liquid fraction in 7.5% and 0.5%, respectively. The phase-change temperature also influenced the results, with a 6.9% higher deviation when switching from the liquidus to the average solidus–liquidus temperature. Furthermore, it was evidenced that, by holding the porosity constant of validation in another geometry, deviations as high as 38.0% could be achieved, whereas this error could be reduced to 5.7% with a proper adjustment. This discrepancy may be even greater if the PCM is altered, leading to unclear results. Lastly, the study provides valuable insight suggesting that, as natural convection intensifies, reducing the porosity constant can mitigate errors. These findings hold practical significance for models developed using the enthalpy-porosity scheme, emphasizing the importance of careful consideration when extending the model applicability beyond the validation conditions.

Analysis of the Influence of External Wall Material Type on the Thermal Bridge at the Window-to-Wall Interface.

Although many works focus on increasing the energy efficiency of buildings, there are still a number of problems that need to be solved, such as reducing heat losses at the window-to-wall interface, especially since the requirements for saving energy used for heating/cooling rooms are constantly increasing. This paper analyses the impact of the material parameters of the external wall and the window installation in the insulation layer on the size of thermal bridges around the window. The aim of the work is to demonstrate the benefits resulting from the correct installation of the window, the appropriate location of the window in relation to the face of the external wall, as well as the correct selection of construction materials. In order to show the improvement in the energy efficiency of buildings, an analysis of the heating/cooling energy consumption was carried out for the selected buildings. The thermal and humidity analyses were carried out using TRISCO program, while the economic analysis was performed using the Audytor OZC program. It was found that the proposed system of window installation in the thermal insulation layer reduced the annual heating demand by at least 10% on average. It has been shown that the method of window installation and the type of the wall structural materials are interrelated and therefore should be considered simultaneously. Their proper selection allows for a reduction in the amount of energy needed for heating and cooling buildings, and thus a reduction of heating/cooling costs, as well as limiting greenhouse gas emissions.

Multibody model of the human-inspired robot CHARMIE

The rapid ageing of the worldwide population raises pressing concerns related to ensuring proper healthcare and quality of life for older adults. A human-like mobile domestic robot, named CHARMIE, is being produced to aid in these situations by performing household chores, thus increasing the autonomy of persons with mobility limitations. The present work provides a valuable contribution to the development of CHARMIE by building a simulation environment that computes the system’s main dynamics. The obtained environment is used to evaluate the quality of the robot’s control system, to perform its structural optimization and to allow a proper selection of actuators. The system is tackled as a kinematic tree that starts on the robot’s base and then splits into three branches at the torso: the left arm, the right arm, and the head. The multibody model solves the forward kinematics and inverse dynamics of the main mechanisms by employing two recursive algorithms centred around the Newton–Euler formulation. A novel, modular, and efficient seven-step methodology was created to implement these two algorithms and program a simulator from start to finish. These seven steps include studying the system’s configuration, converting its properties into software inputs, and computing the phenomena that cannot be automatically addressed by the two recursive formulations. The presented methodology was fully validated by comparing its results to those obtained from a commercial software; the two models produced identical results.

Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells

ObjectivesTo investigate the effect of three different calcium silicate-based materials (CSBM) on the biological behavior of human periodontal ligament stem cells (hPDLSCs).MethodsEluates of Biodentine, NeoPutty and TheraCal PT prepared at 1:1, 1:2, and 1:4 ratios were extracted under sterile conditions. The cytotoxicity of the extracts to the hPDLSCs was assessed using the MTT assay. Scratch wound healing assay was utilized for assessing cell migration. Scanning electron microscopy was used to detect cell attachment and morphology. Calcium ion release was measured using inductively coupled plasma-optical emission spectrometry; the pH-value was evaluated with a pH-meter. ANOVA with post hoc Tukey test was used for statistical analysis.ResultsCell viability was significantly higher for Biodentine and NeoPutty at day 1 with all dilutions (p < 0.05), while at day 3 and day 7 with dilutions 1:2 and 1:4; all materials showed similar behavior (p > 0.05). Biodentine had the highest percentage of cell migration into the scratched area at day 1 for all dilutions (p < 0.05). Stem cells were attached favorably on Biodentine and NeoPutty with evident spreading, and intercellular communications; however, this was not shown for TheraCal PT. Biodentine showed the highest pH values and calcium ion release (p < 0.05).ConclusionsThe resin-free CSBM showed better performance and favorable biological effects on hPDLSCs and were therefore considered promising for usage as endodontic repair materials.Clinical significance: Proper selection of materials with favorable impact on the host stem cells is crucial to ensure outcome in different clinical scenarios.

Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study

IntroductionUrinary tract infection (UTI) is the second most common infectious disease affecting more than 150 million people globally annually. Uropathogenic E. coli (UPEC), the predominant cause of UTI, can occur as a biofilm associated with antimicrobial resistance (AMR). There is a data gap on global AMR patterns from low-income settings, including Tanzania. Data on antimicrobial susceptibility patterns in relation to biofilm formation will help in the proper selection of antibiotics and the fight against AMR.MethodsThis analytical cross-sectional study was conducted among consecutively selected outpatients (n = 344) from January to May 2022 at Morogoro Regional Referal Hospital. Mid-stream urine samples were collected aseptically from symptomatic patients. A significant UTI was defined when more than 105 colonies/ml of urine were recorded. Kirby Bauer’s disc diffusion method was used for antibiotics susceptibility patterns and a Congo Red Agar method was used to determine biofilm formation. Two-sided χ2 test or Fisher’s exact test, Cohen’s kappa coefficient and logistic regression were used for data analysis. A p-value < 0.05 was considered statistically significant.ResultsThe prevalence of UTIs was 41% (141/344) and elders (>=60 years) had five times higher odds of having UTI as compared to adolescents (p < 0.001). E. coli was the most predominant bacteria (47%; 66/141), which displayed moderate susceptibility against ciprofloxacin (59.1%) and nitrofurantoin (57.6%). A total of 72 (51%) of all isolated bacteria were multi-drug resistant. All isolated bacteria demonstrated high resistance (> 85%) against ampicillin and co-trimoxazole. In this study, 51.5% (34/66) were biofilm-forming E. coli and demonstrated relatively higher antibiotic resistance as compared to non-biofilm forming bacteria (p < 0.05).ConclusionWe report high antibiotic resistance against commonly used antibiotics. Slightly more than half of the isolated bacteria were biofilm forming E. coli. A need to strengthen stewardship programs is urgently advocated.

T4 Lung Carcinoma with Infiltration of the Thoracic Aorta: Indication and Surgical Procedure.

Lung carcinomas infiltrate the aorta mostly on the left side and are altogether rare. As an initial step, complete staging is performed and the results are evaluated in an interdisciplinary tumor board. If the patient's general condition including cardiopulmonary reserves is sufficient, and if there is neither distant metastasis nor an N2 situation, surgical resection may be indicated. The option for neoadjuvant chemotherapy should always be taken into consideration. Depending on the anatomic tumor location, partial lung resection and resection of the affected aortic wall are performed employing a cardiopulmonary bypass. The resected aortic wall is replaced by a vascular prosthesis. In recent years, this proven procedure has partly been replaced by an alternative one, avoiding extracorporeal circulation. An endoaortic stent is implanted in the affected area followed by partial lung resection and resection of the diseased aortic wall. This new procedure has significantly reduced perioperative mortality and morbidity. With proper patient selection, long-term survival can be improved even in this complex malignoma.

Sunspot Occurrence Forecasting With Metaheuristic Optimized Recurrent Neural Networks

Solar activity plays an important role when considering terrestrial communication. Solar activity plays an even more important role when working with communication systems relying on artificial satellites. Electromagnetic emissions, known as solar flares, can disrupt communications and damage important infrastructure. However, as powerful solar flares are often preceded by observable occurrences of sunspots, a robust system prognosis system can be leveraged to help improve chances of minimizing damage to infrastructure. This work explored the potential of recurrent neural networks coupled with an introduced modified metaheuristics algorithm to tackle the increasingly pressing challenge of forecasting solar activity based on historical data. Due to the heavy reliance of neural networks on proper parameter selections as well as adequate architectural structure, the introduced optimizer is leveraged for the optimization of these control parameters. The proposed approach is evaluated on a real-world dataset that is publicly available. The outcomes are compared to several well-established optimization metaheuristics, and the outcomes show great promise for tackling this increasingly important topic as we head into the peak of the current solar cycle.

Thermal damage analysis of sub-surface soft tissue sarcoma for indocyanine green mediated photothermal cancer therapy

Photothermal therapy is a minimal invasive technique to treat tumors situated near the skin or other light accessible organs. Here, a photothermal agent is delivered to tumor either intratumorally or intravenously and the tumor is irradiated with near infrared (NIR) radiation to generate heat for thermal damage of tumor. In this paper, thermal damage of soft tissue sarcoma, a type of sub-surface forearm tumor, is evaluated for photothermal therapy using numerical simulations. Indocyanine green (ICG) is used as photothermal agent and the effect of various spatial distributions and doses of ICG for sub surface tumors located at various depths (3–6 mm) were investigated. Further, numerical simulation is validated experimentally through tumor-tissue mimicking phantoms. Computations were performed in MATLAB software using Lattice Boltzmann method and validated through experiments using tumor-tissue mimicking phantoms. Results show that the thermal damage region (damage parameter (Ω) of magnitude 4.6) was enlarged on increasing the concentration of ICG while it got shrunk for the deeper tumors. Computations reveal that ICG concentration of 50 μg/mL is optimum, for intravenous distribution, for photothermal therapy with minimal damage to surrounding tissue. It is found that irradiation duration of more than 900 s is required to achieve the complete damage of tumor. For the case of deeper tumors, about 1200 s of exposure is required, at irradiation intensity of 0.25 W/cm2. This study provides a numerical approach to determine therapeutic parameters and demonstrates the thermal damage for subsurface tumors through ICG mediated photothermal therapy by proper selection of therapeutic parameters.

TESTING THE BREAKING FORCE OF ROCKET PROJECTILE SUSPENSIONS TO PARACHUTE

Design of a recovering system is one of crucial tasks in development work over the rocket projectiles. Properly designed recovering system secures the recovery of testing projectile after firing in undamaged state, what significantly reduces the time and cost of conducted tests. A parachute with its fixation to a projectile which has to be recovered are key components of the recovering system providing its proper operation. Due to the presence of high values of forces acting at the parachute opening and deacceleration of the object the proper selection of suspension is important factor for its efficient recovery. The paper present tests of breaking force for various types of suspensions connecting the object and the parachute.

Comparative analysis of conventional and modern high-rise hotels in Penang based on hourly simulation of cooling load performance using DesignBuilder

The study examines the energy efficiency performance of hotel façades in relation based on the annual cooling energy consumption simulation. In achieving the objective, two case studies of high-rise city hotels are selected within the locality of Penang, Malaysia. The case studies are selected based on the year of construction coupled with the architectural styles encompassing conventional and modern design of hotel facades. In the traditional design of hotel facades, passive design elements including proper selection of window and wall materials alongside window-to-wall ratio (WWR) are less significant. Comparatively, elements of passive design in the modern hotel facades are notable. In assessing the thermal performance of the hotel façade, a case study of the conventional and modern high-rise city hotels in Penang are selected to undergo hourly cooling load simulation of hotel guestroom using the DesignBuilder program in establishing the hotel’s energy efficiency performance. The findings revealed, the average annual cooling energy of the conventional and modern high-rise city hotel guestroom is 553 kWh/m2 and 538 kWh/m2 respectively. The study concludes the elements of passive design including WWR, window material selection, and external wall colour are crucial in determining energy efficient hotel operations.

POWER QUALITY IMPROVEMENT FOR INDUSTRIAL CONNECTED POWER SYSTEM

Power quality is a critical aspect of electrical supply systems, especially in industrial settings where the operation of sensitive equipment and manufacturing processes heavily relies on stable and high-quality electrical power. This paper presents an overview of the challenges associated with power quality in industrial loads and explores various solutions aimed at improving it. Industrial loads are prone to various power quality issues, including voltage sags, harmonic distortions, voltage fluctuations, and transient disturbances. These issues can lead to production downtime, equipment damage, and increased operational costs. To address these challenges, a multifaceted approach is required. This paper discusses several strategies for power quality improvement in industrial loads. These strategies encompass both proactive and reactive measures. Proactive measures include proper equipment selection, load balancing, and the use of power factor correction devices to reduce harmonic distortions and improve overall system efficiency. Reactive measures involve the installation of protective devices such as surge suppressors and voltage regulators to mitigate the impact of voltage sags and transient events. Furthermore, the paper explores the role of advanced technologies such as Dynamic Voltage Restorers (DVRs) in rapidly correcting voltage sags and enhancing power quality. It also emphasizes the significance of real-time monitoring and data analytics for identifying power quality issues and optimizing load management. Key Words: Power quality, Power quality issues, harmonic distortions, Dynamic Voltage Restorers (DVRs),

Ontology-Based Food Menu Recommender System for Patients with Coronary Heart Disease

Coronary heart disease is one of the leading causes of death. Knowledge of dietary patterns and proper food selection is an effort to address the risk and support coronary heart disease's healing process. Therefore, this study developed a food menu recommender system as a reference for patients with coronary heart disease. The recommender system is crucial in creating a proper dietary pattern for managing personalized meal plans. The system calculates the required nutritional needs of users. Ontology is used to represent knowledge about nutrition data and food intake. The ontology base with Semantic Web Rule Language (SWRL) enables the system to identify the most suitable foods for patients with coronary heart disease. We use SWRL rules to generate recommendation conclusions based on the existing ontology. Using this language enhances the descriptive logic capabilities, as the rules can overcome the limitations of the ontology language. Therefore, the system is built to find food menu options that match the required nutrition for patients. The nutritionist knowledge will be used to measure the system's performance compared to the recommendations made by nutritionists. From the user data sample, 150 recommended food menu data were obtained. The validation performance results obtained a precision 0.893, recall 1, and F_Score 94.3%.

Erudition from primary posterior sagittal anorectoplasty for anorectal malformations over two decades.

Perioperative and early post-operative outcomes of Primary Posterior sagittal anorectoplasty (P-PSARP) were evaluated. Retrospective analysis of cases who underwent P-PSARP from 2004 to 2019 was done. Perioperative care, management, complications, voluntary bowel movement, soiling and constipation, graded by Krickenbeck criteria were studied. One hundred fifty six patients (134 girls) underwent P-PSARP at median age of 5months (3months to 14years) in girls and 5(1-10) days in 21 boys. One male cloaca was operated at 5months age. Of 20 boys, 5, 8, 4, 3 had rectobulbar urethral fistula, rectoprostatic urethral fistula, bladder neck fistula and male cloaca. Girls had vestibular fistula, rectovaginal fistula, vulval anus, anterior ectopic anus, pouch perineal fistulae and posterior anus with H type fistula in 114, 7, 6, 5, 1 and 1. Complications included wound infection, excoriation, oedema, mucosal prolapse, anal stricture, anal retraction and mortality in 6, 4, 5, 4, 4, 1 and 1, respectively. 35/155(12 neonates) required postoperative dilatations for 5(1-12) months. At follow-up, 96/114(84.2%) had voluntary bowel movements. 46/155 (29.7%) and 9/155 had constipation and soiling. 32:14:0 had grade 1:2:3 constipation, treated with diet (grade 1) and laxatives (grade 2) respectively. 4:3:2 had grade 1:2:3 soiling for initial 3months, treated with bowel management programme. P-PSARP is feasible, subject to proper case selection and good perioperative care, once learning curve is achieved.

Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis.

Persistence in drug therapy reflects treatment effectiveness and tolerability. We aim to estimate the persistence of apremilast prescribed to patients with psoriatic arthritis (PsA) and to identify characteristics associated with treatment discontinuation in a real-world setting. Patients with PsA treated with apremilast from January 2016 were identified from a large health database and followed until medication stop date (using 3-months grace period), death or the end of observation period (June 2021). Demographic data, Charlson comorbidity index and concomitant and previous use of conventional and biologic DMARDs were extracted. The reasons for drug discontinuation were manually retrieved from patient charts. Time to discontinuation was estimated using survival analysis using Kaplan-Meier functions. Overall, 568 PsA patients treated with apremilast were identified. The mean age was 55.3±14.0 years, of whom 332 (58.5%) were females, 38.4% were obese (BMI>30), 75.2% had a Charlson comorbidity index>1, 24.1% were on concomitant treatment with methotrexate and 72.4% were biologic naïve. The median persistent period was 6.1,95% CI (5.2-6.9) months in which only 16.9% remained persistent on apremilast. No difference was found with regard to age, sex, socioeconomic status, ethnicity and obesity between patients who were persistent compared to patients who discontinued apremilast. Concomitant treatment with methotrexate and prior history of biologic therapy did not affect drug persistency (log rank P=0.957 and 0.082, respectively). Causes for treatment discontinuation were due to lack of skin efficacy in 19.4%, lack of joint efficacy in 33.3%, combined skin and joint inefficacy at 2.3% and due to side effects in 24.1%. In this large observational retrospective cohort of patients treated with apremilast, a relatively low drug persistence was observed with 6-month and 1-year survival rates of 50.3% and 31.3%, respectively. Treatment discontinuation was mainly due to joint inefficacy, advocating for more studies for proper patient selection to assure treatment effectiveness and persistency.

Joint User Scheduling and Precoding for XL-MIMO Systems With Imperfect CSI

We propose an algorithm for joint precoding and user scheduling in multiple-input multiple-output systems with extremely-large aperture arrays, assuming realistic channel conditions and imperfect channel estimates. The use of statistical channel state information (CSI) for user scheduling, and a proper selection of the set of users for which CSI is updated allow for obtaining an improved achievable sum spectral efficiency. We also confirm that the effect of imperfect CSI in the precoding vector design and the cost of training must be taken into consideration for realistic performance prediction.

MnO2 nanotube/GO composite anode for high performance lithium-ion capacitor

Li-ion capacitors (LICs) have emerged as promising energy storage devices within the electronic industry. The performance of LICs is predominantly influenced by the electrode material utilized, making the proper selection and development of said material of utmost importance. This study focuses on fabricating a composite electrode material using a simple, cost-effective, and environmentally friendly technique, combining Manganese dioxide (MnO2) nanotube and graphene oxide (GO). The low cost, high natural abundance, and high theoretical specific capacity (1230 mAh/g) of MnO2 enables it to be effectively used in energy storage systems. The resulting material showcases a distinctive architecture where MnO2 nanotube nanorods are enveloped by GO nanosheets. By employing a binder-free buckypaper approach, the MnO2 nanotube/GO composite anode exhibits exceptional electrochemical performance, including high energy (213.29 Wh/kg) and power density (28.5 kW/kg), improved rate capability, and excellent cyclic stability. These findings undoubtedly indicate a promising future for the MnO2 nanotube/GO composite anode in lithium-ion-based energy storage systems.

FPGA Based Efficient OFDM Based Design and Implementation for Data and Image Transmission for Healthcare

Enormous growth in telecommunication industry demands for high speed data transmission with better quality of service (Qos). The telecommunication networks are offering the services which is from 1 Mbps to several Mbps of speed. However, most of the existing techniques address to assure the very high speed data for multimedia communication. The multimedia data may find a suitable application in healthcare system. The OFDM modulation technique promises to provide the multimedia services at rather high speed using the spectrum more efficient compared traditional scheme like TDMA, FDMA. The orthogonality of carriers eliminates the interference among the closely packed carriers and offers comparatively efficient bandwidth. The OFDM design requires choosing proper parameter selection. Important feature of OFDM is that the multipaths are effectively eliminated by choosing a higher cyclic prefix values which, gives significant results but causing more energy loss. This paper presents an efficient design for OFDMtransceiver by using FPGA. The design is modeled and simulated using Matlab Simulink and finally the design is coded using Verilog RTL and simulated in modelsim and synthesizing and implementation is done using in Xilinx EDA tool. The image type of data is taken for transmission in the proposed OFDM transceiver system. The received image type data achieves PSNR value of 29.920dB and the binary input data achieves 36.06% improvement in power utilization and less area overhead. The paper also shows the improvement in area and power compared to existing authors.