Specific Reasons Research Articles

Study on stable configurations and snap through of the rectangular VS bi-stable laminates with curvilinear fiber alignment

With advances in fiber placement technology, variable stiffness bistable laminates (VSBL) composited by curvilinear fiber format become a subject of intense interest for morphing structures due to their lower weight, adjustable stiffness and a richer range of stable configurations compared to straight fiber bistable laminate. Merely conducting research on square laminates is not enough allowing for practical application scenarios. This article investigates the influence of geometrical parameters of VSBL on the stable state configuration and static snap through actuated by MFC systematically. A quadratic variable curvature polynomial is used to fit the transverse displacement according to classical laminate theory. By means of von-Karman geometrical relationship and the Rayleigh-Ritz method, stable configurations of the VS bistable laminate are solved. By comparing with finite element results, the reliability and precision of the current results are verified. It shows that changing fiber orientation leads to significant effects on the steady state configuration and critical bifurcation points. Theoretical analysis of VS bistable laminates containing the smart piezoelectric material MFC is followed by analytical modeling. The voltage threshold required for actuating snap through of two stable states is acquired by smart material layer MFC. The specific reasons for the differences in the configurations of VS bistable laminates are illustrated by analyzing distribution of the stiffness of VSBL in the plane.

حضرت عمرؓ کے خطبات سے اخذ شدہ احکام و مسائل: ایک علمی و تحقیقی مطالعہ

History is a witness to the fact that in the nature of the Arabs there was harshness, national struggle and rebellion against the royal order, but after taking shelter in the shade of Islam and receiving the grace of the companionship of the Prophet ﷺ, the heart of the Arabs became faithful. They became famous and they became possessors of high morals and character, but those who converted to Islam in the last days of the Prophethood had some traces of ignorance left in their hearts, which could not get rid of this ignorance even with the passage of time. As soon as Hazrat Umar took over the caliphate, he did not neglect his subjects in any way; there was no work that was hidden from him. The hearts of the people were greatly affected by your fear and terror, and the workers were very afraid of you, even the most rebellious could not say anything in front of you. Hazrat Umar's life is full of struggle, courage and strength, patience and steadfastness, judicial piety and humility, knowledge, insight and foresight, and the special reason for this was that during the caliphate of Hazrat Umar, the cultural condition of the Arabs changed.

Two hundred years of indigenous literature in South Africa

As far back as the 1860s, Tiyo Soga wrote about the need to collect and write stories about African pasts so that they could be deposited in newspaper archives, which could become a ‘big corn pit’ of knowledge for the nation. His biographer noted that he was sometimes up after midnight in a hut, ‘notebook in hand’, learning from ‘wrinkled countrymen of his own’ about the past. Izibongo zoogxa, a compilation of some of the writings of Samuel Edward Krune (S.E.K.) Mqhayi, one of the most important figures in the history of Xhosa literature, is part of the multigenerational harvest that Soga envisaged, and there are two special reasons to celebrate its publication.

Theorizing Laughter and Ethnicity in Philo’s Embassy to Gaius

Abstract Philo’s Embassy to Gaius (Legat.) narrates anti-Jewish violence in Alexandria (38–41 CE) and the experiences of a Jewish embassy sent to the Roman emperor Gaius to advocate for the rights of Jews in the city. Philo repeatedly brings up laughter during key episodes, using it to characterize his figures and situations, particularly along ethnic lines. Philo suggests that Egyptians have an inherent proclivity toward derision of Jews, whereas Romans only join in this unjust mockery when they inappropriately allow Egyptians to hold influence over them. In doing so, he establishes a narrative that places the blame of the crisis in Alexandria from 38–41 CE firmly on Egyptians and Egyptianness. In this article, I take Philo as a theorist of laughter, following Eva Mroczek’s arguments for “native theory” and Mary Beard’s work on ancient laughter. Taking up Eve Kosofsky Sedgwick’s interrogation of theories as constructed tools with specific effects, I ask what Philo’s theory of laughter does for him. Ultimately, I argue that Philo’s theorization of laughter supports a specific ethnic reasoning, in Denise Kimber Buell’s language, that condemns Egyptianness while exonerating Romanness, perhaps in an attempt to endear his own Jewish community to the Romans who controlled Alexandria.

Experimental study on combustion characteristics of engineered bamboo considering smoldering and self-extinction

Bamboo and wood materials have the characteristics of low carbon and high strength, making them the best building material for building green buildings. Compared to traditional building materials, the easy to burn characteristic has become an obstacle to the promotion and widespread application of bamboo and wood materials, so it is urgent to study their combustion characteristics. This article investigated the combustion characteristics of engineered bamboo at different heat fluxes, taking into account the smoldering and self-extinction characteristics through cone calorimeter experiments. The combustion performance, mass loss rate, heat release rate, etc. were studied, and the self-extinction phenomenon of the specimens was explored. The results indicated that the direction of heating had a certain impact on the combustion characteristics of glued laminated bamboo (LBL), and the fire resistance of parallel strand bamboo (PSB) was better than that of LBL. When the heat flux exceeded 50 kW/m2, the color of the flame on the surface of the specimen would change from bright yellow to strong orange, which is an important sign that the flame will self-extinguish. The self-extinction of flames at different heat fluxes was caused by insufficient supply of combustible gas generated by bamboo pyrolysis, with slightly different specific reasons. The multi-layer structure of glued laminated bamboo also makes it more difficult to self-extinguish than PSB, cross-laminated timber (CLT), and solid wood is the most prone to self-extinguish. The impact of adhesive layer delamination was not considered in this experiment, and further research is needed.

WP7.6 - Unplanned Re-admisisons - How are we doing; Phase 1 study

Abstract Introduction 30-day unplanned re-admissions provide an indicator of performance in the NHS Framework. Average readmission rate is around 15 to 17%, however surgical re-admission is less published. Therefore, a study was set up to assess the factors influencing surgical re-admissions in a Tertiary Centre. Methods Retrospective study of prospectively collected data from the tertiary centre database including all ‘Unplanned Re-admissions’(URA) aged >15 years in general surgery between January and December 2022. URA <15 years old and to other surgical specialties were excluded. ANOVA test and descriptive statistics were used to analyse the data. Results 289 (58%) of 498 readmissions were URA with 150 (52%) female and 139 (48%) male. 57 (19%) were aged 15-30 years, 121 (42%) 31-60 years, 109 (38%) 61-90 years and 2 > 90 years (Median age 54 years; p<0.05). 191 (66%) were from ED, 84 (29%) were GP referrals, 10 (3%) from clinics and 4 (2%) transferred from network. 178 (62%) URA were within 10 days of discharge, 72 (25%) between 11-20 days and 39 (13%) > 20 days (p < 0.05). The commonest cause of URA was biliary diseases (n = 40, 14%) followed by lower (n=32, 11%) and upper abdominal pain (n=17, 5%) and nonspecific abdominal pain (n=22, 7%). Other causes included appendicitis (n=8, 3%), pancreatitis (n=8, 3%), post-op complications (n=14, 5%) and obstruction (n=24, 8%). Conclusions URA significantly impacts health care provision and patients’ confidence. An initial study has identified reasons and patterns of re-admissions, the next phase involves analysing specific reasons to mitigate factors leading to URA.

The Development of Marketing Plan for a Virtual Cycling Application: A Case Study of China (Beijing)

Background and Aims: Due to the COVID-19 pandemic, people's social activities have been greatly affected, so online activities have seen rapid development and user growth. become the norm. In cycling, the China Cycling Association canceled or postponed several races, affecting cyclists across the country. This is because the mass gatherings and high crowd density associated with such events increase the risk of virus transmission. Because of this, bicycle virtual riding software has developed rapidly, and users have increased rapidly. In addition, the evolving metaverse concept has prompted increased investment in bicycle virtual riding software development. This study explores and analyzes the operation plan of bicycle virtual riding software in China (Beijing) and analyzes the specific needs of Chinese people. Methodology: The main research methods include SWOT analysis, user stories, and population research. Use competitive product analysis such as SWOT analysis to study the specific reasons why other products cannot be promoted and popular in China (Beijing). Collect the main channels for users to obtain information and determine product promotion plans. And conduct user demand research, establish user portraits, and finally propose feasible solutions. Results: The main findings are the difficulties in promoting virtual bicycle riding software in Beijing, China, the reasons why the currently popular software is difficult to promote, the travel habits and consumption willingness of residents, and a complete promotion plan. Conclusion: The study sheds light on factors impeding the adoption of popular software already in use and clarifies the travel habits and consumption attitudes of the locals in Beijing, China. It also highlights challenges in promoting virtual bicycle riding software in Beijing. It provides insights into creating a strong promotion strategy to overcome the obstacles found and increase the adoption of virtual bicycle riding technology through in-depth analysis.

Factors associated with cause-specific discontinuation of long-term anti-tumor necrosis factor agent use in patients with ankylosing spondylitis: a retrospective cohort study

ObjectTo investigate the factors associated with cause-specific discontinuation of long-term anti-tumor necrosis factor (TNF) agent use in patients with ankylosing spondylitis (AS).MethodsAS patients who initiated first-line anti-TNF treatment between 2004 and 2018 and continued treatment for at least two years were enrolled in the study. Enrolled patients were observed until the last visit, discontinuation of treatment, or September 2022. Reasons for discontinuation of the first-line anti-TNF agent were categorized into the following: (1) clinical remission, (2) loss of efficacy, (3) adverse events, and (4) other reasons including loss to follow-up, cost, or reimbursement issues. A cumulative incidence function curve was used to visualize the cumulative failure rates over time for each specific reason. Univariable and multivariable cause-specific hazard models were utilized to identify factors associated with cause-specific discontinuation of the first-line anti-TNF agent.ResultsA total of 429 AS patients was included in the study, with 121 treated with adalimumab (ADA), 176 with etanercept (ETN), 89 with infliximab (INF), and 43 with golimumab (GLM). The median overall survival on the first-line anti-TNF agent was 10.6 (7.9–14.5) years. Among the patients, 103 (24.0%) discontinued treatment, with 36 (34.9%) due to inefficacy, 31 (30.1%) due to clinical remission, 15 (14.6%) due to adverse events, and 21 (20.4%) due to other reasons. Patients treated with ETN had a lower risk of discontinuation due to clinical remission compared to those receiving ADA (hazard ratio [HR] 0.45 [0.21–0.99], P = 0.048). Higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; HR 1.31 [1.04–1.65], P = 0.023) and INF use were linked to a higher risk of treatment discontinuation for inefficacy compared to ADA use (HR 4.53 [1.45–14.16], P = 0.009). Older age was related to an increased risk of discontinuation due to infection-related adverse events (HR 1.07 [1.02–1.12], P = 0.005), and current smoking was a risk factor for discontinuation due to other reasons (HR 6.22 [1.82–21.28], P = 0.004).ConclusionAS patients on their first anti-TNF treatment for at least two years demonstrated a favorable long-term treatment retention rate, with a 24.0% discontinuation rate over a 10.6-year overall survival period. The predictors for discontinuation varied by causes, underscoring the complexity of treatment response and the importance of personalized approaches to treatment management.

Modifiable and Non-Modifiable Factors That Affect Human Milk Oligosaccharides Composition.

Human milk, the gold standard in infant nutrition, is a unique fluid that provides essential nutrients such as lactose, lipids, proteins, and free oligosaccharides. While its primary role is nutritional, it also protects against pathogens. This protection mainly comes from immunoglobulins, with human milk oligosaccharides (HMOs) providing additional support by inhibiting pathogen binding to host cell ligands. The prebiotic and immune-modulatory activity of HMOs strongly depends on their structure. Over 200 individual structures have been identified so far, with the composition varying significantly among women. The structure and composition of HMOs are influenced by factors such as the Lewis blood group, secretor status, and the duration of nursing. HMO profiles are heavily influenced by maternal phenotypes, which are defined based on the expression of two specific fucosyltransferases. However, recent data have shown that HMO content can be modified by various factors, both changeable and unchangeable, including diet, maternal age, gestational age, mode of delivery, breastfeeding frequency, and race. The first part of this overview presents the historical background of these sugars and the efforts by scientists to extract them using the latest chromatography methods. The second part is divided into subchapters that examine modifiable and non-modifiable factors, reviewing the most recent articles on HMO composition variations due to specific reasons and summarizing potential future challenges in conducting these types of studies.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

Treatment trends in patients with de novo metastatic prostate cancer in the era of upfront combination therapy.

The objective of this study is to assess the trends in treatment selection for patients with de novo metastatic castration-sensitive prostate cancer in the era of upfront combination therapy. This multicenter retrospective study included 595 patients treated with either upfront combination therapy (upfront novel hormonal therapies and taxane-based chemotherapy) or vintage therapy (androgen deprivation therapy with or without bicalutamide) between 2016 and 2021. High tumor burden metastatic disease was defined when a patient met the CHAARTED or LATITUDE criteria. We evaluated trends in treatment selection and reasons for selecting vintage therapy. Of the 595, 123 and 472 patients were classified as having low and high tumor-burden disease, respectively. The Use of upfront combination therapy was found to be rapidly increasing with utilization rates of 72% and 54% in 2021 for high and low tumor-burden disease, respectively. Multivariable logistic regression analysis found older age, poor performance status, and nonacademic center were significantly associated with the selection of vintage therapy. Of the 163 patients who received vintage hormone therapy after approval of upfront therapy, 74.2% had a specific reason for avoiding upfront therapy. The reasons for selecting vintage therapy included refusal (39.8%), older age (67.6%), frailty (56.3%), and comorbidity (40.8%). Furthermore, 16.9% of patients declined upfront combination therapy due to cost concerns. Upfront combination therapy use has 72% and 54% prevalence among patients with high and low tumor burden diseases, respectively, in this current practice. Older age, poor performance status, and facility bias were negatively associated with the use of upfront combination therapy.

Modeling interactions in a dynamic heuristic business network

This article presents a novel model for understanding the structure and dynamics of business networks, emphasizing the role of propensities to connect and cooperate as key drivers. The model incorporates behavioral elements and imperfect information updates, departing from traditional rational actor approaches. Starting from the theoretical background, several propositions are outlined, such as dynamism, connection choices, costs, strategy selection, information update, and the update based on experiences. Through simulations, the study successfully demonstrates that the proposed model effectively captures essential characteristics of business networks, including reciprocity, complexity, adaptation, and cooperation. The findings highlight the significance of propensities to connect and cooperate in shaping network structure, evolution, and stability. Particularly, higher propensities to cooperate and connect lead to denser and more cohesive networks, fostering reciprocity, stability, and network performance. The increase only in connection propensities does not have the same result. The lower cooperation propensities result in scale-free networks and asymmetrical distribution of cumulative payoffs. This highlights a crucial insight: different levels of cooperation lead to distinct network properties. Practical implications, increasingly relevant with the rise of digital platforms and metaverse, suggest targeted interventions to enhance network effectiveness, such as incentivizing cooperation, reducing relationship costs, and promoting a culture of trust and collaboration. While providing valuable insights, certain limitations exist, such as not considering the influence of preexisting economic or social structures, equalizing costs and payoffs among actors, and overlooking specific reasons for network connections. Future research should address these refinements and explore their effects on network structure and process characteristics.

Relevansi Batas Usia Perkawinan di Indonesia: Perspektif Madzhab Syafi’i dan Kompilasi Hukum Islam

This research is motivated by the existence of age limits for marriage in Indonesia. The aim is for the common good in building a household built through a marriage bond, although in reality, early marriage can still be carried out by submitting a marriage dispensation through the courts for specific reasons. The focus of this research is: (1) How is the argument of the Syafi'i school of thought about the age limit for marriage; (2) How is the age limit for marriage in the Compilation of Islamic Law (KHI); and (3) The relevance of the age limit for marriage in Indonesia from the perspective of the Syafi'i School of Thought and the Compilation of Islamic Law. The type of research used in this research is library research, namely by using data from books or books that are in accordance with the title of the research as a source of study, along with reviewing and reading writings and books that are related to the object of discussion. The approach used by researchers in this writing is normative, in the sense of trying to examine the law that has been conceptualized as rules and norms that have been applied in society and become a legal reference for everyone. The results of this study, in the view of the Syafi'i School, the age limit for marriage is seen from maturity, namely when he has reached puberty. Among the signs for someone who has reached puberty is the release of semen for men, usually at the age of 12 years, and menstruation for women, usually at the age of 9 years, because for someone who has reached the nature of puberty and aqil, it means that they have become ahliyah al-ada' who can be burdened with the responsibilities of sharia such as muamalah and other transactions. On the other hand, the Compilation of Islamic Law has provided an age limit for marriage, namely 19 years for men and 16 years for women, because Indonesian scholars see several factors that limit the age of marriage, such as avoiding early marriage, which has a terrible impact on married couples. Regarding its relevance in its implementation in Indonesia, the age limit for marriage in the Compilation of Islamic Law has been determined. However, if you still want to marry under the age that has been determined, you must go through a trial process to request a marriage dispensation from the panel of judges. The opinion of the Syafi'i School can be a choice that can be considered by the panel of judges to approve a marriage dispensation, namely the adequacy of the age of puberty as one indicator of maturity.

The Utility of a Comprehensive Hip Fracture Program: Readmission Rates May Not Be a Reasonable Marker of Success.

Introduction This study evaluates the effectiveness of a comprehensive hip fracture protocol, with a focus on specific readmission reasons. Methods A retrospective cohort study of hip fracture patients aged 60 and older who underwent surgery before (control) and after (intervention) implementation of a comprehensive hip fracture program. Objectives included identifying readmission reasons and rates, time to operating room (TOR), length of stay (LOS), reoperation, and mortality rates. Logistic regression was utilized to determine significance. Results One hundred and sixty-three patients (control) vs. 238 patients (intervention) were identified. The intervention group had higher odds of 90-day readmission for a medical reason (OR = 1.735, p = 0.028). Thirty-three out of forty-two patients (79%) in the control group and 68/78 patients (87%) in the intervention group were readmitted secondary to a medical reason (pulmonary etiology being the most common). Surgical-related readmissions (surgical site infections and dislocations are most common) were lower in the intervention group compared with the control group, with 10/78 patients (13%) and 9/42 patients (21%), respectively. Twenty-four-hour TOR was achieved in 125 patients (52.5%) in the intervention group vs. 70 patients (42.9%) in the control group. LOS was shorter by 1.1 days for the intervention group (p = 0.010). Mortality was lower in the intervention group. Discussion A comprehensive hip fracture protocol can reduce LOS, TOR, mortality rate, and even surgical-related readmissions. Readmission rates are mainly due to medical problems, which may be unavoidable and thus may not be an adequate hip fracture effectiveness metric. Potential areas of improvement and additional study may include closer internal medicine oversight and primary care follow-up after discharge.

Analysis Product Control in Minimizing Skincare Product Returns (Case Study on Pt. CBD)

PT. CBD is a company that imports and distributes skincare cosmetics from Korea. The product distribution process flow often results in product returns which cause losses for the company. For this reason, this research aims to analyze the most specific reasons for product returns and find out the factors that cause product returns. Of the total number of returns, there were 14,901 pcs in 2022 and the largest return was in the Sheetmask (CA-10) category, 6,574 pcs. To minimize this, the Seven Tools and 5W1H methods are used . After further research, it was discovered that the results obtained showed that the most specific reason for returns was due to aging stock or goods with a shelf life of more than 3 months with the highest percentage of product returns being 51%, while the company's safe return limit must not exceed 15%. The main factor is that these returns are caused by human factors, namely lack of employee discipline regarding SOPs due to incorrect stock monitoring analysis methods or lack of control over the delivery of goods, so they have to carry out product planning properly and then create a checksheet to control the incoming and outgoing goods.

Design and Development of A Semi-airborne Transient Electromagnetic System

The semi-airborne transient electromagnetic method (SATEM) is a geophysical method that combines the advantages of high-power ground-based transmitting and efficient airborne observation. In recent years, the threshold for SATEM application significantly reduced through the integration of the multi-rotor UAVs and the systems obtained by simple redevelopment of existing ground-based systems. However, it is still difficult to obtain good detection results with such systems for the following specific reasons: in terms of system design, there is a lack of method for estimating the key parameters of the system, resulting in the designed system being unable to effectively meet the requirements of the SATEM method and observation scenarios; in terms of technology, there is a lack of effective means of ensuring a high signal-to-noise ratio (high-current transmitting and effective suppression of major external noise) while meeting the demand for distortion-free observation. In response to these issues, a system bandwidth estimation method based on the analysis of information-carrying capacity is proposed. On this basis, the solutions for large current and fast turn-off transmitter and for overcoming major external noise. Through a survey located in a karst landform area, and the overall application performance of the system is discussed based on the inversion results.

Analyzing the Decline of Luxury Women’s Shoe Brands in China: A Market Analysis – Based Study of STUART WEITZMAN

The luxury goods industry has always been a highly anticipated area in the market. With the development of the global economy and the improvement of people's living standards, the luxury goods market has also flourished. However, overall, according to the quarterly or fiscal annual reports released by major luxury brands in the luxury industry in recent years, their common characteristic is the sharp decline in revenue in China; from a regional perspective, the decline in sales in China has the greatest impact on the decreasing total revenue of brands over the years. Such as STUART WEITZMAN, the representative head luxury women's shoe brand, total direct sales, which include stores and e-commerce, in FY23 both declined by as much as 24% compared to FY22. This article takes STUART WEITZMAN as an example to study the specific reasons for the decline in sales volume of luxury in China market in recent years compared to previous years. This study uses the market mix model to analyze STUART WEITZMAN 's marketing strategy in the market, Using the PEST model to analyze the macro environment, Use SWOT to analyze the internal and external environment of STUART WEITZMAN. Research has found that the main reason for the decline in luxury goods sales in recent years is luxury brands have been raising prices, and consumers are psychologically unable to accept the increasing premium. The middle class is more inclined to consider practicality and cost-effectiveness, pursuing the ultimate cost-effectiveness. Secondly, consumers have more other options. In addition to luxury brands, high-end niche brands, designer brands, high-end custom brands, and traditional Chinese brands have also begun to be favored by luxury consumers. Finally, in the post pandemic era, outbound tourism has resumed, and consumers can purchase the same products overseas at more favorable prices.

COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive. To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak. A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023. The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity. Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis. A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10). In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.

Effectiveness of pharmacological treatments for severe agitation in real-world emergency settings: protocol of individual-participant-data network meta-analysis

BackgroundSevere psychomotor agitation and aggression often require immediate pharmacological intervention, but clear evidence-based recommendations for choosing among the multiple options are lacking. To address this gap, we plan a systematic review and individual-participant-data network meta-analysis to investigate their comparative effectiveness in real-world emergency settings with increased precision.MethodsWe will include randomized controlled trials investigating intramuscular or intravenous pharmacological interventions, as monotherapy or in combination, in adults with severe psychomotor agitation irrespective of the underlying diagnosis and requiring rapid tranquilization in general or psychiatric emergency settings. We will exclude studies before 2002, those focusing on specific reasons for agitation and placebo-controlled trials to avoid concerns related to the transitivity assumption and potential selection biases. We will search for eligible studies in BIOSIS, CENTRAL, CINAHL Plus, Embase, LILACS, MEDLINE via Ovid, PubMed, ProQuest, PsycINFO, ClinicalTrials.gov, and WHO-ICTRP. Individual-participant data will be requested from the study authors and harmonized into a uniform format, and aggregated data will also be extracted from the studies. At least two independent reviewers will conduct the study selection, data extraction, risk-of-bias assessment using RoB 2, and applicability evaluation using the RITES tool. The primary outcome will be the number of patients achieving adequate sedation within 30 min after treatment, with secondary outcomes including the need for additional interventions and adverse events, using odds ratios as the effect size. If enough individual-participant data will be collected, we will synthesize them in a network meta-regression model within a Bayesian framework, incorporating study- and participant-level characteristics to explore potential sources of heterogeneity. In cases where individual-participant data are unavailable, potential data availability bias will be explored, and models allowing for the inclusion of studies reporting only aggregated data will be considered. We will assess the confidence in the evidence using the Confidence in Network Meta-Analysis (CINeMA) approach.DiscussionThis individual-participant-data network meta-analysis aims to provide a fine-tuned synthesis of the evidence on the comparative effectiveness of pharmacological interventions for severe psychomotor agitation in real-world emergency settings. The findings from this study can greatly be provided clearer evidence-based guidance on the most effective treatments.Systematic review registrationPROSPERO CRD42023402365.

Effect of pectineus muscle plane block versus femoral nerve block for postoperative analgesia and early recovery after knee surgery: a randomised controlled trial study protocol

BackgroundFemoral nerve block (FNB) is a prevalent method used for postoperative pain management after knee surgery; however, it decreases the strength of the quadriceps muscle and is not conducive to...