Specific Protocol Research Articles

Compassionate Presence in Seriously Ill Cancer Patients.

Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.

Evaluating the Efficacy of Eccentric Half-Squats for Post-Activation Performance Enhancement in Jump Ability in Male Jumpers

The purpose of the present study was to investigate effect of post-activation performance enhancement (PAPE) induced by the eccentric half-squat exercise on vertical jump performance in male jumpers. The jumping height, peak power, and work were measured and evaluated in twenty male jumpers (age: 21.2 ± 1.7 years, height: 191.1 ± 3.3 cm, body mass: 81.56 ± 7.3 kg) who participated in the national championship last year. Participants performed five eccentric half-squats at 85% of their one-repetition maximum (1 RM), with a knee angle below 90°, followed by immediate and 2 min delayed jump assessments using the Squat Jump (SJ) and Countermovement Jump (CMJ) tests. Results showed that this specific PAPE protocol did not significantly improve jump performance for the SJ (Height: ES = 0.613, p = 0.462, Work: ES = 0.124, p = 0.231, Power: ES = 0.382, p = 0.125) or CMJ (Height: ES = 0.523, p = 0.368, Work ecc: ES = 0.133, p = 0.505 (only main effect time p < 0.05), Work con: ES = 0.114, p = 0.101, Power ecc: ES = 0.134, p = 0.177, Power con: ES = 0.182, p = 0.195, Leg stiffness: ES = 0.095, p = 0.358) tests. Factors such as stimulus specificity, rest intervals, muscle length, and the balance between potentiation and fatigue may explain these results. This study highlights the complexity of PAPE responses and suggests that a single set of eccentric squats with a short rest may not improve jump performance in male jumpers. Further research is required to optimize the interplay between conditioning stimuli and rest periods to maximize PAPE effects in athletic performance enhancement.

Ivabradine: Unraveling the intricacies of heart rate modulation in cardiovascular pathologies

Cardiac dysregulation, specifically perturbations in heart rate constitutes a pivotal factor influencing the morbidity and mortality associated with diverse pathological conditions including angina (chronic/stable), acute coronary syndrome, heart failure, renal failure, respiratory distress, chronic obstructive pulmonary disease, multiorgan dysfunction syndrome, mitral valve prolapse, and mitral stenosis. The pharmacological apparatus for heart rate control refined over decades encompasses various classes of agents each adhering to specific protocols. Among these Ivabradine has garnered attention as a non-inferior alternative to extant heart rate-reducing medications providing a subtle approach to cardiovascular therapeutics.

Optimization of a Photobiomodulation Protocol to Improve the Cell Viability, Proliferation and Protein Expression in Osteoblasts and Periodontal Ligament Fibroblasts for Accelerated Orthodontic Treatment.

Numerous pieces of evidence have supported the therapeutic potential of photobiomodulation (PBM) to modulate bone remodeling on mechanically stimulated teeth, proving PBM's ability to be used as a coadjuvant treatment to accelerate orthodontic tooth movement (OTM). However, there are still uncertainty and discourse around the optimal PBM protocols, which hampers its optimal and consolidated clinical applicability. Given the differential expression and metabolic patterns exhibited in the tension and compression sides of orthodontically stressed teeth, it is plausible that different types of irradiation may be applied to each side of the teeth. In this sense, this study aimed to design and implement an optimization protocol to find the most appropriate PBM parameters to stimulate specific bone turnover processes. To this end, three levels of wavelength (655, 810 and 940 nm), two power densities (5 and 10 mW/cm2) and two regimens of single and multiple sessions within three consecutive days were tested. The biological response of osteoblasts and periodontal ligament (PDL) fibroblasts was addressed by monitoring the PBM's impact on the cellular metabolic activity, as well as on key bone remodeling mediators, including alkaline phosphatase (ALP), osteoprotegerin (OPG) and receptor activator of nuclear factor κ-B ligand (RANK-L), each day. The results suggest that daily irradiation of 655 nm delivered at 10 mW/cm2, as well as 810 and 940 nm light at 5 mW/cm2, lead to an increase in ALP and OPG, potentiating bone formation. In addition, irradiation of 810 nm at 5 mW/cm2 delivered for two consecutive days and suspended by the third day promotes a downregulation of OPG expression and a slight non-significant increase in RANK-L expression, being suitable to stimulate bone resorption. Future studies in animal models may clarify the impact of PBM on bone formation and resorption mediators for longer periods and address the possibility of testing different stimulation periodicities. The present in vitro study offers valuable insights into the effectiveness of specific PBM protocols to promote osteogenic and osteoclastogenesis responses and therefore its potential to stimulate bone formation on the tension side and bone resorption on the compression side of orthodontically stressed teeth.

Wild Birds as Drivers of Salmonella Braenderup and Multidrug Resistant Bacteria in Wetlands of Northern Italy

In this study, the antimicrobial resistance profiles of bacterial strains obtained from wild avian species recovered in wetlands of Northern Italy were described. Cloacal swabs collected from 67 aquatic birds, hunted or found dead in two private hunting grounds, were submitted to microbiological investigations and antimicrobial susceptibility testing using the Vitek 2 system, while specific PCR protocols were applied to screen for genes associated with the resistance. One hundred fifty-seven bacterial strains were characterized. The most frequent isolates were Enterococcus faecalis (36/157; 22.9%) and Escherichia coli (23/157; 14.6%). Seventy-seven isolates (77/157; 49%) were resulted resistant to at least one antibiotic, and eight isolates (8/157; 5%) were classified as multidrug resistant bacteria. Resistance for critically important antibiotics (linezolid, vancomycin, carbapenems, third-generation cephalosporins, and fluoroquinolones) was also described. Salmonella spp. was obtained from a Eurasian teal (Anas crecca), and it was subsequently analyzed by whole genome sequencing, revealing the serovar Salmonella Braenderup ST22. The phylogenetic analysis, performed with all ST22 described in 2021 and 2022, placed the strain under study in a large clade associated with human salmonellosis cases. These results suggest that migratory aquatic birds may be considered as relevant carriers of critically important antibiotic resistant bacteria and zoonotic food-borne pathogens potentially able to impact public health.

Introduction: Sexual Harassment and Gender-Based Violence in Political Science Fieldwork

Political scientists recently have taken great strides in addressing sexual harassment and assault in the discipline. Little has been said, however, about sexual violence that political scientists may confront during field research. Field research involves any data-collection activity that occurs away from a researcher’s home institution, including visiting a prominent archive, interviewing political elites, and conducting direct observation of political phenomenon, and fieldwork is widely considered essential to data collection and career development across political science subfields. Field researchers may experience numerous power disparities that put them at acute risk for sexual or gender-based violence in the field, and evidence suggests that such experiences are pervasive and professionally devastating. In an effort to reduce gender-based violence and discrimination across academic worksites, several disciplines and institutions have developed specific guidelines and protocols to prevent and address sexual harassment and assault during fieldwork (Berkeley PATH to Care Center 2020; University of California, Riverside 2018; University of Toronto, Department of Anthropology 2019; Woodgate et al. 2018). Political scientists, however, have largely failed to conceptualize field placements as work settings or to address gender-based violence during fieldwork in our curriculum, training, and policies. Instead, they rely on deeply held methodological fallacies that insist on a field researcher’s absolute privilege, trivialize experiences of sexual violence, and weaponize rape myths to portray survivors as professionally incompetent (Hunt 2022).

First Description of the Occurrence of Slow Bee Paralysis Virus-1 and Deformed Wing Virus B in Apis mellifera ligustica Honeybee in Italy

Among the causes of bee colony death, viruses are among the number of pathogens that can contribute to the ill health of a colony. This study focuses on two of the several honeybee viruses, Slow Bee Paralysis Virus-1 (SBPV-1) and Deformed Wing Virus B (DWV-B), both belonging to the Iflavirus genus. To date, there is limited information available on the presence of these viruses in Italy. For this research project (IZS LT 04/19 RC), funded by the Ministry of Health, the presence and positivity of several honeybee viruses were evaluated in Italy using molecular methods. Convenience sampling was used, and these samples were analyzed for the two viruses and/or other main honeybee viruses, using specific PCR protocols and Sanger sequencing when necessary. A statistical analysis was conducted to study the independence between the viruses. Our data demonstrate for the first time the presence of SBPV-1 in Italian territory with a rather low number in most of the regions investigated, except for Emilia-Romagna and Lazio where it was detected more frequently, while DWV-B was detected at a higher level in all the regions investigated.

EMDR treatment for people with intellectual disabilities: a systematic review about difficulties and adaptations.

People with intellectual disabilities (ID) are at increased risk for developing Post Traumatic Stress Disorder (PTSD). Emerging evidence indicates that Eye Movement Desensitization and Reprocessing (EMDR) therapy is feasible and potentially effective for this group. However, communication, cognition, stress regulation, and attachment difficulties may interfere with the EMDR process. Adaptation of the EMDR protocol seems therefore required for this population. This review aims to systematically identify and categorize the difficulties in applying EMDR to people with ID and the adaptations made by therapists to overcome these challenges. A literature search was performed in May 2023. Article selection was based on inclusion and exclusion criteria and quality appraisal. After screening, 13 articles remained for further review. The identified difficulties and adaptations were categorized into the three domains of adaptive functioning (i.e., conceptual, social, and practical functioning). Considerable difficulties in applying the EMDR protocol for this group were reported. The adaptations made by therapists to overcome these difficulties were highly variable. They could be divided into three main categories: adaptions in EMDR delivery (e.g., tuning to the developmental level of the client, simplifying language, decreasing pace), involvement of others (e.g., involving family or support staff during or in between sessions), and the therapeutic relationship (e.g., taking more time, supportive attitude). The variability of the number of mentioned difficulties and adaptations per study seems to be partly related to the specific EMDR protocol that was used. In particular, when the Shapiro adult protocol was administered, relatively more detailed difficulties and adaptations were described than in publications based on derived existing versions of an EMDR protocol for children and adolescents. A probable explanation is that already embedded modifications in these protocols facilitate the needed attunement to the client's level of functioning. The authors of this review suggest that EMDR protocols for children and adolescents could be adapted for people with an intellectual disability. Further research should focus on the involvement of trusted others in EMDR therapy for people with ID and the therapeutic relationship from an attachment and relational-based perspective.

Automatic Protocolling of Non-contrast Musculoskeletal MRIs Does Not Result in Increase in Patient Recall Rates for Contrast-Enhanced Studies

IntroductionPhysicians spend large amounts of time on protocolling imaging studies, limiting their time spent on other essential clinical tasks. Most musculoskeletal (MSK) MRI studies are performed for the evaluation of joint pain and internal derangements and usually require no intravenous contrast. Contrast-enhanced MRI studies are performed for the evaluation of infection, suspected or established tumor, and rheumatological conditions. Protocolling all MSK MRI studies takes time away from other important tasks during the workday. Routine joint MRI scans have established set of sequences, and thus, could be scheduled and performed without special protocols by the radiologists. In a large tertiary care center like ours with multiple MRI magnets, we set up a process of automated protocoling and scheduling of non-contrast joint MRI scans ordered by referring doctors. This project's purpose was to assess the effect of this newly established process of ‘automatic protocoling and scheduling’ of MSK MRI scans on the rate of overlooked MRI exams that may have required contrast examinations, and on the patient recall-rate to obtain follow up post-contrast sequences for further diagnostic characterization. MethodsAll musculoskeletal reports of MRIs during the last two months of the years before and after the implementation of automatic protocolling (intervention) were searched for the presence of indications related to neoplasms, infections, and rheumatological conditions. For each of the three disease categories, we determined the number of MRIs obtained with and without contrast before and after the intervention. For each matching study obtained without contrast, the patient chart was reviewed for contraindications to contrast, positive final diagnosis, whether interpreting radiologist mentioned the exam being limited by lack of contrast, and recommendations for a follow-up contrast enhanced study. ResultsA total of 846 musculoskeletal MRIs were performed prior to intervention and 822 MRIs were performed afterwards. Overall, 25% of the studies were performed without contrast prior to the intervention, and 31% of studies were performed without contrast afterwards (Chi square 0.07, p-value 0.79). No report contained a recommendation for contrast enhanced follow-up study before or after the intervention. DiscussionAutomatic protocolling of routine MSK non-contrast MRI studies resulted in statistically insignificant, minimal increase in the overall number of non-contrast enhanced studies obtained for work up of neoplasms, infections, and rheumatological conditions. There was no increase in patient recall rate for additional post contrast sequences and the new process resulted in time savings to fellows and other physicians, being not distracted from other important tasks.

Antiviral discovery in toxic cyanobacteria: Low hanging fruit in the age of pandemics.

The power of novel vaccination technologies and their rapid development were elucidated clearly during the COVID-19 pandemic. At the same time, it also became clear that there is an urgent need to discover and manufacture new antivirals that target emerging viral threats. Toxic species of cyanobacteria produce a range of bioactive compounds that makes them good candidates for drug discovery. Nevertheless, few studies demonstrate the antiviral potential of cyanobacteria. This is partly due to the lack of specific and simple protocols designed for the rapid detection of antiviral activity in cyanobacteria and partly because specialized facilities for work with pathogenic viruses are few and far between. We therefore developed an easy method for the screening of cyanobacterial cultures for antiviral activity and used our private culture collection of non-pathogenic virus isolates to show that antiviral activity is a prominent feature in the cyanobacterium Microcystis aeruginosa. In this proof-of-concept study, we show that M. aeruginosa extracts from three different cyanobacterial strains delay infection of diatom-infecting single-stranded DNA and single-stranded RNA viruses by up to 2 days. Our work shows the ease with which cyanobacteria from culture collections can be screened for antiviral activity and highlights the potential of cyanobacteria as an excellent source for the discovery of novel antiviral compounds, warranting further investigation.

Determining cochlear implant candidacy in children with residual hearing: A scoping review

ObjectivesThe purpose of this review was to summarize what is known about criteria, assessments, and recommendations for evaluating cochlear implant (CI) candidacy in children with residual hearing. MethodsPeer-reviewed studies were identified through a systematic search in five electronic databases. Articles were screened and assessed for eligibility. From the eligible studies, data were extracted to summarize and present a narrative synthesis of the findings. ResultsA total of seven articles (two reviews and five primary studies) were included in the final analysis. Hearing levels better than the moderately severe to severe range (65–90 dB HL) tend to be supported as audiological candidacy criteria for pediatric CI. Recommendations for candidacy consideration based on audiologic thresholds range from 65 to 80 dB Hl pure-tone average as the lower boundary. Our review did not identify any specific assessment protocols. However, additional decision-making considerations related to borderline hearing loss configurations and assessment tools (the Speech Intelligibility Index and the Pediatric Minimum Speech Test Battery) were identified. Supplementary assessment considerations were also reported. ConclusionThere is limited information regarding specific assessment protocols for children with residual hearing. The literature is primarily focused on guidelines related to audiologic criteria, although it is widely recommended that other areas of functioning should also be considered. Most recommendations appear to be based on expert opinion, clinical expertise, and evidence from overall pediatric CI outcomes rather than empirical evidence targeting children with residual hearing. There is an ongoing need for research to further develop protocols and tools that can assist clinicians and families in making cochlear implantation decisions for children with residual hearing.

Self-reported prescribing behaviour of vitamin D prophylaxis in healthy children by Belgian paediatricians.

There is currently no consensus on the guidelines for vitamin D prophylaxis in healthy children. The purpose of this study was to investigate the prescribing behaviour of vitamin D prophylaxis among Belgian paediatricians. Between June and September 2022, a questionnaire was distributed by email to all Belgian paediatricians who are a member of at least one of three scientific or professional organisations, as well as to the heads of every Belgian paediatric or neonatal hospital ward. We analysed 426 completed questionnaires. All regions, age categories and subspecialties were represented. Vitamin D prophylaxis is always or frequently recommended by 98% of paediatricians. Fifty-eight per cent of paediatricians advise vitamin D prophylaxis up to the age of six years and 66% of paediatricians advise a daily dose of 400 IU. In nearly every hospital in Belgium (96%), there is a specific protocol for vitamin D prophylaxis for newborns; but not for the paediatric unit (only 30%). Nearly all Belgian paediatricians prescribe vitamin D prophylaxis to infants. Although not recommended by guidelines, 25(OH)D is frequently measured by paediatricians. Practices regarding duration and dosing of vitamin D prophylaxis show large variability. Most neonatal wards do have a protocol, whereas most paediatric wards do not.

Healthcare provider recognition of pregnancy related risks and management considerations in patients with tuberous sclerosis complex

BackgroundPatients with tuberous sclerosis complex (TSC) face an increased risk of maternal health complications and worsening disease manifestations during pregnancy. There are no established consensus guidelines that address the management of pregnancy in patients with TSC and healthcare providers rely on their individual experiences and preferences to derive treatment decisions. We sought to obtain provider opinion of pregnancy related maternal complications in patients with TSC, and the common evaluation and management strategies used to address these issues.MethodsWe conducted a cross-sectional survey of healthcare providers with diverse areas of expertise related to the multisystem nature of involvement in TSC. Descriptive analyses were used to analyze our three primary variables: (1) provider recognition of maternal risks/complications; (2) provider recommendations before and during pregnancy; and (3) provider/clinic protocols.ResultsWe received responses from 87 providers from 11 countries, with 40.7% (n = 35) seeing > 30 TSC patients yearly. The majority of providers (n = 70, 88.6%) deemed that a patient with TSC needed expert care beyond the standard of care for a typical pregnancy, with over 25% of providers reporting that they have seen lymphangioleiomyomatosis (LAM) exacerbation, seizures, and preterm labor in pregnant patients with TSC. Providers who managed patients treated with mTOR inhibitors (mTORi) also agreed that mTORi use should be stopped prior to pregnancy (n = 45, 68.2%) but there was uncertainty about when to stop the mTORi (one month 28.9%, two months 11.1%, three months 42.2%, and 6–12 months 2.2%). Additionally, there were mixed opinions on restarting mTORi in response to disease progression during pregnancy. When asked about provider or clinic specific protocols, 71.6% (n = 53) of providers stated that they do not have a clear protocol for management decisions for patients with TSC before or during pregnancy.ConclusionHealthcare providers recognize that patients with TSC are at an increased risk for maternal health complications during pregnancy. However, there are wide inter-individual variances in practice, especially pertaining to decisions regarding mTORi use. There is a critical need to better understand the implications of pregnancy for patients with TSC, and to draft consensus recommendations to guide management decisions.

Systematic review on social/moral competence interventions in Physical Education

Abstract Study aim: This systematic review drew the significant findings of carefully selected interventions to promote the social and moral competence (SC and MC, respectively) of children and adolescents mostly by investigating the effect of these interventions and focusing on strategies used. Material and methods: A number of English written, electronic databases (e.g., EBSCO, EBSCOhost Web, ERIC, Master FILE Premier, SPORT, SPORT Discus, and Web of Science) and grey literature – from 2005 to the present – were consulted from September 2021 to December 2021. School-based intervention studies that assessed moral competence (MC) or social competence (SC) were eligible for inclusion. The studies were stratified by pre-school and primary school children (<12 years of age) and adolescents (≥12 years of age). A total of N = 24 documents referring to different intervention studies were included in the review. N = 10 interventions focused on children; while N = 14 targeted adolescents. Results: The most used strategies in the interventions were the ones that included components of MC or evaluated SC using specific protocols and tools. Conclusions: This review pointed at socio-emotional and moral skills which remained underdeveloped in school children unless physical education (PE) teachers adjusted teaching contents and methods during instruction; and implement them into interventions with strategies that targeted elements fostering the sound socio-moral development of a child into adulthood. A model-based approach appeared to be the most, but not the only effective designs in the examined interventions.

The Use of Botulinum Toxin Type A in Medically Refractory Pediatric Patients With Chronic Daily Headaches and Its Impact on the Quality of Life.

Background: Chronic migraine in children has been a challenging condition to treat, prompting the investigation of alternative therapies. This retrospective single-center chart review aimed to evaluate the efficacy and safety of Botox injections for managing chronic migraine in children. Methods: The study included children with chronic daily headaches and chronic migraine who were medically refractory to previous treatments at OSF Healthcare/Illinois Neurological Institute, Peoria, between 2015 and 2021. Botox injections were administered quarterly following a specific protocol. Data were obtained from electronic medical records by manual review. Results: Twenty-four patients met the inclusion criteria (median age 15.4 years, 87% female). Comorbidities included depression (41.6%) and sleep disturbances (33.2%). Prior to Botox treatment, patients had been tried on a median number of 5 (interquartile range [IQR] 4, 7) medications. Botox injections resulted in a significant reduction in headache frequency, with a mean difference (6 months vs pretreatment) in the Headache Impact Test (HIT 3) scores of -19.6 (95% CI -24.8, -14.3), P < .001, and mean difference in the Migraine Disability Assessment (MIDAS) scores of -50.8 (95% CI -62.6, -39.0, P < .001). Subjective improvements included mood enhancement (13/24, 54.2%) and improved concentration (12/24, 50%). Treatment-related side effects were reported by 5/24 (20%) of patients and were mostly mild to moderate. Conclusions: Botox injections offer a promising therapeutic option for managing chronic migraine in children who have not responded to traditional medications. Future controlled trials and long-term follow-up studies are needed to further evaluate Botox treatment's benefits and adverse effects in children with chronic migraine.

Hypernetwork-Based Physics-Driven Personalized Federated Learning for CT Imaging.

In clinical practice, computed tomography (CT) is an important noninvasive inspection technology to provide patients' anatomical information. However, its potential radiation risk is an unavoidable problem that raises people's concerns. Recently, deep learning (DL)-based methods have achieved promising results in CT reconstruction, but these methods usually require the centralized collection of large amounts of data for training from specific scanning protocols, which leads to serious domain shift and privacy concerns. To relieve these problems, in this article, we propose a hypernetwork-based physics-driven personalized federated learning method (HyperFed) for CT imaging. The basic assumption of the proposed HyperFed is that the optimization problem for each domain can be divided into two subproblems: local data adaption and global CT imaging problems, which are implemented by an institution-specific physics-driven hypernetwork and a global-sharing imaging network, respectively. Learning stable and effective invariant features from different data distributions is the main purpose of global-sharing imaging network. Inspired by the physical process of CT imaging, we carefully design physics-driven hypernetwork for each domain to obtain hyperparameters from specific physical scanning protocol to condition the global-sharing imaging network, so that we can achieve personalized local CT reconstruction. Experiments show that HyperFed achieves competitive performance in comparison with several other state-of-the-art methods. It is believed as a promising direction to improve CT imaging quality and personalize the needs of different institutions or scanners without data sharing. Related codes have been released at https://github.com/Zi-YuanYang/HyperFed.

A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension.

The goal of this study was to use image analysis recordings to measure the carrying angle of elite male tennis players during the forehand stroke, with the hypothesis that elite tennis players overstress their elbow in valgus over the physiological degree in the frontal plane just before ball contact on forehand groundstrokes. The carrying angle of male tennis players ranked in the top 25 positions in the ATP ranking was measured on selected video frames with the elbow as close as possible to full extension just before the ball-racket contact in forehands. These frames were extracted from 306 videos professionally recorded for training purposes by a high-profile video analyst. All measures were conducted by three independent observers. Sixteen frames were finally included. The mean carrying angle was 11.5° ± 4.7°. The intraclass correlation coefficient value was 0.703, showing good reliability of the measurement technique. The measured carrying angle was lower than what has been observed in historical cohorts using comparable measurement methodology, suggesting a possible instant varus accommodation mechanism before hitting the ball. The observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi-open stances. As the elbow flexes during the preparation phase, it is less constrained by the olecranon and its fossa, increasing the strain on the medial collateral ligament and capsule structures. Moving towards full extension before the ball-racket contact, the elbow is dynamically stabilised by a contraction of the flexor muscles. These observations could provide a new explanation for medial elbow injuries among elite tennis players and drive specific rehabilitation protocols. Descriptive epidemiology study. Level IV.

Retracted: A Novel Distributed Denial of Service (DDoS) Detection Method in Software Defined Networks

The software Defined Networks (SDN) are the most promising solutions in solving challenges regarding complex network control. The SDNs are responsible for separating network control functions from the network switch. By applying SDNs, communication companies and operators can control and manage networks through one central controller unit therein with no need by applying hardware or the manufacture's guideline. Lack of complex DDoS attack detection, lack of rapid detection sensitivity on packet type attack, lack of methods in promoting detection attack to specific unknown protocols, lack of ability in detecting at switch level, lack of assessing attacks packet types, constitute drawbacks. Although is made in this article to overcome these drawbacks, consequently the GainRatioAttributeEval algorithm and Ranker method are applied. The datasets involved here are the ISCX-SlowDDoS2016, ISCX-IDS2012, CTU-10 and CTU-11.This proposed method is compared with similar methods and it is found that this method with 99.95% accuracy and 0.04 FPR for UNB-ISCX dataset and 99.84% accuracy and 0.1 FPR for CTU-13 dataset is better than others.

$ H_\infty $ deployment of nonlinear multi-agent systems with Markov switching topologies over a finite-time interval based on T–S fuzzy PDE control

&lt;abstract&gt;&lt;p&gt;The deployment of multi-agent systems (MASs) is widely used in the fields of unmanned agricultural machineries, unmanned aerial vehicles, intelligent transportation, etc. To make up for the defect that the existing PDE-based results are overly idealistic in terms of system models and control strategies, we study the PDE-based deployment of clustered nonlinear first-order and second-order MASs over a finite-time interval (FTI). By designing special communication protocols, the collective dynamics of numerous agents are modeled by simple fist-order and second-order PDEs. Two practical factors, external disturbance and Markov switching topology, are considered in this paper to better match actual situations. Besides, T–S fuzzy technology is used to approximate the unknown nonlinearity of MASs. Then, by using boundary control scheme with collocated measurements, two theorems are obtained to ensure the finite-time $ H_\infty $ deployment of first-order and second-order agents, respectively. Finally, numerical examples are provided to illustrate the effectiveness of the proposed approaches.&lt;/p&gt;&lt;/abstract&gt;

A Cross-sectional Study on Neuroimaging in Epilepsy: Diagnostic Value of T2 Relaxometry in Mesial Temporal Lobe Epilepsy

Introduction: The use of Magnetic Resonance Imaging (MRI) T2 relaxometry and spectroscopy has added new dimensions to the imaging of Temporal Lobe Epilepsy (TLE). Advanced techniques like MRI diffusion and MRI perfusion are new additions to the MRI protocol for epilepsy. Aim: To study the diagnostic value of T2 relaxation time in Electroencephalogram (EEG) confirmed seizure cases. Materials and Methods: A single-centre, cross-sectional study was conducted at Department of Radiodiagnosis, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, from December 2020 to November 2022 at a tertiary care hospital. All patients were subjected to MRI with a special epilepsy protocol and T2 relaxometry. Hippocampal T2 relaxation values for each slice were measured by placing a Region of Interest (ROI) on the representative image obtained from the T2 relaxometry sequence, focusing on the hippocampus in both the control and study groups. The control group (n=30) consisted of healthy volunteers, whereas the case group (n=36) comprised patients presenting with a history of seizures with positive MRI and EEG findings. Mean T2 relaxation time was calculated in each ROI, and an average was derived. Mean and Standard Deviation (SD) were calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. To determine the association of T2 relaxometry values in the study and control groups, an unpaired t-test was used. Results: The mean age of participants was 25.14±9.35 years (ranging from 9 to 51 years). The male-to-female ratio was 1.25:1. Hippocampal atrophy (32 out of 36 cases) and T2 signal alteration (30 out of 36 cases) were the most commonly identified features in Mesial Temporal Sclerosis (MTS). MRI without T2 relaxometry had a sensitivity of 94%. In two cases, where only mild hippocampal atrophy was identified in the conventional MRI sequence, making the diagnosis dubious, T2 relaxometry revealed increased T2 relaxation time in the head of the hippocampus and guided a proper diagnosis. EEG was able to lateralise seizures in 8 out of 13 right MTS cases (61.5%), 10 out of 17 left MTS cases (58.9%), and 5 out of 6 cases of bilateral MTS (83%). Conclusion: T2 relaxometry allows quantification of hippocampal signal intensity, allowing the detection of even subtle changes in signal intensity that are difficult to perceive by visual assessment.