Standard Practice Research Articles

Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study.

Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children's Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs' standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies.

Real-world assessment of caregiver preference and compliance to treatment with twice-weekly versus daily rivastigmine patches in Alzheimer's disease.

Adherence is critical in patients with Alzheimer's disease (AD) in order to achieve optimal benefit from therapy. However, patient compliance with the treatment remains a challenge. To evaluate, in a real-world clinical setting, caregiver preference and treatment compliance with twice-weekly versus daily transdermal rivastigmine patch in mild-to-moderate AD. 92 patients who had been treated with daily rivastigmine patch for at least six months prior to switching to twice-weekly patch were evaluated. The change in therapeutic regimen was decided by the treating physician in accordance with standard practice. Caregivers' satisfaction with daily rivastigmine patch was assessed at study entry. Caregiver's preference and satisfaction with twice-weekly patch as well as patient compliance were evaluated at weeks 12 and 24 using the Alzheimer's Disease Caregiver Preference Questionnaire. A significantly higher proportion of caregivers expressed a preference for the twice-weekly patch over the daily patch (p < 0.001), and this preference was found to be associated with ease of use (p < 0.001), ease of following the schedule (p < 0.001), and ease of compliance (p < 0.001). Furthermore, caregivers were more satisfied with the twice-weekly patch (p < 0.0001). At 24 weeks, patient compliance was significantly better with the twice-weekly patch than with the daily patch (p = 0.002). Caregiver burden significantly improved at the end of the treatment (p = 0.003). No serious adverse events were reported. The twice-weekly rivastigmine patch offers a convenient and straightforward dosing regimen for caregivers, with potential to enhance adherence with treatment in AD patients without causing serious adverse events.

Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice.

Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age. Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0-23 + 6 and 24 + 0-27 + 6), very preterm (GA 28 + 0-31 + 6), moderate preterm (GA 32 + 0-33 + 6), late preterm (GA 34 + 0-36 + 6), term (GA 37 + 0-40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions. The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000-2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden. The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.

“We're tired of this Weber guy!”—Force experts, police reforms, and the violence of standardization

AbstractSince the mid‐2000s, the use‐of‐force continuum—a global standard for providing law enforcement with guidelines on the proportionate use of force—has been central in Turkish police training and reporting practices. Liberal police accountability tools, like the use‐of‐force continuum, rely on standardization to prevent police violence. Yet these techniques still result in maimed bodies and psyches and police impunity. Rather than taking the standardization of police force simply as a failed project, a sham, or a mere techno‐fix, I examine how powerful actors like police align with such standards and how they start thinking and acting through them while repurposing them. Drawing on 18 months of fieldwork between 2015 and 2017 among the Turkish National Police, I show how the transnational standardization of police force has in fact enabled police in Turkey to redefine and ultimately reclaim the violence they are professionalized in as what I call “force experts.” Force defies standardization in both theory and practice; however, what sanctions police violence now is not just technical standardization but the expert framing of the democratically reformed police force. This is the violence of standardization, especially in contexts where governments retool reforms to criminalize suspect Others whom they perceive as a “threat” to their rule.

Personalized CZA-ATM dosing against an XDR E. coli in liver transplant patients; the application of the in vitro hollow fiber system.

A patient with an extensively drug-resistant (XDR) New Delhi metallo-β-lactamase (NDM) and oxacillinase (OXA-48) producing Escherichia coli (E. coli) infection was awaiting orthotopic liver transplant. There is no standardized antibiotic prophylaxis regimen; however, in line with the Infectious Diseases Society of America guidance, an antibiotic prophylactic regimen of ceftazidime-avibactam 2.5g TDS with aztreonam 2g three times a day (TDS) IV was proposed. The hollow fiber system (HFS) was applied to inform the individualized pharmacodynamic outcome likelihood prior to prophylaxis. A 4-log reduction in CFU/mL in the first 10 h of the regimen exposure was observed; however, the killing dynamics were slow and six 8-hourly infusions were required to reduce bacterial cells to below the limit of quantification. Thus, the HFS supported the use of the regimen for infection clearance; however, it highlighted the need for several infusions. Standard local practice is to administer prophylaxis antibiotics at induction of orthotopic liver transplantation (OLT); however, the HFS provided data to rationalize earlier dosing. Therefore, the patient was dosed at 24 h prior to their OLT induction and subsequently discharged 8 days after surgery. The HFS provides a dynamic culture solution for informing individualized medicine by testing antibiotic combinations and exposures against the bacterial isolates cultured from the patient's infection. .

American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

Reactive Attitudes and AI-Agents – Making Sense of Responsibility and Control Gaps

Responsibility gaps occur when autonomous machines cause harms for which nobody can be justifiably held morally responsible. The debate around responsibility gaps has focused primarily on the question of responsibility, but other approaches focus on the victims of the associated harms. In this paper I consider how the victims of ‘AI-harm’—by which I mean harms implicated in responsibility gap cases and caused by AI-agents—can make sense of what has happened to them. The reactive attitudes have an important role here. I argue that regulating our reactive attitudes—withdrawing or sustaining them as our understanding of the actions, motives, status, and character of others develops—is an important part of the way in which we make sense of the harms we suffer. But, I argue, AI-agents can disrupt standard practices of regulating the reactive attitudes. This can lead victims of AI-harm to suffer a secondary hermeneutic harm (in addition to the primary AI-harm). This harm, which the responsibility gap and AI ethics literatures have neglected, can occur whether responsibility gaps are real or not.

The Loss of Autonomy in Eating Disorder Treatment: A Patient Perspective.

In this text, the author's lived experiences as a youth with anorexia nervosa, anxiety, and depression are explored. Experiences with accessing North American health services, both in specialized eating disorder (ED) and disordered eating (DE) settings, as well as in healthcare more broadly are shared. This work seeks to shed light on a patient perspective in mental health and to draw attention to some of the ways that the current framings of EDs and DE within the biomedical system might perpetuate harm. In this piece, a collection of the author's lived-experiences and interactions with the healthcare system are explored. The medical framing of EDs as a defect of both mind and body can jeopardize one's autonomy and contribute to a sense of hopelessness. As mental health treatment increasingly prioritizes evidence-based approaches and standardized practices, there is a growing concern that this shift risks undermining the autonomy of those it aims to support. The dualistic conceptualizations of mental and physical health in ED/DE treatment, at times, can cause harm, particularly for those who do not present with the physical manifestations of an ED/DE but remain largely affected in day-to-day life. The imposition of rigid treatment regimens can inadvertently diminish personal agency, overshadowing the nuanced, individualized needs and preferences of patients. Lived experience narratives encompass the personal, subjective insights of individuals navigating mental health challenges, in turn, providing invaluable insight that conventional methods may overlook.

Nexus of Quality Use of Medicines, Pharmacists’ Activities, and the Emergency Department: A Narrative Review

Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as “choosing suitable medicines and using them safely and effectively”, remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED.

2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.

Suicide-related internet use of mental health patients: what clinicians know.

Suicide-related internet use (SRIU), defined as internet use related to one's own feelings of suicide, can be both a risk and protective factor, especially for isolated individuals. Despite its influence on suicidality, clinicians face challenges in assessing SRIU because of the private nature of internet usage. Current recommendations on enquiring about SRIU in a clinical setting concern mostly young people. To address the gap in understanding SRIU among patients of all ages, this study aims to explore mental health clinicians' experiences, attitudes and beliefs regarding enquiring about SRIU, as well as the risks and benefits it presents in the assessment and management of patients. Finally, the study aims to establish the role SRIU potentially plays in the assessment and management of patients. Twelve clinicians practising at secondary mental health services in England participated in interviews. Thematic analyses were used for data interpretation. Clinicians who participated in interviews rarely initiate discussions on SRIU with their patients despite considering this an important factor in suicidality. Age of both patients and clinicians has the potential to influence enquiry into SRIU. Clinicians recognise the potential benefits of patients finding supportive online communities but also express concerns about harmful and low-quality online content related to suicide. Integrating SRIU enquiry into standard clinical practice, regardless of the patient's age, is an important step towards comprehensive patient care. Broader training for clinicians on enquiring about online behaviours is essential to mitigate potential risks and harness the benefits of SRIU in mental health patients.

Roodmus: a toolkit for benchmarking heterogeneous electron cryo-microscopy reconstructions.

Conformational heterogeneity of biological macromolecules is a challenge in single-particle averaging (SPA). Current standard practice is to employ classification and filtering methods that may allow a discrete number of conformational states to be reconstructed. However, the conformation space accessible to these molecules is continuous and, therefore, explored incompletely by a small number of discrete classes. Recently developed heterogeneous reconstruction algorithms (HRAs) to analyse continuous heterogeneity rely on machine-learning methods that employ low-dimensional latent space representations. The non-linear nature of many of these methods poses a challenge to their validation and interpretation and to identifying functionally relevant conformational trajectories. These methods would benefit from in-depth benchmarking using high-quality synthetic data and concomitant ground truth information. We present a framework for the simulation and subsequent analysis with respect to the ground truth of cryo-EM micrographs containing particles whose conformational heterogeneity is sourced from molecular dynamics simulations. These synthetic data can be processed as if they were experimental data, allowing aspects of standard SPA workflows as well as heterogeneous reconstruction methods to be compared with known ground truth using available utilities. The simulation and analysis of several such datasets are demonstrated and an initial investigation into HRAs is presented.

Interventions for left-behind children in Mainland China: A scoping review

BackgroundAs the discussion of Chinese left-behind children (LBC) continues, intervention programs dedicated to this population increase and diversify. While reviews have summarized intervention programs promoting LBC’s health and psychological wellbeing, there is no synthesis depicting a comprehensive picture. This scoping review systematically examines interventions tackling LBC’s various issues and identifies their design and foci. MethodWe performed a systematic literature search to extract intervention studies from four English (i.e., Web of Science, Scopus, Embase, & PsycINFO) and one Chinese (i.e., CNKI) database. The quality of the studies was assessed using the Mixed Methods Assessment Tool (MMAT). Two main rounds of deductive coding were performed on Nvivo 12 plus to identify the design and foci of the interventions. ResultsThirty-three articles were identified for our final review. Twenty-six were published in Chinese and seven in English. Existing interventions have tackled multiple psychological, social, physical, developmental, and sexual problems or needs of Chinese rural left-behind children. Among them, LBC’s psychological wellbeing has drawn the most attention. The majority of the reviewed studies performed a randomized controlled trial (N=20). Quantitative evaluation is prevalent, with only one study applying a purely qualitative evaluation. In addition, only two studies adopted validated interventions, while the others are self-designed. ConclusionsThe review results indicate several gaps in intervention studies for LBC. First, many existing interventions have considered LBC’s psychological and social wellbeing, while little effort has been paid to address their educational and intellectual development. Further, while existing interventions are concerned with LBC’s temporary needs, their long-term life planning, as well as their current self-efficacy and self-concept driving their actions towards future self, were neglected. As for the intervention design, empirically validated interventions are recommended for future studies for their verified efficacy and evidence-based standardized practice. In addition, a qualitative evaluation should be considered because it might be more powerful in eliciting realistic and viable solutions to improve the effectiveness and reliability of the interventions from the participants.

Splenectomy Before Recipient Hepatectomy for Inflow Modulation Using a Very Small Modified Right Hemiliver Graft: A Case Report

Portal inflow modulation has become standard practice in many transplant centers performing living donor liver transplantation. This is believed to counteract the deleterious effects of excess portal flow into a small-for-size graft. A splenectomy negates the contribution of the splenic vein flow completely and thereby substantially reduces portal inflow. Although it has been adopted as a standard strategy by many Japanese centers for inflow modulation, especially while using left hemiliver grafts, there is justifiable apprehension about its usage due to potential increases in morbidity. Described here is a splenectomy performed while using a modified right hemiliver graft with a graft to recipient weight ratio of 0.49. The challenges in decision making and reasons regarding how such a small graft might have worked without manifestations of small-for-size/flow syndrome are discussed.

Early mobilization and its impact on recovery in ICU patients with severe COVID-19: A randomized controlled trial

Introduction. The COVID-19 pandemic has severely impacted critically ill patients, often leading to prolonged immobilization in intensive care units (ICUs), which can result in ICU-acquired weakness (ICUAW) and delayed recovery. Early mobilization has emerged as a promising intervention to counter these effects by promoting faster recovery and reducing complications. This study aims to investigate the effects of early mobilization on physical function, muscle strength, and recovery outcomes in ICU patients with severe COVID-19. Methods. This randomized controlled trial (RCT) included 100 ICU patients (50 in the early mobilization group, 50 in the control group) with severe COVID-19. Early mobilization began within 48 to 72 hours of ICU admission and followed a stepwise progression through four mobility levels. Outcome measures included the Physical Function ICU Test (PFIT), Medical Research Council (MRC) sum score, incidence of delirium, ICU and hospital stay length, ventilator-free days, mortality, and readmission rates. Statistical analysis used intention-to-treat methods, with continuous and categorical variables tested accordingly. Results. The early mobilization group had a significantly shorter time to first mobilization (2.3 days vs. 5.8 days, p &lt; 0.001), higher PFIT scores at ICU discharge (25.4 vs. 18.2, p &lt; 0.001), and improved MRC sum scores (48.6 vs. 35.4, p &lt; 0.001) compared to the control group. The incidence of delirium was significantly lower in the early mobilization group (20% vs. 38%, p = 0.03). ICU and hospital stays were shorter in the early mobilization group (10.4 vs. 14.2 days, p &lt; 0.001; 18.5 vs. 24.1 days, p &lt; 0.001). The early mobilization group had more ventilator-free days (20.3 vs. 14.7, p &lt; 0.001). Mortality and readmission rates were similar between groups. Conclusion. Early mobilization significantly improves functional outcomes, reduces ICU and hospital length of stay, and lowers the incidence of delirium in ICU patients with severe COVID-19. These findings support incorporating early mobilization as standard practice in ICUs to enhance recovery outcomes.

INFLUENCE OF CAPABILITIES FOR RESOURCE MOBILIZATION ON THE PERFORMANCE OF THE LOCAL AUTHORITIES IN ZAMBIA

This study examined the influence of resource mobilization capabilities on the performance of local authorities in Zambia, addressing a decade-long performance challenge despite various government interventions. Using a correlational research design with a sample of 736 employees from 116 local authorities, the study tested the hypothesis that there is no statistically significant influence of resource mobilization capabilities on the financial performance of local authorities. Data collected through a structured questionnaire and analyzed using multiple linear regression revealed a significant positive relationship between capabilities for resource mobilization and local authorities' performance (B = 0.272, t = 6.516, p &amp;lt; .001), with the model explaining 63.7% of the performance variance. While local authorities demonstrated strengths in developing annual work plans, they struggled to provide all required public services. The study concludes that resource mobilization capabilities significantly influence local authorities' performance in Zambia and recommends enhancing resource mobilization strategies, improving service delivery capabilities, promoting knowledge sharing among local authorities, investing in technology-enabled systems for revenue collection and management, and implementing standardized performance management practices to address the identified performance gaps and improve overall public service delivery.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0745/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Cost of Productions and Partial Budget Analysis of Coffee (&amp;lt;i&amp;gt;Coffea arabica&amp;lt;/i&amp;gt; L.) Seedling Across Various Pot Sizes and Biochar-Based Media Preparations

Coffee cultivation mainly lies in the production of coffee seedlings with desirable characteristics under the recommended nursery management operations. Any improper handling made at early stage would remain to cause poor field performances. Biochar is considered as a soil conditioner and a carrier for plant nutrients, which improve the different soil functions, as an amendment to improve soil fertility, soil pH, available phosphorus, organic carbon, and water retention. The experiment was conducted to provide detail information on production costs and gross net profits of reduced sizes poly bag and biochar application used for coffee seedling production under small scale farmers. Biochar to topsoil blended at 1:3 ratio was found to increase (SVI) over the local and standard practice by 66.50% and 7.50%, respectively. Hence, combined effects of reduced pot size (13x19cm) with biochar mixed topsoil 1:3 noticed to significantly improve soil chemical conditions and growth response of coffee seedlings under nursery conditions at the study area. Besides, the result of simple partial budget analysis indicated the cost effectiveness with reduced polybag sizes as compared to the conventional pot sizes, especially for production, transportation and early stage field transplanting of quality coffee seedlings in large quantities. However, it is imperative to assess the effects of the present promising pot size and pot media treatments under field performance by considering growth, yield, and quality performances and profitability to smallholder coffee farmers over locations and year in the study area and other similar agro ecological zones in the country.

A block-based numerical strategy for modeling the dynamic out-of-plane behavior of unreinforced brick masonry walls

AbstractIn this paper, a numerical procedure is proposed to simulate the dynamic out-of-plane response of unreinforced masonry (URM) walls. A state-of-the-art damaging block-based model, originally developed for quasi-static simulations, is extended for the first time in a dynamic regime. The blocks are represented using solid 3D finite elements governed by a plastic-damage constitutive law for both tension and compression. A cohesive-frictional contact-based formulation is used to account for interactions between the blocks. A simplified mechanical characterization is formulated to improve efficiency in wall-level analyses. Dynamic simulation is performed using a generalized HHT-$$\alpha$$ α direct integration implicit solver and by implementing Rayleigh damping in the bulk. Such consideration allows the use of both mass and stiffness proportional terms of the Rayleigh damping without compromising efficiency. The strategy is applied to simulate incremental dynamic experiments performed on full-scale walls, showing good agreement between numerical and experimental results. The calibrated numerical model is then optimized to reduce computational effort while maintaining accuracy. The optimized model is used to investigate the effect of relative support motion on the one-way bending out-of-plane seismic response of URM walls, demonstrating the potential of the modeling strategy to explore the effect of boundary conditions that occur in real buildings but are often overlooked in laboratory experiments. This investigation also explores the adequacy of simplifications in capturing the effect of relative support motion, which can be adopted for simple modeling strategies commonly used in standard engineering practice.

Current and Future Directions of Technology in Assessment of Peyronie's Disease.

This review assesses the effectiveness of various imaging modalities for diagnosing and managing Peyronie's disease (PD), exploring their clinical utility and limitations. Ultrasonography, currently the only modality endorsed by the American Urological Association, effectively detects calcifications and assesses vascular status but struggles with identifying non-palpable plaques. Computed tomography and magnetic resonance imaging provide detailed anatomical views but are costly along with other deterring factors. Autophotography and 3-dimensional imaging offer convenient home assessments but with variable accuracy. Elastography improves upon traditional ultrasonography, while emerging AI technologies show promise for automating precise curvature assessments, pending further validation. A combined approach tailored to each individual patient based on their needs enhances diagnostic accuracy. Supplementing ultrasonography with elastography and potentially AI could improve diagnostic outcomes and better guide treatment decisions. Continued research is vital to integrate these advancements into standard clinical practice and develop updated standardized protocols.

Heart Disease Prediction Using Decision Tree Analysis

Heart disease, alternatively known as cardiovascular disease, encases various conditions that impact the heart and is the primary basis of death worldwide over the span of the past few decades. Therefore, if it is possible to predict diseases that has high mortality rate with patient's data and AI system, they would enable them to be detected and be treated in advance. The objective of the research is to use significant features and factors to design a prediction algorithm using Machine learning. The goal is to accurately classify whether a person has heart disease or not. The dataset contains 1025 records. The records are divided into two categories positive those who have heart disease and negative those who do not. It is currently standard practice to divide the data at random into roughly 70% for training and 30% for testing. The researcher used the MATLAB software tool to create a decision tree model of heart disease prediction. Using a decision tree model, it was determined that the best indicator that someone has heart disease is chest pain.