Standard Practice Research Articles

Cytological Characteristics of the Eye Conjunctiva in Dogs with Atopic Dermatitis

Atopic dermatitis is a chronic, pruritic inflammatory skin disease affecting approximately 10% of dogs worldwide. The disease typically manifests at an early age, causing pruritus and secondary skin lesions in specific anatomical regions. The pathophysiology of canine atopic dermatitis (CAD) remains incompletely understood, but recent research suggests a complex interplay between skin barrier dysfunction, allergic sensitisation, and microbial dysbiosis. Despite the well-established association between atopic dermatitis and conjunctivitis, the prevalence of conjunctivitis in dogs with CAD is often underestimated in clinical practice due to inadequate recognition of symptoms and a lack of specific diagnostic protocols. This study aimed to analyse the cytological characteristics of the conjunctiva in dogs affected by atopic dermatitis. Samples were collected from 24 dogs diagnosed with CAD and treated at the University Veterinary Hospital, Faculty of Veterinary Medicine, University of Zagreb. Cytological analysis was performed on samples obtained using a cytobrush. The results revealed the presence of inflammatory cells in all samples, with lymphocytes most prevalent (87.5%). A mild degree of conjunctival metaplasia was observed in all dogs, regardless of the type of inflammatory cells and the severity of conjunctivitis. These findings suggest that atopic dermatitis may induce changes in the conjunctiva that are not necessarily correlated with the intensity of the inflammatory response. The presence of lymphocytes, along with eosinophils in some cases, underscores the diagnostic value of conjunctival cytology in dogs with CAD. Furthermore, the increased density of goblet cells suggests similarities in the pathophysiology of ocular allergies in dogs and humans, opening avenues for further research to better understand and treat these conditions. This study highlights the importance of an interdisciplinary approach in the diagnosis and treatment of atopic dermatitis, including regular ophthalmologic examinations as part of standard clinical practice.

Evaluating novel in silico tools for accurate pathogenicity classification in epilepsy-associated genetic missense variants.

Determining the pathogenicity of missense variants in clinical genetic tests for individuals with epilepsy is crucial for guiding personalized treatment. However, achieving a definitive pathogenic classification remains challenging, with most missense variants still classified as variants of uncertain significance (VUS) and with the availability of many computational tools which may provide conflicting predictions. Here, we aim to evaluate the performance of state-of-the-art computational tools in pathogenicity prediction of missense variants in epilepsy-associated genes. This will assist in selecting the most appropriate tool and critically assess their use in clinical setting. We assessed the performance of nine in silico pathogenicity prediction tools for missense variants in epilepsy-associated genes on three carefully curated data sets. The first two data sets comprise missense variants in epilepsy associated genes that have been uploaded to ClinVar in the last year and were, therefore, not part of the training set of any of the nine considered tools. These two data sets are based on two different lists of epilepsy-associated genes and comprise ~700 and ~ 250 missense variants, respectively. The third data set includes ~400 missense variants within epilepsy-associated genes for which the functional effects have been determined experimentally and are therefore used here to infer pathogenicity. These three data sets represent the best available approximation to blind and independent test sets. Among the nine assessed tools, AlphaMissense (area under the curve [AUC]: .93, .88, and .95) and REVEL (AUC: .93, .88, and .93) showed the best classification performance, also outperforming other tools in the number of classified variants. We show which recently developed prediction tools achieve higher performance in epilepsy-associated genes and should be integrated, therefore, into the American College of Medical Genetics and Genomics/Association of Molecular Pathology (AGMC/AMP) variant classification process. Periodic reevaluation of genetic test results with newly developed or updated tools should be incorporated into standard clinical practice to improve diagnostic yield and better inform precision medicine.

Reaction-time task reliability is more accurately computed with permutation-based split-half correlations than with Cronbach's alpha.

While it has become standard practice to report the reliability of self-report scales, it remains uncommon to do the same for experimental paradigms. To facilitate this practice, we review old and new ways to compute reliability in reaction-time tasks, and we compare their accuracy using a simulation study. Highly inaccurate and negatively biased reliability estimates are obtained through the common practice of averaging sets of trials and submitting them to Cronbach's alpha. Much more accurate reliability estimates are obtained using split-half reliability methods, especially by computing many random split-half correlations and aggregating them in a metric known as permutation-based split-half reliability. Through reanalysis of existing data and comparison of reliability values reported in the literature, we confirm that Cronbach's alpha also tends to be lower than split-half reliability in real data. We further establish a set of practices to maximize the accuracy of the permutation-based split-half reliability coefficient through simulations. We find that its accuracy is improved by ensuring each split-half dataset contains an approximately equal number of trials for each stimulus, by correcting the averaged correlation for test length using a modified variant of the Spearman-Brown formula, and by computing a sufficient number of split-half correlations: around 5,400 are needed to obtain a stable estimate for median-based double-difference scores computed from 30 participants and 256 trials. To conclude, we review the available software for computing this coefficient.

Natural history of valve disease in patients with mucopolysaccharidosis II and the impact of enzyme replacement therapy.

Mucopolysaccharidosis II (MPS II, Hunter syndrome) is a rare, X-linked lysosomal storage disease caused by reduced activity of iduronate-2-sulfatase (I2S), with subsequent cellular accumulation of the glycosaminoglycans (GAGs), heparan sulfate, and dermatan sulfate (DS). DS is a major component of the extracellular matrix of heart valves, which can be affected in MPS II. We investigated the natural history of valve disease in MPS II and the impact of long-term intravenous enzyme replacement therapy (ERT) with recombinant I2S (idursulfase). In total, 604 cardiac examinations were assessed from serial follow-up of 80 male patients (49 neuronopathic). Valve disease was classified according to standard practice from hemodynamic features evident from echocardiography. The natural history group comprised 48 patients (up to 14.8 years of follow-up; median, 2.6 years; 24 patients started ERT during the study); 56 patients were treated (up to 14.2 years of follow-up; median, 6.2 years). Lifetime GAG burden (calculated from urinary GAG measurements) correlated significantly with the degree of valve disease. Onset of moderate-to-severe valve disease was significantly delayed in treated (median age at onset, 29.1 ± 2 [95% CI: 25.2-32.9] years; Kaplan-Meier estimation) versus untreated patients (17.6 ± 1 [95% Cl: 15.8-19.4] years; p < 0.0001). Cox regression modeling found that long-term ERT reduced the probability of developing severe valve disease (χ2, 32.736; significant after 5 years of ERT). Overall, this study found that valve disease severity in MPS II correlates with GAG burden and that progression is delayed by long-term ERT.

77 Antenatal MgS04 in very preterm babies is not related to improved 36 month neurodevelopmental outcomes once accounting for neonatal interventions

Abstract Background Magnesium Sulphate (MgSO4) has become a standard practice for fetal neuroprotection prior to delivery of very-preterm babies due to an association with MgSO4 and reduction of cerebral palsy at 2 years of age in randomized clinical trials. Objectives In a prospective cohort of very preterm babies, we aimed to define the association between antenatal MgSO4 administration and neurodevelopmental outcome. Design/Methods We included a prospective cohort of 265 infants born ≤ 32 weeks’ gestation recruited at three tertiary neonatal intensive care units (NICU). Infants underwent two brain MRIs, one in the initial weeks after birth and one at term-equivalent age. Neurodevelopmental follow-up assessments were completed using the Bayley-3 at 3 years. Univariate analysis was undertaken to determine whether MgSO4 was associated with outcome. Multiple maternal and neonatal factors were analyzed according to their relationship with outcome. Gestational age was accounted for in all models. Maternal factors associated with MgSO4 administration were hypertension, multiple births and antenatal corticosteroid administration. Neonatal factors were sex, neonatal resuscitation, major surgery, and moderate-severe white matter injury (volume &amp;gt;40mm3). Multivariable linear regression models of maternal and neonatal risk factors were used to account for potential confounders based on those factors that were significantly (p&amp;lt;0.05) associated in univariate analysis. Results On univariate analysis, MgSO4 administration was inversely associated with 36-month motor scores (p&amp;lt;0.05). On the multivariable analysis, no maternal confounders had an impact on the relationship between MgSO4 and outcome (Table 2). MgS04 was no longer statistically related to any Bayley outcomes after adjusting for confounders at 36 months (Table 2). Neonatal surgery was related to poorer 36-month motor and cognitive outcomes. Conclusion Antenatal MgSO4 exposure was not associated with improved measures on the Bayley scales at 3 years after adjusting for potential confounders. However, neonatal interventions remained significant risk factors for poorer neurodevelopmental outcome.

CFD Modeling of HBI/scrap Melting in Industrial EAF and the Impact of Charge Layering on Melting Performance.

The melting of scrap and hot briquetted iron (HBI) in an AC electric arc furnace (EAF) is simulated by an advanced 3D computational fluid dynamics (CFD) model that captures the arc heating, the scrap/HBI melting process, and the solid collapse mechanisms. The CFD model is used to simulate a scenario where charge layering and EAF power profiles are provided by a real EAF operation. CFD simulation of the EAF operation shows proper prediction of the charge melting when compared with standard industry practice. Namely, the CFD model predicts a 32.5%/67.5% ratio of solid/liquid steel at the beginning of refining, which approaches the 30%/70% ratio used in standard practice. Based on this prediction, the melting rate in the CFD results differs by 8.3% from actual EAF operation. The impact of charge layering on melting is also investigated. CFD results show that distributing charge material into a greater number of layers in the first bucket (10 layers as compared to 4) enhances the melting rate by 12%. However, including dense material at the bottom of the furnace deteriorates melting performance, reducing the impact of the number of layers of the charge. The CFD platform can be used to optimize the use of HBI/scrap in real EAF operations and to determine best recipe practices.

An Assessment of the Presence of Clostridium tetani in the Soil and on Other Surfaces

Introduction: Standard emergency medicine practice includes tetanus vaccine administration as part of wound care management for patients who are not fully immunized. Since there have been no available studies in the United States reaffirming the prevalence of Clostridium tetani (C tetani) since 1926, we sought to identify its prevalence in a major urban county in the US. Methods: We sampled soil, rusted metal, concrete, and dog feces to determine the prevalence of C tetani in a single metropolitan county in the United States. Soil samples and swabs were collected from four locations: the soil of a public park and an elementary school; dog feces from a single public dog park; and rusted surfaces (metal and concrete) in common student areas of a university campus. The presence of C tetani in each sample was determined using a quantitative polymerase chain reaction. Results: In total, 200 samples were collected, of which 37 (18.5%) tested positive for C tetani DNA. Among the 140 samples taken from the soil, just one (0.7%) tested positive for C tetani DNA. Of the 40 samples of rusted metal and concrete surfaces, 30 (75%) tested positive for C tetani, and six (30%) of the 20 samples from dog feces tested positive for C tetani. Conclusion: We found that C tetani is frequently present on rusted metal and concrete surfaces but rarely in soil samples. Minor wounds contaminated with soil may be considered low risk for tetanus. However, future studies should assess the burden of C tetani in other similar urban, suburban, and rural environments to help determine the threat of C tetani more exactly.

Incorporating ultrashort-chain compounds into the comprehensive analysis of per- and polyfluorinated substances in potable and non-potable waters by LC-MS/MS

Ultrashort-chain (USC) per- and polyfluoroalkyl substances (PFAS) are small and very polar compounds with carbon chain lengths shorter than C4. Their ubiquitous and high levels of occurrence in environmental aquatic systems are emerging as a significant concern, rivaling the well-established issues associated with long-chain PFAS contamination. Therefore, it is important to analyze both USC and long-chain PFAS together in water samples to comprehensively assess and address the full spectrum of PFAS contamination. The high polarity of USC PFAS poses a challenge for standard chromatographic practices in PFAS analysis, primarily due to insufficient chromatographic retention. In this study, a simple and reliable workflow was developed for the simultaneous analysis of C1 to C14 perfluoroalkyl carboxylic and sulfonic acids, along with other groups of PFAS, in both potable and non-potable waters. The chromatographic separation was conducted using a polar-embedded reversed-phase LC column with an inert coating on the hardware. Three different water matrices (tap water, bottled water, sewage treatment wastewater) were chosen for method evaluation to demonstrate the applicability of the developed workflow for measuring 45 PFAS compounds in diverse water samples. A dilute-and-shoot workflow was evaluated by accuracy and precision analysis at five fortification levels, ranging from 2 to 250 ng/L. Eighteen isotopically labeled PFAS, serving as extracted internal standards, were added to the samples at 100 ng/L to validate the accuracy of the entire workflow. Calibration standards were prepared in reverse osmosis water due to its cleanliness for all analytes. The calibration ranges varied among different analytes, spanning from 1 – 1000 ng/L. All analytes and extracted internal standards exhibited recovery values ranging from 70% to 130% of the nominal concentration across all fortification levels. Satisfactory method precision was demonstrated with %RSD values below 20%. Additional potable and non-potable waters collected from various source waters were tested to further demonstrate that the established workflow is suitable for the accurate quantification of targeted PFAS in a wide range of water matrices.

Uncertainty in dynamic econometric input-output models: a Norwegian case study

Input-output models used for macroeconomic impact and policy analysis are often characterised by large data sets and resource-heavy computing. However, the types of results they provide are sensitive to uncertainty in their core assumptions. Various approaches have been proposed to account for the uncertainty in one or more parts of the analysis assumptions. Although it is standard practice to include varied cases in policy analysis, the notion of stochasticity of parameters across periods of time is less widespread. Costly numerical computing and difficulty in interpreting the results complicate this approach. In this work, we adapt an environmentally-extended dynamic econometric input-output model to account for uncertainty of various kinds. We demonstrate the methodology in the case of building renovation. The results provide insight into situations where explicitly considering uncertainty as part of the analysis is useful, as well as others in which no additional information was gained from such treatment.

Inadequate Postmortem Reports: Investigating the Underlying Factors

Postmortem reports play a vital role in forensic pathology, providing essential information about the causes of death needed for legal investigations. However, several factors undermine the quality of these reports, threatening their reliability and compromising the integrity of the judicial system. This study explores the key issues contributing to inadequate postmortem reports, such as the absence of standardized protocols, lack of adequate training for forensic staff, communication breakdowns, external pressures on forensic teams, overwhelmed laboratories with insufficient infrastructure, personnel, and equipment, and challenges in implementing new technologies. By examining these elements, the research seeks to identify opportunities for improvement to enhance the quality and accuracy of autopsies. An integrated approach is crucial for establishing standardized practices, upgrading facilities and equipment, increasing staffing and laboratory numbers, improving training for forensic professionals, and promoting better communication among all stakeholders in forensic investigations. The findings emphasize the need to address these systemic issues to produce more reliable postmortem reports, which are essential for delivering accurate forensic insights and ensuring just legal outcomes.

A survey of dysphagia services practice in China.

Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China. To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services. This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty-nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple-choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed. Approximately two-thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2=32.70;p<0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2=43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%-100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow-up with patients (60.4%). Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. What is already known on this subject Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. What this study adds to existing knowledge The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. What are the clinical implications of this work? The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China.

Quantifying the impact of a constructed wetland on downstream nitrate concentrations and loads in the U.S. Midwest

Constructed wetlands are standard conservation practices used to reduce nitrate loads in agricultural watersheds. Many studies have examined the efficiency of denitrification in wetlands under various scenarios, but quantifying the watershed-scale impact of wetlands on downstream nitrate levels is rarely done using field observations. In this study, we estimated nitrate removal in a constructed wetland in the headwaters of Mud Creek, a HUC12 watershed in eastern Iowa, from May–September 2022 and May–September 2023 (a ten-month period). We also measured nitrate loads at four successive downstream sites, three along Mud Creek and one below its confluence with the larger Cedar River. The wetland removed 6,200 kg of nitrate (74% of total inputs). At the three downstream locations in Mud Creek, the percentage of each site’s total nitrate load removed by the wetland decreased to 19, 8.6, and 4.1%—this latter value represents the wetland’s influence on nitrate removal in the entire Mud Creek basin. The wetland’s impact of nitrate loads in the Cedar River was negligible (reduction of 0.02%). The percentage of a site’s drainage area treated by the wetland approximately followed a 1:1 relationship to that site’s percent reduction in nitrate. Profiles of nitrate concentrations in Mud Creek notably varied pre- and post-wetland. Concentrations before the installation steadily decreased along the waterway, while post-wetland concentrations rapidly decreased directly downstream of the wetland and steadily increased at each succeeding site. Our results demonstrate that while the wetland successfully lowered local nitrate levels, its effect on the basin’s overall nitrate loads was minimal. Achieving nutrient reduction goals at the watershed scale solely using constructed wetlands appears infeasible given that the required number of practices greatly exceeds current efforts.

Management of Extradural Dead Space During Cranioplasty—A Scoping Review

Background: Cranioplasty after craniectomy restores cerebral spinal fluid (CSF) flow dynamics, protects the brain from trauma, and restores skull contour. However, post-cranioplasty extradural dead space may persist, leading to infection and necessitating further surgical interventions. The purpose of this scoping review was to identify and analyze the existing peer-reviewed literature discussing the management of extra-dural dead space during cranioplasty. Methods: A systematic review of the literature was performed via searches of Embase, Cochrane, and PubMed in accordance with PRISMA guidelines. Included studies focused on managing extradural dead space in supratentorial cranioplasty using rigid implants or autologous bone. Studies solely using soft tissue repairs or non-primary studies were excluded. Data extraction covered study characteristics, management techniques, complications, and patient outcomes. Results: Out of 2196 articles, 135 underwent full-text review, and 28 were included, discussing 117 patients. Indications for dead space management included intractable infection (86%), syndrome of the trephined (25%), high-volume dead space (18%), persistent CSF leak (18%), and scarred dura (7%). Management techniques included muscle flaps (46%), omental flaps (14%), fat grafts (7%), and placement of non-organic materials (11%). Complications occurred in 32% of studies, including flap failure, hematoma, and CSF leak. Muscle flaps had a 22% complication rate but led to a high rate of infection resolution (97%). Conclusions: Managing extradural dead space with vascularized flaps during cranioplasty can reduce infection risk but may be associated with high complication rates. The lack of standardized practices and limited high-quality studies highlight the need for further research to establish the safety, efficacy, and best patient selection criteria for these techniques.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Preoperative prediction of diffuse glioma type and grade in adults: a gadolinium-free MRI-based decision tree.

To develop a gadolinium-free MRI-based diagnosis prediction decision tree (DPDT) for adult-type diffuse gliomas and to assess the added value of gadolinium-based contrast agent (GBCA)enhanced images. This study included preoperative grade 2-4 adult-type diffuse gliomas (World Health Organization 2021) scanned between 2010 and 2021. The DPDT, incorporating eleven GBCA-free MRI features, was developed using 18% of the dataset based on consensus readings. Diagnosis predictions involved grade (grade 2 vs. grade 3/4) and molecular status (isocitrate dehydrogenase (IDH) and 1p/19q). GBCA-free diagnosis was predicted using DPDT, while GBCA-enhanced diagnosis included post-contrast images. The accuracy of these predictions was assessed by three raters with varying experience levels in neuroradiology using the test dataset. Agreement analyses were applied to evaluate the prediction performance/reproducibility. The test dataset included 303 patients (age (SD): 56.7 (14.2) years, female/male: 114/189, low-grade/high-grade: 54/249, IDH-mutant/wildtype: 82/221, 1p/19q-codeleted/intact: 34/269). Per-rater GBCA-free predictions achieved ≥ 0.85 (95%-CI: 0.80-0.88) accuracy for grade and ≥ 0.75 (95%-CI: 0.70-0.80) for molecular status, while GBCA-enhanced predictions reached ≥ 0.87 (95%-CI: 0.82-0.90) and ≥ 0.77 (95%-CI: 0.71-0.81), respectively. No accuracy difference was observed between GBCA-free and GBCA-enhanced predictions. Group inter-rater agreement was moderate for GBCA-free (0.56 (95%-CI: 0.46-0.66)) and substantial for GBCA-enhanced grade prediction (0.68 (95%-CI: 0.58-0.78), p = 0.008), while substantial for both GBCA-free (0.75 (95%-CI: 0.69-0.80) and GBCA-enhanced (0.77 (95%-CI: 0.71-0.82), p = 0.51) molecular status predictions. The proposed GBCA-free diagnosis prediction decision tree performed well, with GBCA-enhanced images adding little to the preoperative diagnostic accuracy of adult-type diffuse gliomas. Question Given health and environmental concerns, is there a gadolinium-free imaging protocol to preoperatively evaluate gliomas comparable to the gadolinium-enhanced standard practice? Findings The proposed gadolinium-free diagnosis prediction decision tree for adult-type diffuse gliomas performed well, and gadolinium-enhanced MRI demonstrated only limited improvement in diagnostic accuracy. Clinical relevance Even inexperienced raters effectively classified adult-type diffuse gliomas using the gadolinium-free diagnosis prediction decision tree, which, until further validation, can be used alongside gadolinium-enhanced images to respect standard practice, despite this study showing that gadolinium-enhanced images hardly improved diagnostic accuracy.

Development of professional skills in kickboxing athletes using virtual reality technologies

Ukrainian sports are currently facing numerous problems due to the hostile military operations by the Russian Federation, leading to the emigration of gifted athletes from the nation. Considering these challenges, the search for novel ways to support and enhance athletes throughout their careers has become critically important. Cutting-edge technologies, especially virtual reality (VR), are being proposed as a potent means to enhance professional training. They facilitate the fusion of traditional and innovative methods, ensuring that athletic training evolves to meet contemporary demands. This strategy adjusts the requirements of athletes across the spectrum, from beginners to professionals, as well as mentors and sports entities eager to incorporate unconventional technologies into their training regimen. Employing immersive VR settings enables the replication of authentic competitive scenarios and training intensities. It offers the capability to monitor biometric data, evaluating the athletes' resilience to stress, their focus, and their strategic expertise. Anticipated outcomes of this holistic approach include enhanced training session productivity, reinforced mental strength in competitors during events, and expedited recuperation from injuries. The introduction and application of VR technology in sports training signifies a leap towards revitalizing traditional training techniques, ensuring they are modular and adaptable. This facilitates seamless integration into a range of sports disciplines and alignment with diverse training schemes, enhancing Ukraine's global sports standing and positioning the nation as a pioneer in athlete training innovation. In this study, we explored the incorporation of VR technology in kickboxing, specifically targeting the 10–12-year age bracket. At this developmental stage, children are particularly receptive to new experiences and stimuli, making such a technologically enriched environment a powerful tool to boost training enthusiasm. Virtual reality holds the promise of breaking the routine of standard training practices, rendering them more captivating and interactive, which is crucial for attracting young participants.

Neonatology Staffing Practices: An In-Depth Exploration of Leaders’ Perspectives

To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking. We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts. Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be≤24hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs. Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.

Proposing New Standard and ANFIS Calculation Approaches for Precast Concrete Connections with Steel Tube Elements: Lessons from Experimental Studies

The importance of establishing a proper method for calculating newly studied structural elements and primarily translating the results of experimental and numerical analyses into practical standards poses a significant challenge for structural researchers. In this study, which focuses on the importance of previously studied connections for the precast industry as a case study, two approaches are proposed for calculating the capacity of elements connected by rectangular steel tubes. The first approach involves a step-by-step calculation for analyzing the forces and capacities of different steel tube or concrete section parts under bending and shear, aiming to establish a standard calculation approach. Despite its complexity, the standard calculation approach has proven its accuracy by successfully solving examples with features similar to those of the experimental tests describing the process. The second approach relies on a look-up table generated from experimental data, developing an Adaptive Neuro-Fuzzy Inference System (ANFIS) for interpreting the data. ANFIS not only facilitates the evaluation of the capacity of non-experimentally tested elements but also resembles the calculation process. Evaluating ANFIS’s performance concerning the original results underscores its remarkable capacity to analyze experimental data. With a maximum calculation error of only 13% when compared to the experimental tests, ANFIS demonstrates considerable accuracy and user-friendliness. Following the initial internal force evaluations, the proposed standard calculation method requires eight specific control inputs, and comparing these inputs with experimental tests further confirms the effectiveness and safety of this approach for connection design.

Cybersecurity in Prognostics and Health Management

PHM continues to show its value by improving operational efficiencies, increasing safety, reducing downtime, and decreasing cost of operations. PHM technologies are therefore not only being deployed as retrofit solutions but are being integrated into new systems as standard practice. Deployment covers areas such as medical equipment, nuclear power plants, aeronautics applications, oil and gas, mining, and many others. As the impact of PHM increases, it is imperative to also consider the potential vulnerabilities that are being exposed. Hackers have famously used Supervisory Control and Data Acquisition (SCADA) and Programmable Logic Controller (PLC) systems to sabotage industrial facilities. As such, it is important to understand the exposure to malfeasance to ensure that PHM does not end up being the enabling mechanism for unauthorized access to the system it is meant to keep in running order. It is also important to understand the measures that need to be taken to avoid or respond to an attack. These range from extensive penetration testing to conducting extensive counter-social engineering training, setting up a PHM-specific CERT plan and team in place. This paper discusses various threats that are emerging and that may have to be considered when designing a PHM solution. Additionally, the NIST cybersecurity framework is discussed in the context of PHM. Finally, this paper looks at the diagnostic capabilities of PHM systems to detect cyber security attacks and to contain these threats.

Prognosis related to treatment plan in patients with biliary tract cancer: A nationwide database study

BackgroundBiliary tract cancer (BTC) is a malignancy characterized by a low 5-year survival rate (<20 %). Clinical aspects such as tumor resectability, Eastern Cooperative Oncology Group performance status score (ECOG-PS), and molecular profiling are used to determine the treatment for these patients. Diagnosis and treatment are typically established by a multidisciplinary team (MDT). However, standardized practices for BTC are lacking, and there is a need to assess the impact of current MDT treatment decisions on BTC outcomes. The purpose of this study was to investigate the role of the treatment plan proposed by the first MDT conference on survival in patients with BTC, and to identify risk factors for poor survival in this population. MethodThis nationwide, multicenter, retrospective cohort study examined data from the Danish Liver Cancer Group (2013–2020) with confirmed BTC diagnoses. Multiple imputation was used to handle missing data. Survival and variable-survival rate relationships were analyzed using the Kaplan-Meier estimator, and the Cox regression model, respectively. ResultsEligible BTC-confirmed cases: n=1923. The overall median survival was 7.7 months (95 % CI: 7.1–8.5), with a 5-year survival rate of 16.3 %. Patients over 70 years of age, with ECOG-PS 3 or 4, non-operable cases, and with unresectable tumors had lower survival rates. Surgery as the first therapeutic option showed the highest median survival (33.1 months, 95 % CI: 27.2–41.6; p < 0.0001). Multivariable analysis showed that poor ECOG-PS, palliative and neoadjuvant chemotherapy, stereotactic radiotherapy, and best supportive care significantly increased mortality risk in patients with BTC (p=0.05). ConclusionAmong the therapeutic options prescribed by the MDT for patients with BTC, surgery offered the best survival rates, likely due to patient-related prognostic factors. High ECOG-PS was linked to an increased mortality risk regardless of age, highlighting the importance of this criterion in treatment decisions.