Study of pediatric appendicitis scores and management strategies: A prospective observational feasibility study.

OBJECTIVE: The objective was to investigate the feasibility of prospectively validating multiple clinical prediction scores (CPSs) for pediatric appendicitis in an Australian pediatric emergency department (ED). METHODS: A literature search was conducted to identify potential CPSs and a single-center prospective observational feasibility study was performed between November 2022 and May 2023 to evaluate the performance of identified CPSs. Children 5-15 years presenting with acute right-sided or generalized abdominal pain and clinician suspicion of appendicitis were included. CPSs were calculated by the study team from prospectively clinician-collected data and/or review of medical records. Accuracy of CPSs were assessed by area under the receiver operating characteristic curve (AUC) and proportions correctly identifiable as either low-risk or high-risk with the best performing CPS compared to clinician gestalt. Final diagnosis of appendicitis was confirmed on histopathology or by telephone/email follow-up for those discharged directly from ED. RESULTS: Thirty CPSs were identified in the literature search and 481 patients were enrolled in the study. A total of 150 (31.2%) patients underwent appendectomy with three (2.0%) having a normal appendix on histopathology. All identified CPSs were calculable for at least 50% of the patient cohort. The pediatric Appendicitis Risk Calculator for pediatric EDs (pARC-ED; n = 317) was the best performing CPS with AUC 0.90 (95% confidence interval [CI] 0.86-0.94) and specificity 99.0% (95% CI 96.4%-99.7%) in diagnosing high-risk cases and a misclassification rate of 4.5% for low-risk cases. CONCLUSIONS: The study identified 30 CPSs that could be validated in a majority of patients to compare their ability to assess risk of pediatric appendicitis. The pARC-ED had the highest predictive accuracy and can potentially assist in risk stratification of children with suspected appendicitis in pediatric EDs. A multicenter study is now under way to evaluate the potential of these CPSs in a broader range of EDs to aid clinical decision making in more varied settings.

Poor sleep quality and its associated factors among working adults during COVID-19 pandemic in Malaysia.

Background: In Malaysia, a nationwide movement control order (MCO), implemented to curb the COVID-19 spread, impacted on the lives of the working population which could impair sleep quality. Objective: This study aims to find the sleep quality status and its association with the socioeconomic, employment and lifestyle factors of working adults during the MCO period. Methods: A cross-sectional study was conducted among 500 eligible working adults. Data were collected using a structured questionnaire consisting of the Pittsburg Sleep Quality Index. Results: The proportion of poor sleep quality is found to be 59.4%. Analysis shows that the use of electronic devices before sleep (OR = 2.33, 95% CI = 1.02-5.35, p-value = 0.046), increased amount of workload (OR = 0.45, p-value = 0.005), decreased in amount of workload (OR = 0.48, p-value = 0.003) and distracted while working (OR = 0.57, p-value = 0.014) are the factors significantly associated with and are predictors of poor sleep quality. Conclusion: During crisis, there is a need for public health interventions for the working population to adopt a healthy lifestyle. Employers are recommended to support employees' well-being and to provide a healthy workplace during challenging times. Policy recommendations are also made to implement flexible working arrangements, workload management, workplace mental health support and legal protections on reasonable working hours, rest breaks and time off during crises.

A Study on the Shrinkage and Compressive Strength of GGBFS and Metakaolin Base Geopolymer under Different NaOH Concentrations.

Geopolymers (GPs) are gaining prominence due to their low carbon emissions and sustainable attributes. However, one challenge with GPs, particularly those made with ground granulated blast furnace slag (GGBFS), is their significant shrinkage during the geopolymerization process, limiting its practical applicability. This study focuses on how the substitution ratio of metakaolin (MK) and the concentration of sodium hydroxide (NaOH) in the activator can influence the shrinkage and strength of a GGBFS-based GP. The experimental approach employed a 3 × 3 parameter matrix, which varied MK substitution ratios (0%, 50%, and 100%) and adjusted the NaOH concentration (6 M, 10 M, and 14 M). The results revealed that increasing MK substitution, particularly with 6 M NaOH activation, reduced the GP shrinkage but also diminished compressive strength, requiring higher NaOH concentrations for strength improvement. Statistical tools, including analysis of variance (ANOVA) and second-order response surface methodology (RSM), were employed for analysis. ANOVA results indicated the significant impacts of both the MK content and NaOH concentration on compressive strength, with no observable interaction. However, the shrinkage exhibited a clear interaction between MK content and NaOH concentration. The RSM model accurately predicted compressive strength and shrinkage, demonstrating a high predictive accuracy, for which the coefficients of determination (R2) were 0.99 and 0.98, respectively. The model provides a reliable method for determining the necessary compressive strength and shrinkage for GGBFS-based GP based on MK substitution and NaOH concentration. Within the optimization range, the RSM model compared with experimental results showed a 6.04% error in compressive strength and 0.77% error in shrinkage for one interpolated parameter set. This study establishes an optimized parameter range ensuring a GP performance that is comparable to or surpassing OPC, with a parameter set achieving a compressive strength of 34.9 MPa and shrinkage of 0.287% at 28 days.

Left atrial diastasis strain slope is a marker of hemodynamic recovery in post-ST elevation myocardial infarction: the Laser Atherectomy for STemi, Pci Analysis with Scintigraphy Study (LAST-PASS).

Background: Left atrial (LA) mechanics are strongly linked with left ventricular (LV) filling. The LA diastasis strain slope (LADSS), which spans between the passive and active LA emptying phases, may be a key indicator of the LA-LV interplay during diastole. Aim: This study aimed to investigate the LA-LV interdependencies in post-ST elevation myocardial infarction (STEMI), with particular focus on the LADSS. Materials and methods: Patients with post-anterior STEMI who received primary percutaneous coronary intervention underwent contrast cardiac magnetic resonance imaging (MRI) during acute (5-9 days post-STEMI) and chronic (at 6 months) phases. The LADSS was categorized into three groups: Groups 1, 2, and 3 representing positive, flat, and negative slopes, respectively. Cross-sectional correlates of LADSS Group 2 or 3 compared to Group 1 were identified, adjusting for demographics, LA indices, and with or without LV indices. The associations of acute phase LADSS with the recovery of LV ejection fraction (LVEF) and scar amount were investigated. Results: Sixty-six acute phase (86.4% male, 63.1 ± 11.8 years) and 59 chronic phase cardiac MRI images were investigated. The distribution across LADSS Groups 1, 2, and 3 in the acute phase was 24.2%, 28.9%, and 47.0%, respectively, whereas in the chronic phase, it was 33.9%, 22.0%, and 44.1%, respectively. LADSS Group 3 demonstrated a higher heart rate than Group 1 in the acute phase (61.9 ± 8.7 vs. 73.5 ± 11.9 bpm, p < 0.01); lower LVEF (48.7 ± 8.6 vs. 41.8 ± 9.9%, p = 0.041) and weaker LA passive strain rate (SR) (-1.1 ± 0.4 vs. -0.7 [-1.2 to -0.6] s-1, p = 0.037) in the chronic phase. Chronic phase Group 3 exhibited weaker LA passive SR [relative risk ratio (RRR) = 8.8, p = 0.012] than Group 1 after adjusting for demographics and LA indices; lower LVEF (RRR = 0.85, p < 0.01), higher heart rate (RRR = 1.1, p = 0.070), and less likelihood of being male (RRR = 0.08, p = 0.058) after full adjustment. Acute phase LADSS Groups 2 and 3 predicted poor recovery of LVEF when adjusted for demographics and LA indices; LADSS Group 2 remained a predictor in the fully adjusted model (ß = -5.8, p = 0.013). Conclusion: The LADSS serves both as a marker of current LV hemodynamics and its recovery in post-anterior STEMI. The LADSS is an important index of LA-LV interdependency during diastole. Clinical Trial Registration: https://clinicaltrials.gov/, identifier NCT03950310.

Respiratory Syncytial Virus Reinfections in Children in Western Australia.

Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.

Use of Geopolymer and Carbon Fiber-Reinforced Polymer for Repairing Reinforced Concrete Deck Soffit.

This study aimed to assess the feasibility of utilizing geopolymer for repairing reinforced concrete beams. Three types of beam specimens were fabricated: benchmark specimens without any grooves, rectangular-grooved beams, and square-grooved beams. The repair materials employed included geopolymer material, and epoxy resin mortar, while carbon fiber sheets were used as reinforcement in select cases. The repair materials were applied to the rectangular and square-grooved specimens, with the carbon fiber sheets attached to the tension side of the specimens. To evaluate the flexural strength of the concrete specimens, a third-point loading test was conducted. The test results indicated that the geopolymer exhibited higher compressive strength and shrinkage rate compared to the epoxy resin mortar. Furthermore, the specimens reinforced with carbon fiber sheets demonstrated even greater strength than the benchmark specimens. In terms of flexural strength under cyclic third-point loading tests, the carbon fiber-reinforced specimens exhibited the ability to withstand over 200 cycles of repeated loading at 0.8 times the ultimate load. In contrast, the benchmark specimens could only withstand seven cycles. These findings highlight that the use of carbon fiber sheets not only enhances compressive strength but also improves resistance to cyclic loading.

Comparing Factors Associated With Intimate Partner Violence Among Rural and Urban Women in Northern Uganda.

Intimate partner violence (IPV) is an important public health issue with negative effects at individual and societal levels. In northern Uganda, IPV prevalence is high but literature on it is limited. Northern Uganda has a long history of socio-economic and political upheavals, which are recognized risk factors for IPV. We compare IPV prevalence among rural and urban women in northern Uganda. This was a cross-sectional survey of 856 northern Ugandan women, 409 women living in rural areas, and 447 women working in an urban marketplace. Data were analyzed using logistic regression. High rates of emotional, physical, and sexual IPV were found. Almost four of five participants had experienced at least one type of IPV during their lifetime, and approximately half of the participants had experienced IPV in the 12 months prior to the survey. Many women stated that IPV was justified in certain situations. Younger age was a significant determinant of IPV in both cohorts (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] [0.93-0.97]). Determinants of IPV among the rural cohort included male partner's alcohol abuse (aOR 2.22, CI [1.34-3.73]); having been in a physical fight with another man (aOR 1.90, 95% CI [1.12-3.23]); and controlling behaviors (aOR 1.21, CI [1.08-1.36]). Possible protective factors in the urban cohort included markers of economic empowerment such as being the decision maker on large household items (59.2% vs. 44.6%, p = .002) and having a mobile phone (20.4% vs. 12.4%, p = .024). Our study shows that IPV is a significant issue in northern Uganda. Economic empowerment is associated with lower rates of IPV in urban women, and interventions to reduce gender wealth inequality may reduce IPV prevalence. Further studies on enablers of IPV and the effect of conflict on IPV prevalence are needed to inform future interventions.

The Length Change Ratio of Ground Granulated Blast Furnace Slag-Based Geopolymer Blended with Magnesium Oxide Cured in Various Environments.

Geopolymer (GP) has been considered a potential material to replace ordinary Portland cement (OPC) because of its excellent mechanical properties and environmentally friendly process. However, the promotion of GP is limited due to the large shrinkage and the different operating procedures compared to cement. This study aims to reduce the shrinkage of ground granulated blast furnace slag (GGBFS) based GP by the hydration expansion properties of activated magnesium oxide (MgO). The slurry of GP was blended from GGBFS, MgO, and activator; and the compositions of the activator are sodium hydroxide (NaOH), sodium silicate (Na2SiO3), and alumina silicate(NaAlO2). Herein, the GGFBS and MgO were a binder and a shrinkage compensation agent of GP, respectively. After unmolding, the GP specimens were cured under four types of environments and the lengths of the specimens were measured at different time intervals to understand the length change ratio of GP. In this study, two groups of GP specimens were made by fixing the activator to binder (A/B) ratio and the fluidity. The test results show that adding MgO will reduce the shrinkage of GP as A/B ratio was fixed. However, fixing the fluidity exhibited the opposite results. The X-ray diffraction (XRD) was used to check the Mg(OH)2 that occurred due to the MgO hydration under four curing conditions. Three statistical and machine learning methods were used to analyze the length change of GP based on the test data. The testing and analysis results show that the influence of curing environments is more significant for improving the shrinkage of GP than additive MgO.

Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia.

BACKGROUND: Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020. METHOD: At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020. RESULTS: RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity. INTERPRETATION: The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.

Using Geopolymer Technology on Synthesizing Leucite Ceramics.

The aim of this study is to assess the process of synthesizing potassium-based geopolymers (KGL) into leucite ceramics with regard to five variables, namely, alkaline solution ratio (R), sintering time (S), calcining temperature (T), mixing time (M), and curing time (C). Under these conditions, the specimens were tested by the viscosity test, the mechanical properties test, X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, and scanning electron microscopy (SEM) to understand the geopolymerization reactions and the characteristics of the KGL network. The results indicate that a KOH to K2O/SiO2 ratio of 1:1 promotes the reaction within metakaolin. XRD analysis of the KGL shows that, when the temperature is 1100 °C, the phase transforms into the leucite phase. Moreover, XRD analysis, mechanical properties, and FTIR all indicate improved characteristics when the curing time increases from 1 to 8 h. This might be attributed to the enhancement of the strong interaction between the matrix and the alkaline solution upon achieving adequate time to complete the geopolymerization process and forming a more stable three-dimensional structure. The formulation which formed the purest leucite phase consisted of: a 1:1 alkaline solution ratio, 10 min mixing time, 8 h curing time, 1200 °C calcining temperature, and 2 h sintering time.

Fabrication of Low-Temperature Sintering Building Bricks Using Drilling Cutting and Geopolymeric Technology.

This study explores the practicability of using drill cutting (DC) as raw material to fabricate building bricks through the high-temperature sintering method and low-temperature geopolymeric setting (LTGS) process. Drilling mud can be recycled and reutilized after certain treatment procedures and is considered as a non-hazardous waste. However, the treatment process is time-consuming and not cost-effective. For the sintering method, low porosity and high mechanical strength bricks can be sintered at temperatures above 800 °C and meet CNS standards. For the low-temperature geopolymeric setting process, sodium silicate was selected as an activating agent for geopolymerization of drill cutting. Several process parameters, such as Si2O/Na2O modulus of alkali solution and low-temperature geopolymeric setting temperature, were investigated. The physical and mechanical properties of the fabricated brick were evaluated. According to the test results, 72.4 MPa compressive strength building bricks with low porosity (13.9%) and water absorption (6.0%) can be fabricated with 2.0 Si2O/Na2O alkali solution at 500 °C. The drill cutting brick fabricated not only meets the CNS 382.R2002 common brick standard, but also solve its disposal problem.

Medical Disimpaction for Children With Organic Esophageal Foreign Body in the Era of Eosinophilic Esophagitis.

OBJECTIVE: Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE. METHODS: A retrospective chart review was performed using the International Classification of Diseases codes and the emergency department database of patients presenting with EFBI from January 2010 to December 2014. Response to MD was defined as symptomatic relief of obstruction. Age, object ingested, medical agent used, EoE status, complications, and outcome were recorded. RESULTS: A total of 317 presentations of EFBI were identified during the study period, of which organic EFBI accounted for 101 impactions (31.9%). Medical disimpaction was attempted for 42 (41.6%) with organic EFBI, resulting in resolution of symptoms for 16 (38.1%). One child with EoE responded to MD compared with 15 without EoE (4.8% vs 71.4%, P < 0.0001). CONCLUSIONS: Medical disimpaction was ineffective in children with EoE but may be of help with symptom resolution in approximately 70% of children without EoE.

Pediatric Abdominal Pain in Children Presenting to the Emergency Department.

BACKGROUND: Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED). OBJECTIVES: The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED. METHODS: A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site. The primary outcome was to describe the prevalence of CSAP and appendicitis. Age, sex, length of stay, surgery or interventional procedure, investigations, and analgesia use were recorded. RESULTS: There were 555 presentations with abdominal pain during the study period with a median age of 9 years (interquartile range, 6-12 years). Eighty-two patients (14.8%; 95% confidence interval, 11.8-17.7) had CSAP, of which 41 (7.4%, 5.2-9.6) had appendicitis. Three hundred forty-eight (62.7%, 58.7-66.7) were discharged directly from ED, and 207 (37.3%, 33.2-41.3) were admitted. Two hundred fifty-five (45.9%, 41.8-50.1) had pathology tests, and 173 (31.2%, 27.3-35.1) had imaging tests in ED. Of those contacted for telephone follow-up, 100 (50.5%, 43.5-57.5) of 198 reported ongoing pain after discharge, and 13.1% (8.4-17.8) had missed over a week of school due to abdominal pain. CONCLUSIONS: The prevalence of CSAP and appendicitis in our study was 14.8% (11.8-17.7) and 7.4% (5.2-9.6), respectively. Fewer than half of patients received blood tests, and a third received imaging during their ED attendance. The presentation of abdominal pain conveys a significant health burden on families with time off school and ongoing symptoms of pain.

Sustainable Development and Performance Evaluation of Marble-Waste-Based Geopolymer Concrete.

The key objective of this study was to develop marble-based geopolymer concrete and examine the viability of its application as a sustainable structural material for the construction industry. The results of the research demonstrated that marble-based geopolymer concrete can be developed, and its physical/mechanical properties were shown to have a very good performance. According to various experimental tests and a large-scale ready-mixed plant test, it was found that the marble-based geopolymer concrete displayed a good workability and was not easily influenced by temperature changes. The results showed that marble-based geopolymer concrete has an excellent potential for further engineering development in the future.

Characterizing the cancer-associated microbiome with small RNA sequencing data.

The microbiome is recognized as a quasi-organ in the human body. When dysbiosis of the microbiome occurs, this variation may contribute to alterations in the microenvironment, potentially inducing an inflammatory immune response and providing a niche for neoplastic growth. However, there is limited evidence regarding the correlation and interaction between the microbiome and tumorigenesis. By utilizing microRNA sequencing data of patients with colon and rectal cancer from The Cancer Genome Atlas, we designed a novel analytical process to extract non-human small RNA sequences and align them with the microbial genome to obtain a comprehensive view of the cancer-associated microbiome. In the present study, we identified >1000 genera among 630 colorectal samples and clustered these samples into three distinctive colorectal enterotypes. Furthermore, we found 12 genera from these clusters that are associated with cancer stages and revealed their putative functions. Our results indicate that the proposed analytical approach can effectively determine the cancer-associated microbiome. It may be readily applied to explore other types of cancer, in which specimens of the microbiome are difficult to collect.

Geographical disparities in emergency department presentations for acute respiratory infections and risk factors for presenting: a population-based cohort study of Western Australian children.

INTRODUCTION: Studies examining acute respiratory infections (ARIs) in emergency department (EDs), particularly in rural and remote areas, are rare. This study aimed to examine the burden of ARIs among Aboriginal and non-Aboriginal children presenting to Western Australian (WA) EDs from 2002 to 2012. METHOD: Using a retrospective population-based cohort study linking ED records to birth and perinatal records, we examined presentation rates for metropolitan, rural and remote Aboriginal and non-Aboriginal children from 469 589 births. We used ED diagnosis information to categorise presentations into ARI groups and calculated age-specific rates. Negative binomial regression was used to investigate association between risk factors and frequency of ARI presentation. RESULTS: Overall, 26% of presentations were for ARIs. For Aboriginal children, the highest rates were for those aged <12 months in the Great Southern (1233 per 1000 child-years) and Pilbara regions (1088 per 1000 child-years). Rates for non-Aboriginal children were highest in children <12 months in the Southwest and Kimberley (400 and 375 per 1000 child-years, respectively). Presentation rates for ARI in children from rural and remote WA significantly increased over time in all age groups <5 years. Risk factors for children presenting to ED with ARI were: male, prematurity, caesarean delivery and residence in the Kimberley region and lower socio-economic areas. CONCLUSION: One in four ED presentations in WA children are for ARIs, representing a significant out-of-hospital burden with some evidence of geographical disparity. Planned linkages with hospital discharge and laboratory detection data will aid in assessing the sensitivity and specificity of ARI diagnoses in ED.

Geopolymer technology for the solidification of simulated ion exchange resins with radionuclides.

In this study, geopolymer was applied to convert ion exchange resins contaminated with radionuclides into a solid waste form. Geopolymer has superior properties to enable the encapsulation of spent resins. The allowable limit of resin content in the converted waste form was analyzed to evaluate the solidification capability of geopolymer. The encapsulation of ion exchange resins into solid waste form was conducted using geopolymer prepared with ground granulated blast furnace slag and alkaline solution in an ambient atmosphere, with the addition of wollastonite powder to adjust its mechanical properties. The physical and mechanical properties of the converted solid wastes prepared using different resin content ratios and various SiO2/Na2O molar ratios were tested. The results indicate the wet ion exchange resin (the moisture content in the resin is 51%) content and the compressive strength of the solid resin waste were measured as 45 wt% and 8.5 MPa, respectively. The morphology and mineral phases of the formed solid wastes were characterized using SEM and EDS. The mechanical performance test results proved the formed solid wastes could comply with the fuel cycle and material administration standards ruled by the Atomic Energy Council of Taiwan. These results suggest that this blast furnace slag-based geopolymer is a promising matrix material for the solidification of radioactive wastes.