Analyzing the Functional Interdependence of Verbal Behavior with Multiaxial Radar Charts.

The functional analysis of complex verbal behavior requires an evaluation of topographically similar responses under multiple sources of control. Traditional graphical displays of behavior were designed to show the manipulation of isolated controlling variables and may not be amenable to displaying the multidimensional properties of complex behavior. Researchers have recently demonstrated the use of multiaxial radar charts for comparing the functional performance of biological systems. Here we extend the use of multidimensional analyses to compare the relative performance distributions of verbal behavior across four potential controlling variables. First, we provide a conceptual analysis of intraverbal and extraverbal control as continua along which stimuli range from formal to thematic and explain how the intersection of these stimulus fields creates a radar chart for multidimensional analysis. Then we demonstrate how data may be gathered through a verbal operant experimental analysis. We employed repeated measures to map the conditioning history of a child with autism spectrum disorder across 2 years of early intensive behavioral intervention and analyzed the results using shape descriptors for quantitative comparisons. We also compared the polygonal language profiles of children with autism against that of a neurotypical peer. Extending a multidimensional analysis to the field of verbal behavior provides the basis for a language growth chart that researchers and clinicians can use to monitor language acquisition over time. We discuss the use of radar charts as a framework for understanding the interdependence of verbal operants and suggest their use for complex analyses of complex verbal behavior. Supplementary Information: The online version contains supplementary material available at 10.1007/s40614-024-00404-6.

Argentine and World Health Organization head circumference standards: A comparison study. / Estándares de perímetro cefálico argentinos y de la Organización Mundial de la Salud: estudio comparativo.

Introduction. Several studies have shown population differences in head circumference (HC) that question the universal validity of the World Health Organization (WHO) standard to assess head growth. Objectives. To compare the Argentine reference charts for HC from 0 to 5 years of age with the WHO standards. Population and methods. The 3rd and 97th percentiles for HC based on the Argentine reference charts were compared with the corresponding WHO standard and the percentage of children classified as having microcephaly (HC < 3rd percentile of the WHO) and macrocephaly (HC > 97th percentile of the WHO) at specific ages between 0 and 5 years were estimated. Results. The comparison of the Argentine reference charts with the WHO standards shows that, in both males and females, at the 3rd percentile, the Argentine reference charts are below the WHO standards from 1 to 6 months of age, similar from 9 to 18 months of age, and then above until 60 months old. In relation to the 97th percentile, the Argentine reference charts are above the WHO standards from birth to 60 months in both boys and girls. Conclusions. The head size of Argentine children is different from that established by the WHO standards. The adoption of the WHO standards for our population increases the percentage of macrocephaly diagnosis at all ages.

Introducción. Diversos estudios han evidenciado diferencias poblacionales en el tamaño cefálico que cuestionan la validez universal del estándar de la Organización Mundial de la Salud (OMS) para evaluar el crecimiento cefálico. Objetivos. Comparar las referencias argentinas de perímetro cefálico (PC) de 0 a 5 años con los estándares de la OMS. Población y métodos. Se compararon los percentiles 3 y 97 de PC de las referencias argentinas con los correspondientes del estándar de la OMS y se calcularon los porcentajes de niños clasificados como microcefálicos (PC < percentil 3 de la OMS) y macrocefálicos (PC > percentil 97 de la OMS) a edades específicas entre el nacimiento y los 5 años de edad. Resultados. La comparación de las referencias argentinas con los estándares de la OMS, muestra que ­en ambos sexos­ en el percentil 3, desde el primer mes y hasta los 6 meses, las referencias argentinas se encuentran por debajo de los estándares de la OMS, son similares entre los 9 y 18 meses, y luego se ubican por encima hasta los 60 meses. En relación con el percentil 97, las referencias argentinas se ubican por encima de los estándares de la OMS desde el nacimiento hasta los 60 meses en ambos sexos. Conclusiones. El tamaño cefálico de los niños y niñas argentinos difiere del de los estándares de la OMS. La adopción de los estándares de la OMS en nuestra población incrementa el porcentaje de diagnóstico de macrocefalia a todas las edades.

Developmental Curves of the Paediatric Brain Using FLAIR MRI Texture Biomarkers.

Purpose: Analysis of FLAIR MRI sequences is gaining momentum in brain maturation studies, and this study aimed to establish normative developmental curves for FLAIR texture biomarkers in the paediatric brain. Methods: A retrospective, single-centre dataset of 465/512 healthy paediatric FLAIR volumes was used, with one pathological volume for proof-of-concept. Participants were included if the MRI was unremarkable as determined by a neuroradiologist. An automated intensity normalization algorithm was used to standardize FLAIR signal intensity across MRI scanners and individuals. FLAIR texture biomarkers were extracted from grey matter (GM), white matter (WM), deep GM, and cortical GM regions. Sex-specific percentile curves were reported and modelled for each tissue type. Correlations between texture and established biomarkers including intensity volume were examined. Biomarkers from the pathological volume were extracted to demonstrate clinical utility of normative curves. Results: This study analyzed 465 FLAIR sequences in children and adolescents (mean age 10.65 ± 4.22 years, range 2-19 years, 220 males, 245 females). In the WM, texture increased to a maximum at around 8 to 10 years, with different trends between females and males in adolescence. In the GM, texture increased over the age range while demonstrating a local maximum at 8 to 10 years. Texture had an inverse relationship with intensity in the WM across all ages. WM and edema in a pathological brain exhibited abnormal texture values outside of the normative growth curves. Conclusion: Normative curves for texture biomarkers in FLAIR sequences may be used to assess brain maturation and microstructural changes over the paediatric age range.

Noonan Syndrome Growth Charts and Genotypes: 15-Year Longitudinal Single-Centre Study.

INTRODUCTION: Growth patterns in Noonan syndrome (NS) remain relatively unknown. The objective of this study was to provide growth reference curves for patients with NS and identify correlations between their growth, genotype, and clinical features. METHODS: This was a 15-year-long, monocentric, observational, retrospective, non-interventional study. Children with NS followed up between 2005 and 2022 at "Bambino Gesù" Children's Hospital, Italy, were included and excluded if they had received growth hormone treatment. Comparison of growth curves of participants with NS versus the general Italian population and further genotypic analyses were performed. RESULTS: Overall, 190 eligible participants with NS were identified, with median (interquartile range) age of 14.01 (9.05-19.25) years (55.8% male). Cardiovascular anomalies were present in 85.3% of participants, most commonly pulmonary stenosis (52.6%) and atrial septal defects (36.8%); 48.1% of male participants had cryptorchidism. The most frequently detected mutations were in PTPN11 (66.3%) and SOS1 (13.9%). NS sex-specific centile curves for height, weight, body mass index, and height velocity were produced. For both sexes, the 50th percentile of height and weight for participants with NS overlapped with the 3rd percentile for the general Italian population. Both sexes with a PTPN11 mutation had a significantly lower height and weight than those with "other mutations" at 5 years old. No significant associations were observed between cardiac anomalies and PTPN11 mutation status. CONCLUSION: We present longitudinal data describing growth curves and trends, the natural history, and genotypes of the NS population, which provide a useful tool for clinicians in the management of NS.

Control charts in healthcare quality monitoring: a systematic review and bibliometric analysis.

Control charts, used in healthcare operations to monitor process stability and quality, are essential for ensuring patient safety and improving clinical outcomes. This comprehensive research study aims to provide a thorough understanding of the role of control charts in healthcare quality monitoring and future perspectives by utilizing a dual methodology approach involving a systematic review and a pioneering bibliometric analysis. A systematic review of 73 out of 223 articles was conducted, synthesizing existing literature (1995-2023) and revealing insights into key trends, methodological approaches, and emerging themes of control charts in healthcare. In parallel, a bibliometric analysis (1990-2023) on 184 articles gathered from Web of Science and Scopus was performed, quantitatively assessing the scholarly landscape encompassing control charts in healthcare. Among 25 countries, the USA is the foremost user of control charts, accounting for 33% of all applications, whereas among 14 health departments, epidemiology leads with 28% of applications. The practice of control charts in health monitoring has increased by more than one-third during the last 3 years. Globally, exponentially weighted moving average charts are the most popular, but interestingly the USA remained the top user of Shewhart charts. The study also uncovers a dynamic landscape in healthcare quality monitoring, with key contributors, research networks, research hotspot tendencies, and leading countries. Influential authors, such as J.C. Benneyan, W.H. Woodall, and M.A. Mohammed played a leading role in this field. In-countries networking, USA-UK leads the largest cluster, while other clusters include Denmark-Norway-Sweden, China-Singapore, and Canada-South Africa. From 1990 to 2023, healthcare monitoring evolved from studying efficiency to focusing on conditional monitoring and flowcharting, with human health, patient safety, and health surveys dominating 2011-2020, and recent years emphasizing epidemic control, COronaVIrus Disease of 2019 (COVID-19) statistical process control, hospitals, and human health monitoring using control charts. It identifies a transition from conventional to artificial intelligence approaches, with increasing contributions from machine learning and deep learning in the context of Industry 4.0. New researchers and journals are emerging, reshaping the academic context of control charts in healthcare. Our research reveals the evolving landscape of healthcare quality monitoring, surpassing traditional reviews. We uncover emerging trends, research gaps, and a transition in leadership from established contributors to newcomers amidst technological advancements. This study deepens the importance of control charts, offering insights for healthcare professionals, researchers, and policymakers to enhance healthcare quality. Future challenges and research directions are also provided.

Prevalence and Risk Factors for Metamorphopsia after Successful Retinal Detachment Surgery.

INTRODUCTION: The aim of the study was to determine the prevalence of metamorphopsia following rhegmatogenous retinal detachment (RRD) surgery, as well as associated predictive factors. METHODS: A total of 107 eyes successfully operated for RRD underwent metamorphopsia severity assessment using M-CHARTS, and foveal microstructure analysis by spectral domain optical coherence tomography, at 1 and 6 months postoperatively. Univariate and multivariate logistic regression rendered evaluation of preoperative risk factors. The correlation between metamorphopsia score and outer retinal layer (ORL) integrity was investigated and preoperative risk factors evaluated. RESULTS: The prevalence of postoperative metamorphopsia decreased from 51.4 to 29.9% and the median metamorphopsia score significantly improved (0.5, 95% CI: 0.3; 0.9, to 0.2, 95% CI: 0; 0.5, p < 0.001) from 1 to 6 months, respectively. Preoperative macular detachment was the only predictor found (OR 11.0, 95% CI: 3.1; 39.4, p < 0.001). Metamorphopsia severity was significantly associated with outer nuclear layer thickness and the status of the ellipsoid and cone interdigitation zones. One-month M-CHARTS had 81% sensitivity and 87% specificity in predicting full metamorphopsia recovery at 6 months (0.45 cut-off score). CONCLUSION: The prevalence of metamorphopsia decreased in parallel to ORL restoration, thus demonstrating the etiological role of photoreceptor-level morphological changes. M-CHARTS allowed for monitoring and predicting metamorphopsia recovery after RRD.

Decreasing incidence of admission neonatal hypothermia in Gandhi Memorial Hospital, Addis Ababa, Ethiopia: quality improvement project.

BACKGROUND: WHO reported that neonatal hypothermia accounts for about 27% of newborn deaths worldwide. It is a serious concern in Ethiopia and other parts of sub-Saharan Africa; it poses a serious threat to global health, increasing morbidity and mortality. Hypothermic neonates are more likely to experience respiratory distress, infections and other issues that could result in longer hospital stays and delayed development. The objective of this quality improvement project was to minimise intensive medical treatments, maximise resource usage and enhance overall health outcomes for newborns at Gandhi Memorial Hospital by reducing neonatal hypothermia. METHODS: Over 10 months (from 1 March 2021 to 30 January 2022), neonatal hypothermia incidence was assessed using Quality Supervision Mentoring Team and Health Management Information System data. Root cause analysis and literature review led to evidence-based interventions in a change bundle. After team training and neonatal intensive care unit (NICU) relocation, Plan-Do-Study-Act cycles tested the bundle. Close temperature monitoring and data collection occurred. Run charts evaluated intervention success against baseline data, informing conclusions about effectiveness. RESULT: The quality improvement project reduced neonatal hypothermia in NICU admissions from a baseline median of 80.6% to a performance median of 30%. CONCLUSION AND RECOMMENDATION: The quality improvement project at Gandhi Memorial Hospital effectively reduced neonatal hypothermia through interventions such as the temperature management bundle and NICU relocation, leading to improved patient care, fewer hypothermic neonates and enhanced body temperature management. Continuous monitoring, adherence to best practices, sharing success and outcome assessment are crucial for enhancing the project's effectiveness and sustaining positive impacts on neonatal hypothermia reduction and patient outcomes.

Reference Ranges for Arterial Oxygen Saturation, Heart Rate, and Cerebral Oxygen Saturation during Immediate Postnatal Transition in Neonates Born Extremely or Very Preterm.

OBJECTIVE: To define percentile charts for arterial oxygen saturation (SpO2), heart rate (HR), and cerebral oxygen saturation (crSO2) during the first 15 minutes after birth in neonates born very or extremely preterm and with favorable outcome. STUDY DESIGN: We conducted a secondary-outcome analysis of neonates born preterm included in the Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth III (COSGOD III) trial with visible cerebral oximetry measurements and with favorable outcome, defined as survival without cerebral injuries until term age. We excluded infants with inflammatory morbidities within the first week after birth. SpO2 was obtained by pulse oximetry, and electrocardiogram or pulse oximetry were used for measurement of HR. crSO2 was assessed with near-infrared spectroscopy. Measurements were performed during the first 15 minutes after birth. Percentile charts (10th to 90th centile) were defined for each minute. RESULTS: A total of 207 neonates born preterm with a gestational age of 29.7 (23.9-31.9) weeks and a birth weight of 1200 (378-2320) g were eligible for analyses. The 10th percentile of SpO2 at minute 2, 5, 10, and 15 was 32%, 52%, 83%, and 85%, respectively. The 10th percentile of HR at minute 2, 5, 10, and 15 was 70, 109, 126, and 134 beats/min, respectively. The 10th percentile of crSO2 at minute 2, 5, 20, and 15 was 15%, 27%, 59%, and 63%, respectively. CONCLUSIONS: This study provides new centile charts for SpO2, HR, and crSO2 for neonates born extremely or very preterm with favorable outcome. Implementing these centiles in guiding interventions during the stabilization process after birth might help to more accurately target oxygenation during postnatal transition period.

Joint monitoring of mean and variance using Max-EWMA control chart under lognormal process with application to engine oil data.

The control charts are frequently employed in process monitoring to assess the average and variability of a process, assuming a normal distribution. However, it is worth noting that some process distributions tend to exhibit a positively skewed distribution, such as the lognormal distribution. This article proposed a maximum exponential weighted moving average control chart for joint monitoring of mean and variance under a lognormal process. The proposed control chart is evaluated by using the run length profile such as ARL and SDRL. The Monte Carlo simulation is conducted by using the R language to find the run length profile. An application is presented to demonstrate the design of the proposed control chart.

Brazilian growth charts for Williams-Beuren Syndrome at ages 2 to 18 years

Abstract Objective: To develop growth charts for weight-for-age, height-for-age, and body mass index (BMI)-for-age for both genders aged 2 to 18 years for Brazilian patients with Williams-Beuren Syndrome (WBS). Methods: This is a multicenter, retrospective, and longitudinal study, data were collected from the medical records of boys and girls with a confirmed diagnosis of WBS in three large university centers in the state of Sao Paulo, Brazil. Growth charts stratified by gender and age in years were developed using LMSchartmaker Pro software. The LMS (Lambda Mu Sigma) method was used to model the charts. The quality of the settings was checked by worm plots. Results: The first Brazilian growth charts for weight-for-age, height-for-age, and BMI-for-age stratified by gender were constructed for WBS patients aged 2 to 18 years. Conclusion: The growth charts developed in this study can help to guide family members and to improve the health care offered by health professionals.

Argentine reference charts for head circumference from birth to 19 years of age. / Referencias argentinas de perímetro cefálico desde el nacimiento hasta los 19 años.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts werehigher than those of the Nellhaus charts at all ages. The values for the 2nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

Partnered pharmacist medication charting and prescribing in Australian hospitals.

Medication charting and prescribing errors commonly occur at hospital admission and discharge. Pharmacist medication reconciliation, after medicines are ordered by a medical officer, can identify and resolve errors, but this often occurs after the errors have reached the patient. Partnered pharmacist medication charting and prescribing are interprofessional, collaborative models that are designed to prevent medication errors before they occur, by involving pharmacists directly in charting and prescribing processes. In the partnered charting model, a pharmacist and medical officer discuss the patient's current medical and medication-related problems and agree on a medication management plan. Agreed medicines are then charted by the pharmacist on the inpatient medication chart. A similar collaborative model can be used at other points in the patient journey, including at discharge. Studies conducted at multiple Australian health services, including rural and regional hospitals, have shown that partnered charting on admission, and partnered prescribing at discharge, significantly reduces the number of medication errors and shortens patients' length of stay in hospital. Junior medical officers report benefiting from enhanced interprofessional learning and reduced workload. Partnered pharmacist medication charting and prescribing models have the best prospect of success in environments with a strong culture of interprofessional collaboration and clinical governance, and a sufficiently resourced clinical pharmacist workforce.

Significant differences in the length and weight measurements of Jordanian infants compared to the World Health Organization 2006 growth standards.

BACKGROUND: In 2006, the World Health Organization (WHO) introduced new growth standards based on data derived globally from optimally nourished breastfed infants. The aim of this study was to assess the effects of implementing WHO growth standards on the growth patterns of Jordanian infants. In addition, it was to ascertain the necessity of establishing country-specific growth standards and charts tailored to Jordanian infants. MATERIALS AND METHODS: The data of 102,846 infants (50.1% boys, 49.9% girls) aged 0-24 months, from 115 primary healthcare centers across the country were retrieved from a National E-health Program. Weight and length measurements were analyzed, and age- and sex-specific z-scores were calculated relative to the WHO growth standards. Data was analyzed using SPSS version 26. Mann-Whitney U test was performed to determine significant differences between the measurements for boys and girls in terms of age, length, and weight. RESULTS: Jordanian infants exhibited significantly shorter length-for-age measurements than WHO standards with mean z-scores of -0.56 and -0.38, for boys and girls, respectively. Weight-for-age measurements showed a good fit and were comparable to the WHO growth standards for boys (mean z score = -0.05) and girls (mean z score = 0.04). Notably, Jordanian infants displayed higher weight-for-length measurements, with mean z-scores of 0.51 for boys and 0.47 for girls. CONCLUSION: The availability of Jordanian-specific growth standards will improve the accuracy of assessing infant growth and enhance the monitoring and evaluation of their health and development.

Critical considerations for communicating environmental DNA science.

The economic and methodological efficiencies of environmental DNA (eDNA) based survey approaches provide an unprecedented opportunity to assess and monitor aquatic environments. However, instances of inadequate communication from the scientific community about confidence levels, knowledge gaps, reliability, and appropriate parameters of eDNA-based methods have hindered their uptake in environmental monitoring programs and, in some cases, has created misperceptions or doubts in the management community. To help remedy this situation, scientists convened a session at the Second National Marine eDNA Workshop to discuss strategies for improving communications with managers. These include articulating the readiness of different eDNA applications, highlighting the strengths and limitations of eDNA tools for various applications or use cases, communicating uncertainties associated with specified uses transparently, and avoiding the exaggeration of exploratory and preliminary findings. Several key messages regarding implementation, limitations, and relationship to existing methods were prioritized. To be inclusive of the diverse managers, practitioners, and researchers, we and the other workshop participants propose the development of communication workflow plans, using RACI (Responsible, Accountable, Consulted, Informed) charts to clarify the roles of all pertinent individuals and parties and to minimize the chance for miscommunications. We also propose developing decision support tools such as Structured Decision-Making (SDM) to help balance the benefits of eDNA sampling with the inherent uncertainty, and developing an eDNA readiness scale to articulate the technological readiness of eDNA approaches for specific applications. These strategies will increase clarity and consistency regarding our understanding of the utility of eDNA-based methods, improve transparency, foster a common vision for confidently applying eDNA approaches, and enhance their benefit to the monitoring and assessment community.

Infant growth by INTERGROWTH-21st and Fenton Growth Charts: Predicting 1-year anthropometry in South African preterm infants.

Post-natal growth influences short- and long-term preterm infant outcomes. Different growth charts, such as the Fenton Growth Chart (FGC) and INTERGROWTH-21st Preterm Post-natal Growth Standards (IG-PPGS), describe different growth curves and targets. This study compares FGC- and IG-PPGS-derived weight-for-postmenstrual age z-score (WZ) up to 50 weeks postmenstrual age (PMA50) for predicting 1-year anthropometry in 321 South African preterm infants. The change in WZ from birth to PMA50 (ΔWZ, calculated using FGC and IG-PPGS) was correlated to age-corrected 1-year anthropometric z-scores for weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) and BMI-for-age (BMIZ), and categorically compared with rates of underweight (WAZ < -2), stunting (LAZ < -2), wasting (WLZ < -2) and overweight (BMIZ > + 2). Multivariable analyses explored the effects of other early-life exposures on malnutrition risk. At PMA50, mean WZ was significantly higher on IG-PPGS (-0.56 ± 1.52) than FGC (-0.90 ± 1.52; p < 0.001), but ΔWZ was similar (IG-PPGS -0.26 ± 1.23, FGC -0.11 ± 1.14; p = 0.153). Statistically significant ΔWZ differences emerged among small-for-gestational age infants (FGC -0.38 ± 1.22 vs. IG-PPGS -0.01 ± 1.30; p < 0.001) and appropriate-for-gestational age infants (FGC + 0.02 ± 1.08, IG-PPGS -0.39 ± 1.18; p < 0.001). Correlation coefficients of ΔWZ with WAZ, LAZ, WLZ and BMIZ were low (r < 0.45), though higher for FGC than IG-PPGS. Compared with IG-PPGS, ΔWZ < -1 on FGC predicted larger percentages of underweight (42% vs. 36%) and wasting (43% vs. 39%) and equal percentages of stunting (33%), while ΔWZ > + 1 predicted larger percentages overweight (57% vs. 38%). Both charts performed similarly in multivariable analysis. Differences between FGC and IG-PPGS are less apparent when considering ΔWZ, highlighting the importance of assessing growth as change over time, irrespective of growth chart.

New adaptive EWMA CV control chart with application to the sintering process.

This research presents a new adaptive exponentially weighted moving average control chart, known as the coefficient of variation (CV) EWMA statistic to study the relative process variability. The production process CV monitoring is a long-term process observation with an unstable mean. Therefore, a new modified adaptive exponentially weighted moving average (AAEWMA) CV monitoring chart using a novel function hereafter referred to as the "AAEWMA CV" monitoring control chart. the novelty of the suggested AAEWMA CV chart statistic is to identify the infrequent process CV changes. A continuous function is suggested to be used to adapt the plotting statistic smoothing constant value as per the process estimated shift size that arises in the CV parametric values. The Monte Carlo simulation method is used to compute the run-length values, which are used to analyze efficiency. The existing AEWMA CV chart is less effective than the proposed AAEWMA CV chart. An industrial data example is used to examine the strength of the proposed AAEWMA CV chart and to clarify the implementation specifics which is provided in the example section. The results strongly recommend the implementation of the proposed AAEWMA CV control chart.

Quantitative evaluation of metamorphopsia with M-CHARTS™ and evaluation of retinal morphologic changes by optical coherence tomography before and after pars plana vitrectomy in patients with idiopathic epiretinal membrane.

PURPOSE: We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores. MATERIALS AND METHODS: This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (group1) and patients with decreasing metamorphopsia scores as the other group (group 2). RESULTS: In "group 2", preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (P: 0.028) higher than in "group 1". CONCLUSION: A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery.

Quality improvement initiative: improving obstetric triaging practices in a rural maternal hospital in central India.

Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability in obstetric triage. Specific obstetric triage index tools improve maternal and neonatal outcomes but remain underused. The aim was to introduce a validity-tested obstetric triage tool to improve the percentage of correctly triaged patients (correctly colour-coded in accordance with triage index tool and attended to within the stipulated time interval mandated by the tool) from the baseline of 49% to more than 90% through a quality improvement (QI) process.A team of nurses, obstetricians and postgraduates did a root cause analysis to identify the possible reasons for incorrect triaging of obstetric patients using process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address issues identified.The interventions included introduction and application of an obstetric triage index tool, training of triage nurses and residents. We implemented these interventions in eight PDSA cycles and observed outcomes by using run charts. A set of process, output and outcome indicators were used to track if changes made were leading to improvement.Proportion of correctly triaged women increased from the baseline of 49% to more than 95% over a period of 8 months from February to September 2020, and the results have been sustained in the last PDSA cycle, and the triage system is still sustained with similar results. The median triage waiting time reduced from the baseline of 40 min to less than 10 min. There was reduction in complications attributable to improper triaging such as preterm delivery, prolonged intensive care unit stay and overall morbidity. It can be thus concluded that a QI approach improved obstetric triaging in a rural maternity hospital in India.

Retrospective charts for reporting, analysing, and evaluating disaster emergency response: a systematic review.

OBJECTIVE: Given the frequency of disasters worldwide, there is growing demand for efficient and effective emergency responses. One challenge is to design suitable retrospective charts to enable knowledge to be gained from disasters. This study provides comprehensive understanding of published retrospective chart review templates for designing and updating retrospective research. METHODS: We conducted a systematic review and text analysis of peer-reviewed articles and grey literature on retrospective chart review templates for reporting, analysing, and evaluating emergency responses. The search was performed on PubMed, Cochrane, and Web of Science and pre-identified government and non-government organizational and professional association websites to find papers published before July 1, 2022. Items and categories were grouped and organised using visual text analysis. The study is registered in PROSPERO (374,928). RESULTS: Four index groups, 12 guidelines, and 14 report formats (or data collection templates) from 21 peer-reviewed articles and 9 grey literature papers were eligible. Retrospective tools were generally designed based on group consensus. One guideline and one report format were designed for the entire health system, 23 studies focused on emergency systems, while the others focused on hospitals. Five papers focused specific incident types, including chemical, biological, radiological, nuclear, mass burning, and mass paediatric casualties. Ten papers stated the location where the tools were used. The text analysis included 123 categories and 1210 specific items; large heterogeneity was observed. CONCLUSION: Existing retrospective chart review templates for emergency response are heterogeneous, varying in type, hierarchy, and theoretical basis. The design of comprehensive, standard, and practicable retrospective charts requires an emergency response paradigm, baseline for outcomes, robust information acquisition, and among-region cooperation.

Toward an internationally accepted standard for reading charts.

Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic diagnosis and therapy, and because a significant lack of comparability between reading charts still exists, there is an increasing need for a worldwide standard in the form of a norm for diagnostic reading charts. Already, applied advancements such as digital print, which allow a calibration of the print sizes of reading charts in correctly progressing geometric proportions by using the actual height of a lower case "x" in millimeters (x-height), and psychophysically standardizing reading charts and their test items by applying modern statistical methods have significantly contributed to establishing a norm for reading charts. In 2020, a proposal of the British delegation was accepted by the International Organization for Standardization (ISO) group "Visual Optics and Optical Instruments," and a working group was established. Bearing in mind the efforts of the ISO with regard to an international norm, this review article is intended to (a) give an overview of the historical background and related normative approaches for diagnostic reading tests used in ophthalmology and optometry, (b) explain psychophysical and technical concerns, and (c) discuss the possibilities and limits of concepts that seem relevant to developing a modern standard for reading charts.