A comparison of clinical paediatric murmur assessment with echocardiography

Objective: To compare the clinical acumen of paediatric cardiovascular examination between various hospital paediatrician grades. Design: Prospective data collection of clinical and echocardiography findings on paediatric echocardiography referrals. Setting and patients: All paediatric patients (birth - 14 years) referred for echocardiography, in a regional hospital catering for the island population of Malta. Echocardiography was carried out by three paediatricians with tertiary training in this technique. Main outcome measures: Pre-echocardiography clinical diagnoses were compared with echocardiography results according to grade of referring hospital doctor (ranging from houseman to consultant). Both normal and abnormal hearts at echocardiography were included. Results: Echocardiographers had the highest clinical accuracy and the highest attempts at reaching a clinical diagnosis. Accuracy and attempts at diagnosis decreased as doctor's hospital grade decreased, from consultant to houseman. Ventricular septal defect was the most easily diagnosed lesion. Atrial septal defect was often misdiagnosed as pulmonary stenosis.peer-reviewe

How linear features alter predator movement and the functional\ud response

In areas of oil and gas exploration, seismic lines have been reported to alter the movement patterns of wolves (Canis lupus). We developed a mechanistic first passage time model, based on an anisotropic elliptic partial differential equation, and used this to explore how wolf movement responses to seismic lines influence the encounter rate of the wolves with their prey. The model was parametrized using 5 min GPS location data. These data showed that wolves travelled faster on seismic lines and had a higher probability of staying on a seismic line once they were on it. We simulated wolf movement on a range of seismic line densities and drew implications for the rate of predator–prey interactions as described by the functional response. The functional response exhibited a more than linear increase with respect to prey density (type III) as well as interactions with seismic line density. Encounter rates were significantly higher in landscapes with high seismic line density and were most pronounced at low prey densities. This suggests that prey at low population densities are at higher risk in environments with a high seismic line density unless they learn to avoid them

Longitudinal MRI assessment: the identification of relevant features in the development of posterior fossa syndrome in children

Up to 25% of children who undergo brain tumour resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterised by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in lobes within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Intra-operative MRI (IoMRI) is used during surgical procedures at the Alder Hey Children’s Hospital, Liverpool, England, in the treatment of Posterior Fossa tumours and allows visualisation of the brain during surgery. The final MR scan on the IoMRI allows early assessment of the ION immediately after the surgical procedure. The longitudinal MRI data of 28 patients was analysed in a collaborative study with Alder Hey Children’s Hospital, in order to identify the most relevant imaging features that relate to the development of PFS, specifically related to HOD. A semi-automated segmentation process was carried out to delineate the ION on each MRI. Feature selection techniques were used to identify the most relevant features amongst the MRI data, demographics and clinical data provided by the hospital. A support vector machine (SVM) was used to analyse the discriminative ability of the selected features. The results indicate the presence of HOD as the most efficient feature that correlates with the development of PFS, followed by the change in intensity and size of the ION and whether HOD occurred bilaterally or unilaterally

The value of multiple 2D ultrasound scanning views in the detection of Congenital Heart Disease in the second trimester (18 to 24 weeks)

Antenatal detection for Congenital Heart Disease (CHD) is poor, but may be improved by adding views to routine ultrasound scanning. From June 2014-July 2015, 600 randomly selected women between 18 to 24 weeks of pregnancy, had a routine 4-chamber ultrasound scan at Mater Dei Hospital view (Basic 4CV). In addition, they completed an Extended Cardiac Ultrasound Examination (ExCUSE) including the left outflow tract, right outflow tract, 5-chamber view and 3-vessel view. All views were timed. The results obtained from the 600 women who received Basic and the ExCUSE scanning were followed-up clinically after delivery of the infants. Validity testing of both 4CV and ExCUSE views was carried out, and the detection rate of CHD compared. During the 12-month period, 61 cases from a total of 4,200 children up to 1 year of age were diagnosed with CHD by Paediatric Echocardiography. 19 were included in the 600-study cohort, of which 12 were detected antenatally, 1 via the 4CV alone, 4 by both the 4CV plus at least 1 of the ExCUSE views and 7 by 1 or more of the ExCUSE views alone. On average, ExCUSE views took approximately 6 minutes longer, yet there was a significant difference between the detection rate of CHD by the 4CV compared with the ExCUSE views (χ2 = 0.031, p=0.05). Sensitivity and specificity of the 4CV were 31.6% and 100%, respectively, and 63.1% and 100%, respectively for ExCUSE views. Antenatal diagnosis of CHD is improved with additional ultrasound views, but this will necessitate staff training and adjustments in clinic schedules to accommodate increased scan time.peer-reviewe

Regional differences in childhood BMI data : the Malta childhood national body mass index study

Introduction: Obesity is a problem of major public health concern all over the world and Malta has high obesity prevalence rates. With over a third of Maltese children being overweight or obese, the Malta Childhood National Body Mass Index study was devised to quantify the extent of the problem precisely. This paper looks at regional differences in the BMI data obtained. Methods: Training in measurement was provided to physical education teachers and identical stadiometers were used. Data was processed using World Health Organisation cut-offs for underweight, overweight and obesity. Results: A total of 41,343 students from 145 schools were measured. Age range from 4.7 to 17 years. Approximately 40% of school-aged children in Malta were overweight or obese, with higher percentages of obesity than overweight being observed. Results show significant differences in BMI between children living in Northern and Southern regions of Malta. Conclusion: Results from this study further confirm the high levels of overweight and obesity in Maltese children. The North-South differences should help better target public health resources and should be further evaluated in more focussed research.peer-reviewe

Identifying quantitative imaging features of posterior fossa syndrome in longitudinal MRI

Up to 25% of children who undergo brain tumor resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterized by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in structures within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Longitudinal MRI datasets of 28 patients were acquired consisting of pre-, intra-, and postoperative scans. A semiautomated segmentation process was used to segment the ION on each MR image. A full set of imaging features describing the first- and second-order statistics and size of the ION were extracted for each image. Feature selection techniques were used to identify the most relevant features among the MRI features, demographics, and data based on neuroradiological assessment. A support vector machine was used to analyze the discriminative features selected by a generative k-nearest neighbor algorithm. The results indicate the presence of hyperintensity in the left ION as the most diagnostically relevant feature, providing a statistically significant improvement in the classification of patients (p=0.01) when using this feature alone

Fully-automated identification of imaging biomarkers for post-operative cerebellar mutism syndrome using longitudinal paediatric MRI

Post-operative cerebellar mutism syndrome (POPCMS) in children is a post- surgical complication which occurs following the resection of tumors within the brain stem and cerebellum. High resolution brain magnetic resonance (MR) images acquired at multiple time points across a patient’s treatment allow the quantification of localized changes caused by the progression of this syndrome. However, MR images are not necessarily acquired at regular intervals throughout treatment and are often not volumetric. This restricts the analysis to 2D space and causes difficulty in intra- and inter-subject comparison. To address these challenges, we have developed an automated image processing and analysis pipeline. Multi-slice 2D MR image slices are interpolated in space and time to produce a 4D volumetric MR image dataset providing a longitudinal representation of the cerebellum and brain stem at specific time points across treatment. The deformations within the brain over time are represented using a novel metric known as the Jacobian of deformations determinant. This metric, together with the changing grey-level intensity of areas within the brain over time, are analyzed using machine learning techniques in order to identify biomarkers that correspond with the development of POPCMS following tumor resection. This study makes use of a fully automated approach which is not hypothesis-driven. As a result, we were able to automatically detect six potential biomarkers that are related to the development of POPCMS following tumor resection in the posterior fossa

Grasping the Links in the Chain: Understanding the Unintended Consequences of International Counter-Narcotics Measures for the EU

No abstract available

Stemming and best practice in the mining industry : a literature review

In 2015, after amendments to the explosives regulations, stemming became a mandatory activity for all South African mining operations. There are, however, circumstances in which it is thought stemming has an adverse impact on the blasting outcome. Some of these circumstances include blasting in hot holes, in reactive ground, or when blasting a pre-split. In order to determine when stemming is necessary, its role in the control of adverse blasting phenomena and impact on explosive performance were reviewed. Stemming was found to play a significant role in the fragmentation process and burden movement. Additionally, stemming significantly influences the control of flyrock, air-blast, and toxic fume generation. The review of the literature indicates some motivation for not using stemming for presplit, trim, hot hole, and reactive ground blasting, provided the benefits associated with not stemming the holes outweigh the risks of stemming them. Best practice for stemming from the literature indicates a stemming length of 0.7 × burden is best for larger hole diameters, and 20 to 30 × Ø for smaller hole diameters. Crushed aggregate appears to be the most effective stemming material. The South African explosives regulations pertaining to stemming were found to be consistent with those of Australia and the USA.http://www.saimm.co.za/journal-papersam2022Mining Engineerin

Physical and energy demand of soccer: A brief review

Soccer is a complex and exhaustive team-sport requiring a high level of tactical, technical, and physical ability to succeed. During a competitive match, a random combination of explosive and powerful activities, together with technical and tactical gestures, is performed in an intermittent manner over a 90-minute game. This review presents a detailed analysis and up-to-date synthesis of the literature describing activities and energy system contribution during soccer to provide to strength and conditioning coaches a clear understanding of soccer players’ physical needs during competition