Acoustic emission sensing of pipe-soil interaction: Development of an early warning system for buried pipe deformation

This paper describes a programme of research that aims to develop a continuous, real-time acoustic emission (AE) monitoring system that can be distributed at discrete locations along buried pipelines to sense pipe/soil interaction and provide early warning of adverse behaviour to enable targeted and timely interventions. Pipe/soil interaction-generated AE propagates as guided waves along pipelines. Novel AE interpretation is allowing the evolution of the pipe/soil interaction behaviour to be characterised, and the rate and magnitude of deformation to be quantified. New understanding of AE propagation and attenuation in buried pipes is enabling source localisation methodologies to be developed. Results from normal faulting experiments performed on buried full-scale steel pipes at the buried infrastructure research facility at Queen’s University, Canada, are presented to demonstrate the potential of the AE technique for early detection of buried pipe deformation

Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS

Digital vs conventional implant impressions: a systematic review and meta-analysis

Purpose: To systematically review in vitro and clinical studies comparing quantitatively the 3D accuracy (global implant deviations) of digital vs conventional implant impressions for partially and completely edentulous patients. Materials and Methods: Electronic and manual searches were conducted to identify in vitro and clinical studies, reporting on the 3D accuracy between digital and conventional implant impressions. Secondary outcomes were the effect of implant angulation, type of conventional impression technique, and type of intraoral scanner on the accuracy of implant impressions. Results: The inclusion criteria were met by 9 in vitro studies and 1 clinical study reporting on completely edentulous impressions, while 6 in vitro and 2 clinical studies reported on partially edentulous impressions. Quantitative meta-analysis was performed for 5 completely edentulous and 6 partially edentulous studies. The studies exhibited high values for heterogeneity. A random effects model was conducted to estimate the effect size. Based on 5 in vitro studies on completely edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 8.20 µm (95% CI: −53.56, 37.15) and the digital impressions had nominally less deviation (p = 0.72). Based on 1 clinical and 5 in vitro studies on partially edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 52.31 µm (95% CI: 6.30, 98.33) and the conventional impressions had nominally less deviation (p = 0.03). Five in vitro and 2 clinical studies were not included in the quantitative analysis due to heterogeneity in the methodology. Implant angulation affected the accuracy in favor of the partially edentulous conventional impressions whereas the effect of different scanners was not statistically significant on the completely edentulous impressions (p = 0.82). Conclusions: Digital scans appear to have comparable 3D accuracy with conventional implant impressions based mainly on in vitro studies. However, clinical trials are recommended to investigate the clinical accuracy of digital scans and digitally fabricated interim or prototype prostheses, before digital implant scans can be recommended for routine clinical use

A Microwave Reflectometry Technique for Profiling the Dielectric-Conductivity Properties of the Hagia Sophia Globe

A microwave free space reflectometry technique with swept frequency measurements for the profiling of wall structures and the detection of hidden (covered) layers has been applied to the Hagia Sophia byzantine monument. Experimental measurement results are presented and compared with three-dimensional (3D) simulated results, exhibiting fair agreement in some (though not all) aspects. Based on the experimental results, the possibility of clear discrimination between regions with and without covered mosaic layers, and hence the detection of such layers, is demonstrated

Antibiotics and Cure Rates in Childhood Febrile Urinary Tract Infections in Clinical Trials: A Systematic Review and Meta-analysis

Purpose: Urinary tract infections (UTIs) are common bacterial infections among children. Objective: To systematically review the antimicrobials used for febrile UTIs in paediatric clinical trials and meta-analyse the observed cure rates and reasons for treatment failure. Materials and Methods: We searched Medline, Embase and Cochrane central databases between January 1, 1990, and November 24, 2016, combining MeSH and free-text terms for: “urinary tract infections”, AND “therapeutics”, AND “clinical trials” in children (age range 0–18 years). Two independent reviewers assessed study quality and performed data extraction. The major outcome measures were clinical and microbiological cure rates according to different antibiotics. Results: We identified 2762 published studies and included 30 clinical trials investigating 3913 cases of paediatric febrile urinary tract infections. Children with no underlying condition were the main population included in the trials (n = 2602; 66.5%). Cephalosporins were the most frequent antibiotics studied in trials (22/30, 73.3%). Only a few antibiotics active against resistant UTIs have been tested in randomised clinical trials, mainly aminoglycosides. The average point cure rate of all investigational drugs was estimated to 95.3% (95% CI 93.5–96.9%). Among 3002 patients for whom cure and failure rates were reported, only 3.9% (3.9%; 118/3002) were considered clinically to have treatment failure, while 135 (4.5%; 135/3002) had microbiological failure. Conclusions: We observed high treatment cure rates, regardless of the investigational drug chosen, the route of administration, duration and dosing. This suggests that future research should prioritise observational studies and clinical trials on children with multi-drug-resistant infections. © 2018, Springer Nature Switzerland AG

Urinary Tract Infection Antibiotic Trial Study Design: A Systematic Review

Context: Urinary tract infections (UTIs) represent a common bacterial infections in children. No guidance on the conduct of pediatric febrile UTI clinical trials (CTs) exist. Objective: To assess the criteria used for patients selection and the efficacy endpoints in febrile pediatric UTI CTs. Data Sources: Medline, Embase, Cochrane central databases and ClinicalTrials.gov between January 1, 1990, and November 24, 2016. Study Selection: We combined MeSH and free-text terms for: “urinary tract infections”, AND “therapeutics”, AND “clinical trials” in children (0–18 years), identifying 3,086 papers. Data Extraction: Two independent reviewers assessed study quality and performed data extraction. Results: Forty CTs investigating 4,381 cases of pediatric febrile UTIs were included. Positive urine culture and fever were the most common inclusion criteria (93% and 78%, respectively). Urine sampling method, pyuria and colonies thresholds were highly variable. Clinical and microbiological endpoints were assessed in 88% and 93% of the studies, respectively. Timing for endpoints assessment was highly variable, and only 3 studies (17%), out of the 18 performed after the Food and Drug Administration 1998 guidance publication, assessed primary and secondary endpoints consistently with this guidance. Limitations: Mixed population of healthy children and with underlying condition. Six trials studied a subgroup of patients with afebrile UTI. Conclusions: We observed a wide variability in the microbiological inclusion criteria and the timing for endpoints assessment. The available guidance for adults appear not to be used by pediatricians and do not seem applicable to the childhood UTI. A harmonized design for pediatric UTIs CT is required