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Congenital heart disease is associated with impaired early brain development and adverse neurodevelopmental outcomes. This study investigated how individualized measures of preoperative cortical gyrification index differ in 142 infants with congenital heart disease, using a normative modelling approach with reference data from 320 typically developing infants. Gyrification index Z -scores for the whole brain and six major cortical areas were generated using two different normative models: one accounting for post-menstrual age at scan, post-natal age at scan and sex, and another additionally accounting for supratentorial brain volume. These Z -scores were compared between congenital heart disease and control groups to test the hypothesis that cortical folding in infants with congenital heart disease deviates from the normal developmental trajectory. The relationships between whole-brain gyrification index Z -scores from the two normative models and both cerebral oxygen delivery and neurodevelopmental outcomes were also investigated. Global and regional brain gyrification was significantly reduced in neonates with congenital heart disease, but not when supratentorial brain volume was accounted for. This finding suggests that whilst cortical folding is reduced in congenital heart disease, it is primarily driven by a reduction in brain size. There was a significant positive correlation between cerebral oxygen delivery and whole-brain gyrification index Z -scores in congenital heart disease, but not when supratentorial brain volume was accounted for. Cerebral oxygen delivery is therefore likely to play a more important role in the biological processes underlying volumetric brain growth than cortical folding. No significant associations between whole-brain gyrification index Z -scores and motor/cognitive outcomes or autism traits were identified in the 70 infants with congenital heart disease who underwent neurodevelopmental assessment at 22-months. Our results suggest that chronic in utero and early post-natal hypoxia in congenital heart disease is associated with reductions in cortical folding that are proportional to reductions in supratentorial brain volume., Competing Interests: The authors report no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12-18 months of a child's life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: H Frail, R O’Halloran, F Padormo, M Poorman, J Rogers, L Sacolick, K Siddiqui, R Teixeira, M Traughber are employees of Hyperfine.io W Hollander, T. Karaulanov, and C Weiant are employees of CaliberMRI. C Akgun, and P Velasco are employees of Flywheel.io, (Copyright © 2024. Published by Elsevier Ltd.)

Background: Congenital heart disease (CHD) is common and is associated with impaired early brain development and neurodevelopmental outcomes, yet the exact mechanisms underlying these associations are unclear., Purpose: To utilize MRI data from a cohort of fetuses with CHD as well as typically developing fetuses to test the hypothesis that expected cerebral substrate delivery is associated with total and regional fetal brain volumes., Study Type: Retrospective case-control study., Population: Three hundred eighty fetuses (188 male), comprising 45 healthy controls and 335 with isolated CHD, scanned between 29 and 37 weeks gestation. Fetuses with CHD were assigned into one of four groups based on expected cerebral substrate delivery., Field Strength/sequence: T2-weighted single-shot fast-spin-echo sequences and a balanced steady-state free precession gradient echo sequence were obtained on a 1.5 T scanner., Assessment: Images were motion-corrected and reconstructed using an automated slice-to-volume registration reconstruction technique, before undergoing segmentation using an automated pipeline and convolutional neural network that had undergone semi-supervised training. Differences in total, regional brain (cortical gray matter, white matter, deep gray matter, cerebellum, and brainstem) and brain:body volumes were compared between groups., Statistical Tests: ANOVA was used to test for differences in brain volumes between groups, after accounting for sex and gestational age at scan. P FDR -values <0.05 were considered statistically significant., Results: Total and regional brain volumes were smaller in fetuses where cerebral substrate delivery is reduced. No significant differences were observed in total or regional brain volumes between control fetuses and fetuses with CHD but normal cerebral substrate delivery (all P FDR  > 0.12). Severely reduced cerebral substrate delivery is associated with lower brain:body volume ratios., Data Conclusion: Total and regional brain volumes are smaller in fetuses with CHD where there is a reduction in cerebral substrate delivery, but not in those where cerebral substrate delivery is expected to be normal., Evidence Level: 3 TECHNICAL EFFICACY: Stage 3., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Hypoglycaemia in term infants is very common. Deciding on appropriate investigations and management is often challenging. The aims of this article are to help with understanding when, how and why to investigate symptoms of hypoglycaemia in full-term infants (born ≥37 weeks' gestational age)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Ultra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system., Methods: Images were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM)., Results: There was no significant difference between temperature before and after scanning ( p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy., Discussion: We demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bridgen, Tomi-Tricot, Uus, Cromb, Quirke, Almalbis, Bonse, De la Fuente Botella, Maggioni, Cio, Cawley, Casella, Dokumaci, Thomson, Willers Moore, Bridglal, Saravia, Finck, Price, Pickles, Cordero-Grande, Egloff, O'Muircheartaigh, Counsell, Giles, Deprez, De Vita, Rutherford, Edwards, Hajnal, Malik and Arichi.)

Background: Magnetic Resonance (MR) imaging is key for investigation of suspected newborn brain abnormalities. Access is limited in low-resource settings and challenging in infants needing intensive care. Portable ultralow field (ULF) MRI is showing promise in bedside adult brain imaging. Use in infants and children has been limited as brain-tissue composition differences necessitate sequence modification. The aim of this study was to develop neonatal-specific ULF structural sequences and test these across a range of gestational maturities and pathologies to inform future validation studies., Methods: Prospective cohort study within a UK neonatal specialist referral centre. Infants undergoing 3T MRI were recruited for paired ULF (64mT) portable MRI by convenience sampling from the neonatal unit and post-natal ward. Key inclusion criteria: 1) Infants with risk or suspicion of brain abnormality, or 2) preterm and term infants without suspicion of major genetic, chromosomal or neurological abnormality. Exclusions: presence of contra-indication for MR scanning. ULF sequence parameters were optimised for neonatal brain-tissues by iterative and explorative design. Neuroanatomic and pathologic features were compared by unblinded review, informing optimisation of subsequent sequence generations in a step-wise manner. Main outcome: visual identification of healthy and abnormal brain tissues/structures. ULF MR spectroscopy, diffusion, susceptibility weighted imaging, arteriography, and venography require pre-clinical technical development and have not been tested., Findings: Between September 23, 2021 and October 25, 2022, 102 paired scans were acquired in 87 infants; 1.17 paired scans per infant. Median age 9 days, median postmenstrual age 40 +2 weeks (range: 31 +3 -53 +4 ). Infants had a range of intensive care requirements. No adverse events observed. Optimised ULF sequences can visualise key neuroanatomy and brain abnormalities. In finalised neonatal sequences: T2w imaging distinguished grey and white matter (7/7 infants), ventricles (7/7), pituitary tissue (5/7), corpus callosum (7/7) and optic nerves (7/7). Signal congruence was seen within the posterior limb of the internal capsule in 10/11 infants on finalised T1w scans. In addition, brain abnormalities visualised on ULF optimised sequences have similar MR signal patterns to 3T imaging, including injury secondary to infarction (6/6 infants on T2w scans), hypoxia-ischaemia (abnormal signal in basal ganglia, thalami and white matter 2/2 infants on T2w scans, cortical highlighting 1/1 infant on T1w scan), and congenital malformations: polymicrogyria 3/3, absent corpus callosum 2/2, and vermian hypoplasia 3/3 infants on T2w scans. Sequences are susceptible to motion corruption, noise, and ULF artefact. Non-identified pathologies were small or subtle., Interpretation: On unblinded review, optimised portable MR can provide sufficient contrast, signal, and resolution for neuroanatomical identification and detection of a range of clinically important abnormalities. Blinded validation studies are now warranted., Funding: The Bill and Melinda Gates Foundation, the MRC, the Wellcome/EPSRC Centre for Medical Engineering, the MRC Centre for Neurodevelopmental Disorders, and the National Institute for Health Research (NIHR) Biomedical Research Centres based at Guy's and St Thomas' and South London & Maudsley NHS Foundation Trusts and King's College London., Competing Interests: PC is supported by the Medical Research Council Centre for Neurodevelopmental Disorders [MR/N026063/1] to undertake this work and received an educational stipend from ISMRM to attend the international ISMRM conference and present this work. FP was employed by the Guy′s & St. Thomas′ NHS Foundation Trust & King’s College London as a senior MR physicist at study outset, during experimental design and initial participant recruitment, he is now a senior clinical scientist employed by Hyperfine Inc., since May 2022–drawing a salary, shares and stock options. RT is an MR sequence developer employed by Hyperfine Inc., and is a holder of shares and stock option of Hyperfine Inc. JOM has institutional funding from the Bill & Melinda Gates Foundation Consortium grant to support research work by his group in neurodevelopment, including data from conventional 3T MRI and Hyperfine scanners–this grant is focused on image analysis and is not commercially sponsored. SW has received funding from the Bill & Melinda Gates Foundation for attendance and travel to sites for training and knowledge exchange during the development and delivery of this project. TA is supported by the UK MRC for a Translational support fellowship [MR/V036874/1] for personal salary, and funding for 3T MRI scans, the MRC Centre for Neurodevelopmental Disorders, King’s College London [MR/N026063/1] for administrative support, funding, and a Clinician Scientist Fellowship [MR/P008712/1]—for personal salary and funding for 3T MRI scans. TA is supported by the EPSRC UK Network grant, co-investigator [EP/W035154/1]. DE and JVH: The Hyperfine machine (Swoop® MR System) was provided by the Bill and Melinda Gates Foundation as part of the Unity Consortium., (© 2023 The Author(s).)

Background Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors. Methods and Results A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants. Z- scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of Z -score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate P <0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate P =0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate P =0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate P <0.027). Conclusions Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short- and long-term hypoxic injury.

We report an important case of periventricular white matter damage in a 1-month-old infant, demonstrated on high quality structural (T2) and diffusion weighted magnetic resonance imaging. The infant was born at term following an uneventful pregnancy and discharged home shortly after, but was brought to the paediatric emergency department five days after birth with seizures and respiratory distress, testing positive for COVID-19 infection on PCR. These images highlight the need to consider brain MRI in all infants with symptomatic SARS-Cov-2 infection, and show how this infection can lead to extensive white matter damage in the context of multisystem inflammation., Competing Interests: The authors have no conflicts of interest to disclose., (© 2023 The Authors. Published by Elsevier Ltd.)

Purpose: Ultralow-field (ULF) point-of-care MRI systems allow image acquisition without interrupting medical provision, with neonatal clinical care being an important potential application. The ability to measure neonatal brain tissue T 1 is a key enabling technology for subsequent structural image contrast optimization, as well as being a potential biomarker for brain development. Here we describe an optimized strategy for neonatal T 1 mapping at ULF., Methods: Examinations were performed on a 64-mT portable MRI system. A phantom validation experiment was performed, and a total of 33 in vivo exams were acquired from 28 neonates with postmenstrual age ranging from 31 +4 to 49 +0  weeks. Multiple inversion-recovery turbo spin-echo sequences were acquired with differing inversion and repetition times. An analysis pipeline incorporating inter-sequence motion correction generated proton density and T 1 maps. Regions of interest were placed in the cerebral deep gray matter, frontal white matter, and cerebellum. Weighted linear regression was used to predict T 1 as a function of postmenstrual age., Results: Reduction of T 1 with postmenstrual age is observed in all measured brain tissue; the change in T 1 per week and 95% confidence intervals is given by dT 1  = -21 ms/week [-25, -16] (cerebellum), dT 1  = -14 ms/week [-18, -10] (deep gray matter), and dT 1  = -35 ms/week [-45, -25] (white matter)., Conclusion: Neonatal T 1 values at ULF are shorter than those previously described at standard clinical field strengths, but longer than those of adults at ULF. T 1 reduces with postmenstrual age and is therefore a candidate biomarker for perinatal brain development., (© 2022 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Loperamide is an over-the-counter, peripherally-acting, μ -opioid receptor agonist commonly used in the treatment of diarrhoea. It has increasingly been recognised as a potential drug of misuse, having previously been thought to have low potential for abuse owing to its low bioavailability and poor penetration of the central nervous system. High doses can result in life-threatening cardiac-toxicity. We present a case of a young woman who had been self-treating her depression with high doses of loperamide for one year, who then presented to hospital with syncope secondary to ventricular tachycardia (VT). While in the emergency department (ED) the patient had monomorphic pulseless VT requiring electrical cardioversion multiple times. Transfer to a tertiary cardiac centre was immediately arranged after she was stabilised and intubated. This complicated the diagnostic process as a thorough history could not be obtained on arrival to the tertiary centre, which meant the loperamide misuse only came to light multiple days into admission, after the patient was extubated. The final diagnosis of loperamide-induced secondary long-QT syndrome was made and the patient made a full recovery., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Medinews (Cardiology) Limited.)

Aim: Following extreme preterm birth, there has traditionally been felt an imperative to rush baby to the neonatal unit for ongoing intensive care. Immediate needs of parents to bond with their babies through direct early physical contact have often been overlooked; many weeks can pass before parents get to hold their babies for the first time. Recognition of the importance of early contact is growing. We aimed to review the safety and value of routinely practising delivery room cuddles for extremely preterm babies., Methods: We reviewed delivery room cuddles in babies born <27 weeks' gestation in our centre between 2006 and 2017 via case-control. We also conducted a questionnaire survey of mothers who experienced a delivery room cuddle to gain their feedback and perspectives., Results: We found no difference in age or temperatures on neonatal unit admission. There was no case of inadvertent extubation associated with cuddles. Parental feedback was very positive., Conclusion: With appropriate safeguards, delivery room cuddles are feasible and achievable for extremely preterm babies irrespective of birth gestation. Facilitation of the cuddle is an early and very important family-centred care practice which seems much appreciated by parents and which may improve bonding, lactation, and maternal mental health., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Doctor of Pharmacy (PharmD) programs continually engage in curricular redesign to ensure practice readiness of graduates. With ever-increasing demands on clinical competency and curricular time, it is important to be intentional when determining curricular priorities and prioritize contemporary pharmacist practice. This paper describes how to adapt a national framework for pharmacotherapy curricula to emphasize the pharmacist's role within a given topic area in order to facilitate conversations about allotting curricular time during a curricular redesign. Customized Tier descriptions based on various factors expected of student pharmacists during Advanced Pharmacy Practice Experiences (APPEs) were developed (e.g., relative autonomy of the pharmacist in managing the topic, emphasis on licensing exams, frequency with which students can expect to encounter the topic at school-specific experiential placements, and condition-specific information). Topics were also reprioritized to address regional variations in practice and ideologies. Customizing a national framework to determine program-specific considerations for prioritizing topics within the pre-APPE curriculum can help faculty and students alike maintain focus on highly critical and foundational concepts, while also making sure not to completely disregard topics of lower priority. We have proposed such a framework for programs to utilize when facilitating conversations surrounding curricular reforms and topic prioritization.

Introduction: Coronavirus disease 2019 (COVID-19) is an extremely infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak of this virus has resulted in significant morbidity and mortality throughout the world. We have seen an unprecedented spread of this virus, leading to extreme pressure on health-care services. Mycoplasma pneumoniae causes atypical bacterial pneumonia and is known to co-infect patients with viral pneumonias., Methods: In this retrospective study, patients' data of 580 inpatients with confirmed SARS-CoV-2 infection were reviewed retrospectively over a 3-month period which included the the first peak of COVID-19 infections in the UK., Results: Eight patients with COVID-19 and M. pneumoniae coinfection were identified - four males and four females. All patients were Caucasian, with an age range of 44-89 years. 37.5% of patients were hypertensive, whereas 25% had Type 2 diabetes mellitus. Dyspnea, cough, and pyrexia were found to be very common in these patients. Majority of the patients had abnormal C-reactive protein, lymphopenia, neutrophilia along with bilateral consolidation, and ground-glass opacities. Two patients required admission to intensive care, both of whom unfortunately died along with one patient receiving ward based care., Conclusion: Our confirmed the presence of co-infection with M. pneumoniae and describes the clinical features, investigation results, clinical course, and outcomes for these patients. Further research is needed to review the role of procalcitonin in excluding bacterial co-infection and to assess the impact of co-infection of patients with COVID-19 on morbidity and mortality., Competing Interests: None

Low-frequency, high-acuity emergency events can and do occur within health care settings. Having a strong sense of daily situational and operational awareness is the first step in responding to any emergency event. To maintain high reliability, hospital leaders and staff must understand the full impact to the organization as the emergency event evolves. The Medical University of South Carolina health system has implemented the common practice of a daily operations safety briefing, called the Daily Check-In, to communicate any issues that could impact the operational ability of the hospitals within the enterprise, or any other associated resources during a disaster or emergency. Throughout various emergency events, including extreme weather, the Daily Check-In has evolved as a standard process for use during emergencies that is open to all staff and uses highly reliable systems.

Objectives: To ascertain parental perceptions of the impact of restricted visiting policies to neonatal intensive care units during the current COVID-19 pandemic., Design: Cross-sectional survey of parents impacted by visitation policies., Setting: Six tertiary level neonatal units, four from the UK and two from the USA, participated in the study., Participants: Parents and families of infants hospitalised in the participating centres between 1 May 2020 and 21 August 2020., Methods: Online-based and/or paper-based survey, querying the visitation policies and their impact on parents' ability to visit, care for and bond with their infants., Results: A total of 231 responses were received. Visitation limited to a single visitor with no restrictions on duration was the most frequently reported policy; 140/217 (63%). Visitation policies were perceived as being restrictive by 62% (138/219) of the respondents with 37% (80/216) reporting being able to visit less often than desired, 41% (78/191) reporting being unable to bond enough and 27% (51/191) reporting not being able to participate in their baby's daily care. Mild to severe impact on breast feeding was reported by 36% (75/209) of respondents. Stricter policies had a higher impact on families and were significantly associated with a lack of bonding time, inability to participate in care and an adverse impact on breast feeding., Conclusions: Visitation policies during the COVID-19 pandemic varied between centres and over time with stricter restrictions implemented earlier on in the pandemic. Parents reported significant impacts on their ability to visit, care for and bond with their infants with perceived severity of impact worse with stricter restrictions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

State-of-the-art ultrasonic non-destructive evaluation (NDE) uses an array to rapidly generate multiple, information-rich views at each test position on a safety-critical component. However, the information for detecting potential defects is dispersed across views, and a typical inspection may involve thousands of test positions. Interpretation requires painstaking analysis by a skilled operator. In this paper, various methods for fusing multi-view data are developed. Compared with any one single view, all methods are shown to yield significant performance gains, which may be related to the general and edge cases for NDE. In the general case, a defect is clearly detectable in at least one individual view, but the view(s) depends on the defect location and orientation. Here, the performance gain from data fusion is mainly the result of the selective use of information from the most appropriate view(s) and fusion provides a means to substantially reduce operator burden. The edge cases are defects that cannot be reliably detected in any one individual view without false alarms. Here, certain fusion methods are shown to enable detection with reduced false alarms. In this context, fusion allows NDE capability to be extended with potential implications for the design and operation of engineering assets., Competing Interests: We declare we have no competing interests., (© 2020 The Author(s).)

Introduction: Older adults have complex medication self-management challenges that can contribute to poor disease control., Methods: In 2016, an interprofessional medication self-management program was implemented in an internal medicine primary care residency clinic caring for a large proportion of indigent patients. This was a 1-year, quasi-experimental, pre-post study approved by the Institutional Review Board to evaluate the impact of this program on hypertension and diabetes control in older adults. Patients aged 60 years or older with both systolic blood pressure > 140 mm Hg and A1C > 7.5% were included in the study; patients who did not have these characteristics were excluded. Interprofessional team members (nurses, certified medical assistants, pharmacist, dietician, social worker, and nurse technician) obtained 6-month medication fill histories from pharmacies and provided findings to physicians prior to patient appointments. During patient appointments, medication self-management interventions were performed such as motivational interviewing and regimen simplification. Members contacted patients by phone after each appointment for ongoing medication self-management support., Results: Of 50 patients, the mean age was 67 years, 78% were female, 88% were black, the mean baseline systolic blood pressure was 159.8 mm Hg, and A1C was 9.7%. The 1-year mean systolic blood pressure was significantly reduced [151.5 mm Hg vs 141.8 mm Hg, -9.7 mm Hg difference, 95% confidence interval (CI) -6.19 to -13.19, P < 0.001], and the 1-year mean A1C was significantly reduced (9.6% vs 8.6%, -1.0% difference, 95% CI -0.49 to -1.39, P < 0.001) after implementation. Compared to baseline, the mean systolic blood pressure and A1C were significantly lower at each follow-up visit., Conclusion: This interprofessional medication self-management initiative improved systolic blood pressure and A1C in underserved older adults in an internal medicine residency clinic., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Kim et al.)

Hypoxic ischaemic encephalopathy may lead to death or severe long-term morbidity. Therapeutic hypothermia (TH) increases survival without impairments in childhood, but prognostic uncertainty may remain for years after birth. Clear and accurate communication is imperative but challenging. This article explores the predictive value of routinely performed assessments during TH, as well as the qualitative research relating to parental experience. This article will benefit paediatric trainees, consultants and nurse practitioners in providing: (1) the background information needed for initiating a conversation with parents regarding outcome and (2) optimising their communication with parents in translating jargon, prognosis and uncertainty., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

In guided wave structural health monitoring, defects are typically detected by identifying high residuals obtained through the baseline subtraction method, where an earlier measurement is subtracted from the "current" signal. Unfortunately, varying environmental and operational conditions (EOCs), such as temperature, also produce signal changes and hence, potentially, high residuals. While the majority of the temperature compensation methods that have been developed target the changed wave speed induced by varying temperature, a number of other effects are not addressed, such as the changes in attenuation, the relative amplitudes of different modes excited by the transducer, and the transducer frequency response. A temperature compensation procedure is developed, whose goal is to correct any spatially dependent signal change that is a systematic function of temperature. At each structural position, a calibration function that models the signal variation with temperature is computed and is used to correct the measurements, so that in the absence of a defect the residual is reduced to close to zero. This new method was applied to a set of guided wave signals collected in a blind trial of a guided wave pipe monitoring system using the T(0, 1) mode, yielding residuals de-coupled from temperature and reduced by at least 50% as compared with those obtained using the standard approach at positions away from structural features, and by more than 90% at features such as the pipe end. The method, therefore, promises a substantial improvement in the detectability of small defects, particularly at the existing pipe features.

Cracks in critical sections of steel structures pose a major safety concern in many industries. Existing high-frequency ultrasonic techniques offer high detection sensitivity to cracks but have poor inspection volume coverage, limiting their practical use for monitoring large areas of structures. Low-frequency guided waves have relatively high inspection area coverage and are currently used in pipeline monitoring for corrosion defects but face challenges in detecting critical cracks that often cause over an order of magnitude lower cross-sectional area loss. A study of scattering from small cracks in a thin-walled (<12 mm) section with an incident plane SH0 guided wave at higher frequencies but remaining below the SH1 cutoff is presented here using quasi-static approximations, the aim being to explore the possibility of using this regime for crack growth monitoring applications. A 3-D solution was developed using dimensional analysis, which showed that the SH0 reflection ratio is proportional to frequency to the power 1.5, to the effective crack size cubed, and is inversely proportional to the plate thickness and to the square root of the distance from the crack to the receiving sensor. Finite element analysis was used to validate these power coefficients and to calculate the proportionality constant. The results show that a higher inspection frequency offers improved sensitivity, but the validity of the results here is limited to the SH1 cutoff frequency. The predicted 3-D solution was validated by measurements on a pipe with a progressively grown notch.

Theoretical models are commonly used to describe ultrasonic backscattering in polycrystalline materials. However, although a full multiple scattering formalism has been derived, due to the difficulty in evaluation, currently only the single and double scattering effects have been evaluated. Three-dimensional finite element (3D FE) models have recently been demonstrated to be capable of predicting ultrasonic attenuation in polycrystalline materials and thereby show great potential in overcoming this limitation. In this paper, the application of 3D FE models is extended to the backscatter problem. First, longitudinal-to-longitudinal backscattering amplitudes from single grains are predicted, where the setup and configuration of the finite element (FE) model are verified with an isotropic spherical inclusion for which an exact solution is available. Subsequently, backscatter in terms of the root-mean-square noise levels in two different pulse-echo scenarios is investigated; the first is an idealised configuration with plane wave transmission and point reception; the second represents a more realistic finite-size transducer acting with the same apodization in both transmission and reception. Comparisons of FE predictions and approximate theoretical solutions within a range of validity show good agreement; however, the results demonstrate that 3D FE is useful where the simple Independent Scatterer models break down. As computing power increases, 3D FE is an increasingly viable tool to further the understanding of wave propagation in polycrystalline materials.

The interaction between SH 0 guided waves and simple defects is well understood and documented, and the SH 0 and related torsional guided waves are commonly used in inspection. However, tilted and branching cracks, for which vertical notches are a poor approximation, are found in some environments, particularly when pipes are buried in alkaline soils. This paper studies the interaction between SH 0 guided waves and tilted, surface-breaking cracks, investigating the effect of the tilt and depth of the defect. The incident wave interacts with the tilted crack to generate a transmitted wave, a reflected wave, and a wave trapped below the crack. It is shown that the direction of the tilt of the crack relative to the incident wave direction does not affect the scattering behavior. In addition, the axial extent of the crack plays a major role in the reflectivity of the crack, leading to transmission nulls in some configurations. These transmission nulls appear for all crack depths, the frequency range over which the transmission is significantly reduced increasing with crack depth. This behavior is shown to be analogous to the acoustic energy flow in a duct when a Helmholtz resonator is introduced. The null is not seen above the SH 1 cutoff as the propagating signals are no longer monomodal. The existence of a transmission null and corresponding reflection maximum is promising for the detection of small defects and measurement of the frequency at which the null occurs will assist with defect characterization. Experimental validations of the key results are presented.

Ultrasonic guided waves are used extensively when checking for defects in petrochemical and other industries and are mostly generated using piezoelectric transducers on an angled wedge or electromagnetic acoustic transducers (EMATs) in different configurations. Low-frequency inspection allows for long-distance propagation, but it is best suited for detecting relatively large defects, while at higher frequencies, the presence of multiple wave modes limit defect detectability, so achieving practical single Lamb mode excitation via careful transduction is very beneficial. This paper investigates the relative ability of angled piezoelectric and meander coil EMAT probes to produce single-mode transduction in the medium (~1-5 MHz-mm) and high (>5 MHz-mm) frequency-thickness regions of the dispersion curves. The nature of each transducer is studied analytically by simulating the corresponding surface forces, followed by the use of a Fourier transform in time and space (2-D fast Fourier transform) to highlight the excitation region in the wavenumber-frequency space. With angled wedge excitation there is a linear relationship between the excitation frequency and the wavenumber which means that the excitation tends to track typical dispersion curves, allowing for easier pure mode generation. In contrast, the EMAT controls frequency and wavenumber separately which makes it more difficult to generate a pure mode when dispersion curves are close together; however, by narrowing the frequency bandwidth via a large number of cycles in the excitation signal, pure mode generation via an EMAT was shown to be possible even in areas of closely spaced modes. As example cases, analytical results, backed up by experiments, showed that signals dominated by the A0 mode at 1.5 MHz-mm and also the A1 mode at 18 MHz-mm can be generated with both angled piezoelectric and EMAT probes.

Permanently installed guided wave monitoring systems are attractive for monitoring large structures. By frequently interrogating the test structure over a long period of time, such systems have the potential to detect defects much earlier than with conventional one-off inspection, and reduce the time and labour cost involved. However, for the systems to be accepted under real operational conditions, their damage detection performance needs to be evaluated in these practical settings. The receiver operating characteristic (ROC) is an established performance metric for one-off inspections, but the generation of the ROC requires many test structures with realistic damage growth at different locations and different environmental conditions, and this is often impractical. In this paper, we propose an evaluation framework using experimental data collected over multiple environmental cycles on an undamaged structure with synthetic damage signatures added by superposition. Recent advances in computation power enable examples covering a wide range of practical scenarios to be generated, and for multiple cases of each scenario to be tested so that the statistics of the performance can be evaluated. The proposed methodology has been demonstrated using data collected from a laboratory pipe specimen over many temperature cycles, superposed with damage signatures predicted for a flat-bottom hole growing at different rates at various locations. Three damage detection schemes, conventional baseline subtraction, singular value decomposition (SVD) and independent component analysis (ICA), have been evaluated. It has been shown that in all cases, the component methods perform significantly better than the residual method, with ICA generally the better of the two. The results have been validated using experimental data monitoring a pipe in which a flat-bottom hole was drilled and enlarged over successive temperature cycles. The methodology can be used to evaluate the performance of an installed monitoring system and to show whether it is capable of detecting particular damage growth at any given location. It will enable monitoring results to be evaluated rigorously and will be valuable in the development of safety cases.

In older sections of industrial pipework there are often regions of general corrosion that typically have a Gaussian thickness distribution. During guided wave inspection this corrosion causes an increase in the background noise and a significant attenuation of the inspection wave. These effects are investigated in this paper through finite element modelling of the interaction of torsional guided waves with rough surfaces in pipes. Pipes of different diameter and rough surface profile are modelled and it is found that the attenuation of waves is explained by significant mode conversion and scattering within the rough surface. This mode conversion is greatest when the non-axisymmetric modes to which energy is scattered are close to the cutoff frequency or when the ratio of surface correlation length to wavelength is around 0.2-0.25. Mode conversion increases with increasing surface roughness and is a strong function of frequency-diameter product, with larger pipes causing more mode conversion. When this mode conversion occurs the energy is lost mostly to those waves with a displacement profile closest to the original torsional inspection wave. Resulting attenuation of the inspection signal can be severe; for example a mean wall thickness loss of 28% can cause 2.7 dB/m attenuation in a pulse-echo configuration.

A feasibility study on grain noise suppression using baseline subtraction is presented in this paper. Monitoring is usually done with permanently installed transducers but this is not always possible; here instead monitoring is conducted by carrying out repeat C-scans and the feasibility of grain noise suppression by subtracting A-scans extracted from the C-scans is investigated. The success of this technique depends on the ability to reproduce the same conditions for each scan, including a consistent stand-off, angle, and lateral position of the transducer relative to the testpiece. The significance of errors are illustrated and a 3D cross correlation is used which enables the same lateral position to be located within successive C-scans. The experimental results show that a noise reduction of around 15 dB is obtained after baseline subtraction, which will significantly improve the defect detection sensitivity. In practice however, successive C-scans may be conducted at different temperatures and with different transducers of similar specifications but a varying frequency response. Compensation techniques to reduce the impact of such variations are then presented and their effectiveness is verified experimentally. It is shown that it is feasible to obtain an overall improvement of around 10 dB in the signal to noise ratio via baseline subtraction, where a temperature difference of up to 10  ∘ C and a peak frequency shift of as much as ±250 kHz from a baseline value of around 7 MHz can be tolerated. However, this improvement was obtained in laboratory conditions with no changes to the surface of the specimen due to oxidation or corrosion. It is shown that differences in temperature and transducer frequency response are more difficult to compensate for than changes in test geometry and position.

The application of long-range guided-wave testing to pipes embedded in concrete results in unpredictable test-ranges. The influence of the circumferential extent of the embedding-concrete around a steel pipe on the guided wave propagation is investigated. An analytical model is used to study the axisymmetric fully embedded pipe case, while explicit finite-element and semi-analytical finite-element simulations are utilised to investigate a partially embedded pipe. Model predictions and simulations are compared with full-scale guided-wave tests. The transmission-loss of the T(0,1)-mode in an 8 in. steel pipe fully embedded over an axial length of 0.4 m is found to be in the range of 32-36 dB while it reduces by a factor of 5 when only 50% of the circumference is embedded. The transmission-loss in a fully embedded pipe is mainly due to attenuation in the embedded section while in a partially embedded pipe it depend strongly on the extent of mode-conversion at entry to the embedded-section; low loss modes with energy concentrated in the region of the circumference not-covered with concrete have been identified. The results show that in a fully embedded pipe, inspection beyond a short distance will not be possible, whereas when the concrete is debonded over a fraction of the pipe circumference, inspection of substantially longer lengths may be possible.

Next-generation 3-Tesla magnetic resonance (MR) scanners offer improved neonatal neuroimaging, but the greater associated radiofrequency radiation may increase the risk of hyperthermia. Safety data for neonatal 3-T MR scanning are lacking. We measured rectal temperatures continuously in 25 neonates undergoing 3-T brain MR imaging and observed no significant hyperthermic threat., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Guided wave inspection is used extensively in petrochemical plants to check for defects such as corrosion. Long-range low-frequency inspection can be used to detect relatively large defects, while higher frequency inspection provides improved sensitivity to small defects, but the presence of multiple dispersive modes makes it difficult to implement. This paper investigates the possibility of exciting a single-mode Lamb wave with low dispersion at a frequency thickness of around 20 MHz-mm. It is shown by finite element (FE) analysis backed up by experiments that a signal dominated by the A1 mode can be generated, even in a region where many modes have similar phase velocities. The A1 mode has relatively little motion at the plate surface which means that only a small reflection is generated at features such as T-joints; this is verified numerically. It is also expected that it will be relatively unaffected by surface roughness or attenuative coatings. These features are very similar to those of the higher order mode cluster (HOMC) reported by other authors, and it is shown that the A1 mode shape is very similar to the deflected shape reported in HOMC.

Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals. Eligible participants included all acute care hospitals plus home health organizations, nursing facilities, hospices, and other health care organizations. Measures were degree of statewide participation, curricular engagement, adoption of evidence-based improvement strategies, and readmission rate changes. Fifty-nine of 64 (92%) acute care hospitals and 9 of 10 (90%) hospital systems participated in collaborative events. Curricular engagement included: webinars and coaching calls (49/59, 83%), statewide in-person meetings (35/59, 59%), regional in-person meetings (44/59, 75%), and individualized consultations (46/59, 78%). Among 34 (58%) participating hospitals completing a survey at the completion of Year 1, respondents indicated complete implementation of multidisciplinary rounding (58%), post-discharge telephone calls (58%), and teach-back (32%), and implementation in process of high-quality transition records (52%), improved discharge summaries (45%), and timely follow-up appointments (39%). A higher proportion of hospitals had significant decreases (≥10% relative change) in all-cause readmission rates for acute myocardial infarction (55.6% vs. 30.4%, P=0.01), heart failure (54.2% vs. 31.7%, P=0.09), and chronic obstructive pulmonary disease (41.7% vs. 33.3%, P=0.83) between 2011-2013 compared to earlier (2009-2011) trends. Focus on reducing readmissions is driving numerous, sometimes competing, quality improvement initiatives. PART successfully engaged the majority of acute care facilities in one state to harmonize and accelerate adoption of evidence-based care transitions strategies.

Commercially available Finite Element packages are being used increasingly for modelling elastic wave propagation problems. Demand for improved capability has resulted in a drive to maximise the efficiency of the solver whilst maintaining a reliable solution. Modelling waves in unbound elastic media to high levels of accuracy presents a challenge for commercial packages, requiring the removal of unwanted reflections from model boundaries. For time domain explicit solvers, Absorbing Layers by Increasing Damping (ALID) have proven successful because they offer flexible application to modellers and, unlike the Perfectly Matched Layers (PMLs) approach, they are readily implemented in most commercial Finite Element software without requiring access to the source code. However, despite good overall performance, this technique requires the spatial model to extend significantly outside the domain of interest. Here, a Stiffness Reduction Method (SRM) has been developed that operates within a significantly reduced spatial domain. The technique is applied by altering the damping and stiffness matrices of the system, inducing decay of any incident wave. Absorbing region variables are expressed as a function of known model constants, helping to apply the technique to generic elastodynamic problems. The SRM has been shown to perform significantly better than ALID, with results confirmed by both numerical and analytical means., (Copyright © 2013 Elsevier B.V. All rights reserved.)

In industrial non-destructive evaluation (NDE), it is increasingly common for data acquisition to be automated, driving a recent substantial increase in the availability of data. The collected data need to be analysed, typically necessitating the painstaking manual labour of a skilled operator. Moreover, in automated NDE a region of an inspected component is typically interrogated several times, be it within a single data channel due to multiple probe passes, across several channels acquired simultaneously or over the course of repeated inspections. The systematic combination of these diverse readings is recognized to offer an opportunity to improve the reliability of the inspection, but is not achievable in a manual analysis. This paper describes a data-fusion-based software framework providing a partial automation capability, allowing component regions to be declared defect-free to a very high probability while readily identifying defect indications, thereby optimizing the use of the operator's time. The system is designed to applicable to a wide range of automated NDE scenarios, but the processing is exemplified using the industrial ultrasonic immersion inspection of aerospace turbine discs. Results obtained for industrial datasets demonstrate an orders-of-magnitude reduction in false-call rates, for a given probability of detection, achievable using the developed software system.

Background: Despite the growth of hospital medicine, few guidelines exist to guide effective management of hospital medicine groups (HMGs)., Methods: The Society of Hospital Medicine Board of Directors appointed a workgroup consisting of individuals who have experience with a wide array of HMG models. The workgroup developed an initial draft of characteristics, which then went through a multistep process of review and redrafting. In addition, the workgroup went through a 2-step Delphi process to consolidate characteristics and/or eliminate characteristics that were redundant or unnecessary. Over an 18-month period, a broad group of stakeholders in hospital medicine and the broader healthcare industry provided comments and feedback., Results: The final framework consists of 47 key characteristics of an effective HMG organized under 10 principles., Conclusions: These principles and characteristics provide a framework for HMGs seeking to conduct self-assessments, outlining a pathway for improvement and better defining the central role of hospitalists in coordinating team-based, patient-centered care in the acute-care setting. They are designed to be aspirational, helping to raise the bar for the specialty of hospital medicine., (© 2014 Society of Hospital Medicine.)

Daily recombinant growth hormone (GH) restores normal growth and body composition in GH-deficient children and adults; however, daily injections are inconvenient and can be distressing for some children. On top of this compliance is a problem in up to 75% of children. Developing long-acting GH formulations has proved challenging, and questions remain regarding safety and efficacy. In this review, we focus on the rationale for generating long-acting GH agonists and the technologies being developed to deliver prolonged exposure to GH., (© 2013 John Wiley & Sons Ltd.)

Guided wave tomography offers a method to accurately quantify wall thickness losses in pipes and vessels caused by corrosion, using ultrasonic waves transmitted over distances of approximately 1 to 2 m, and measured by an array of transducers. These measurements are then used to reconstruct a map of wall thickness throughout the inspected region. To achieve accurate estimations of remnant wall thickness, it is vital that a suitable Lamb mode is chosen. This paper presents a detailed evaluation of the two most suitable modes, S0 and A0, to compare their performance using both numerical and experimental data. The sensitivity of A0 to thickness variations was shown to be superior to S0; however, the attenuation from A0 when a liquid loading was present was much higher than S0. A0 was less sensitive to the presence of coatings on the surface than was S0. Finally, it was shown that both modes could achieve a similar level of resolution in the plane of the plate surface.

Guided wave inspection has proven to be a very effective method for the rapid inspection of large structures. The fundamental shear horizontal (SH) wave mode in plates and the torsional mode in pipe-like structures are especially useful because of their non-dispersive character. Guided waves can be generated by either piezoelectric transducers or electro- magnetic acoustic transducers (EMATs), and EMATs can be based on either the Lorentz force or magnetostriction. Several EMAT configurations can be used to produce SH waves, the most common being Lorentz-force periodic permanent magnet and magnetostrictive EMATs, the latter being directly applied on the sample or with a bonded strip of highly magnetostrictive material on the plate. This paper compares the performance of these solutions on steel structures. To quantitatively assess the wave amplitude produced by different probes, a finite element model of the elementary transducers has been developed. The results of the model are experimentally validated and the simulations are further used to study the dependence of ultrasonic wave amplitude on key design parameters. The analysis shows that magnetostrictive EMATs directly applied on mild steel plates have comparatively poor performance that is dependent on the precise magneto-mechanical properties of the test object. Periodic permanent magnet EMATs generate intermediate wave amplitudes and are noncontact and insensitive to the variations in properties seen across typical steels. Large signal amplitudes can be achieved with magnetostrictive EMATs with a layer of highly magnetostrictive material attached between the transducer and the plate, but this compromises the noncontact nature of the transducer.

Objectives: To implement a Learning Bridge tool to improve educational outcomes for pharmacy students as well as for preceptors and faculty members., Design: Pharmacy faculty members collaborated to write 9 case-based assignments that first-year pharmacy (P1) students worked with preceptors to complete while at experiential sites., Assessment: Students, faculty members, and preceptors were surveyed about their perceptions of the Learning Bridge process. As in our pilot study,(1) the Learning Bridge process promoted student learning. Additionally, the Learning Bridge assignments familiarized preceptors with the school's P1 curriculum and its content. Faculty teamwork also was increased through collaborating on the assignments., Conclusions: The Learning Bridge assignments provided a compelling learning environment and benefited students, preceptors, and faculty members.

Successful ultrasonic guided wave detection of flaws at support locations relies on the ability to distinguish between the reflection produced by a simple support on an undamaged pipe and the reflection produced by pipe flaws. Consequently, it is essential to know how the reflections produced by simple supports behave; very little work has so far been reported on this subject. Through finite element simulations and experiments, this study develops a systematic understanding of how ultrasonic guided waves propagating along a pipe, in particular the T(0, 1) mode, interact with simple supports. It is shown that, unlike the T(0, 1) mode in a free pipe, the torsional mode in a supported region has a cut-off frequency, below which it will not propagate; below this frequency the T(0, 1) reflection coefficient is large, and it quickly reduces beyond the cut-off.

Conventional ultrasonic transducers cannot withstand high temperatures for two main reasons: the piezoelectric elements within them depolarize, and differential thermal expansion of the different materials within a transducer causes them to fail. In this paper, the design of a high-temperature ultrasonic thickness gauge that bypasses these problems is described. The system uses a waveguide to isolate the vulnerable transducer and piezoelectric elements from the high-temperature measurement zone. Use of thin and long waveguides of rectangular cross section allows large temperature gradients to be sustained over short distances without the need for additional cooling equipment. The main problems that had to be addressed were the transmission and reception of ultrasonic waves into and from the testpiece that the waveguides are coupled to, and optimization of the wave propagation along the waveguide itself. It was found that anti-plane shear loading performs best at transmitting and receiving from the surface of a component that is to be inspected. Therefore, a nondispersive guided wave mode in large-aspect-ratio rectangular strips was employed to transmit the anti-plane shear loading from the transducer to the measurement zone. Different joining methods to attach the waveguides to the component were investigated and experiments showed that clamping the waveguides to the component surface gave the best results. The thickness of different plate samples was consistently measured to within less than 0.1 mm. Performance at high temperatures was tested in a furnace at 730°C for 4 weeks without signal degradation. Thicknesses in the range of 3 to 25 mm could be monitored using Hanning windowed tonebursts with 2 MHz center frequency.

The noncontact nature of electromagnetic acoustic transducers (EMATs) offers a series of advantages over traditional piezoelectric transducers, but these features are counter-balanced by their relatively low signal-to-noise ratio and their strong dependence on material properties such as electric conductivity, magnetic permeability, and magnetostriction. The implication is that full exploitation of EMATs needs detailed modeling of their operation. A finite element model, accounting for the main transduction mechanisms, has been developed to allow the optimization of the transducers. Magnetostriction is included and described through an analogy with piezoelectricity. The model is used to predict the performance of a simple EMAT: a single current-carrying wire, parallel to a bias magnetic field generating shear horizontal waves in a nickel plate close to it. The results are validated against experiments. The model is able to successfully predict the wave amplitude dependence on significant parameters: the static bias field, the driving current amplitude, and the excitation frequency. The comparison does not employ any arbitrary adjustable parameter; for the first time an absolute validation of a magnetostrictive EMAT model has been achieved. The results are satisfactory: the discrepancy between the numerical predictions and the measured values of wave amplitude per unit current is less than 20% over a 200 kHz frequency range. The study has also shown that magnetostrictive EMAT sensitivity is not only a function of the magnetostrictive properties, because the magnetic permeability also plays a significant role in the transduction mechanism, partly counterbalancing the magnetostrictive effects.

Detection and sizing of corrosion in pipelines and pressure vessels over large, partially accessible areas is of growing interest in the petrochemical industry. Low-frequency guided wave diffraction tomography is a potentially attractive technique to rapidly evaluate the thickness of large sections of partially accessible structures. Finite element simulations of a 64-element circular array on a plate show that when the scattering mechanism of the object to be reconstructed satisfies the Born approximation, the reconstruction of the thickness is accurate. However, the practical implementation is more challenging because the incident field is not known. This paper describes the baseline subtraction approach commonly used in structural health monitoring applications and proposes a new approach in which the measurement of the incident field is not required when using a circular array of transducers. Experimental results demonstrate that ultimately the scattering from the array of transducers is a major source of error in the tomographic reconstruction, but when there is no scattering from the array of transducers the reconstructions are very similar to the finite element simulations.

Defect characterization using guided ultrasonic waves remains a challenging subject and requires a full understanding of the interaction of guided waves with a realistic representation of the defect. The characteristics of pulse echo reflection of the SH0 mode from part-thickness elliptical defects in plates is studied via finite element analysis and experimental measurements. The study shows that the reflection ratio spectrum of the SH0 mode from an elliptical defect exhibits periodic pattern due to interference between reflections from the two edges of the defect. The pattern of the reflection ratio spectrum is determined by the ratio of defect length in the incidence direction to wavelength, while the magnitude is affected by the maximum depth and the effective aspect ratio of the defect. Both the pattern and magnitude of the reflection ratio spectrum are found to be highly sensitive to the incidence angle, and the form of the variation of the reflection with angle is a strong function of the defect shape. In addition, a study of circular defects with tapered depth profiles reveals that the reflection is a function of average length of the tapered defect to wavelength ratio, and the magnitude of the reflection diminishes as the ratio increases.

Guided ultrasonic waves have been successfully applied to detect defects and corrosion in plates and pipes; however, defect sizing remains challenging due to the complex profiles of the defects encountered in practice. A study of the reflection of the fundamental torsional mode T(0,1) from an axi-symmetric defect with varying depth profile has been carried out via finite element modeling and experimental validation. Defects with gradually varying depth are represented by a series of tapered steps. It is revealed that, for both tapered up- and down-steps, the wave packet is reflected only at the start and end of the steps. The reflections from the start and end of the step have been predicted, and the frequency dependence of the overall reflection from the step has been studied. The study shows that the reflection coefficient varies as a function of the ratio of the average length of the tapered defect to the wavelength due to the interference between the waves reflected from the two ends of the defect. The reflection coefficient maxima decrease as the slope of the taper becomes more gradual, this effect being more pronounced when the ratio of the average defect length to the wavelength increases.

Objectives: To assess the impact of a program to integrate introductory pharmacy practice experiences with pharmaceutical science topics by promoting active learning, self-directed learning skills, and critical-thinking skills., Design: The Learning Bridge, a curriculum program, was created to better integrate the material first-year (P1) students learned in pharmaceutical science courses into their introductory pharmacy practice experiences. Four Learning Bridge assignments required students to interact with their preceptors and answer questions relating to the pharmaceutical science material concurrently covered in their didactic courses., Assessment: Surveys of students and preceptors were conducted to measure the effectiveness of the Learning Bridge process. Feedback indicated the Learning Bridge promoted students' interaction with their preceptors as well as development of active learning, self-directed learning, and critical-thinking skills. Students also indicated that the Learning Bridge assignments increased their learning, knowledge of drug information, and comprehension of relevant data in package inserts., Conclusion: The Learning Bridge process integrated the didactic and experiential components of the curriculum, enhancing student learning in both areas, and offered students educational opportunities to interact more with their preceptors.

A sparse-array structural health monitoring (SHM) system based on guided waves was applied to the door of a commercial shipping container. The door comprised a corrugated steel panel approximately 2.4 m by 2.4 m surrounded by a box beam frame and testing was performed in a nonlaboratory environment. A 3-D finite element (FE) model of the corrugations was used to predict transmission coefficients for the A0 and S0 modes across the corrugations as a function of incidence angle. The S0 mode transmission across the corrugations was substantially stronger, and this mode was used in the main test series. A sparse array with 9 transducers was attached to the structure, and signals from the undamaged structure were recorded at periodic intervals over a 3-week period, and the resulting signal database was used for temperature compensation of subsequent signals. Defects in the form of holes whose diameter was increased incrementally from 1 to 10 mm were introduced at 2 different points of the structure, and signals were taken for each condition. Direct analysis of subtracted signals allowed understanding of the defect detection capability of the system. Comparison of signals transmitted between different transducer pairs before and after damage was used to give an initial indication of defect detectability. Signals from all combinations of transducers were then used in imaging algorithms, and good localization of holes with a 5-mm diameter or above was possible within the sparse array, which covered half of the area of the structure.

Surgical intervention for chronic aortic or mitral regurgitation in asymptomatic individuals is recommended on the basis of regurgitant severity and the hemodynamic consequences on the left ventricle (LV). Echocardiography is the standard tool in clinical practice for evaluation of adults with chronic regurgitation. Regurgitant volume (RV) and fraction (RF) can be determined as the difference between stroke volumes measured at two intracardiac sites: antegrade flow across the regurgitant valve compared to antegrade flow across a normal valve. Alternatively, these severity measures can be determined by imaging the proximal flow convergence. Regurgitant orifice area also can be determined. However, limitations do exist with echocardiography due to poor image quality, variability in measuring flow diameters and foreshortened views of the ventricle. Cardiac magnetic resonance (CMR) imaging is a promising modality which can also measure regurgitant severity and may provide additional information about LV size and function. Q-flow methods allow measurement of flow velocity and instantaneous volume flow rates in the aorta or pulmonary artery; this data can be integrated over the cardiac cycle to determine RV and RF. CMR also allows accurate measurement of left and right ventricular volumes; the difference in stroke volume between the two ventricles is regurgitant volume. The role of CMR in clinical management of adults with valve regurgitation merits further study. Currently, we find CMR helpful when regurgitant severity is indeterminant on echocardiography (particularly if LV dysfunction is present), when more accurate measures of LV function are needed and when aortic dilation is present.

Background: Great emphasis is placed on optimizing treatment of hospitalized patients with diabetes and hyperglycemia., Objective: This study was conducted to determine if the application of hospital-wide insulin order sets improved inpatient safety by reducing the number of actual hypoglycemic and hyperglycemic events and increasing at-target blood glucose., Design: A retrospective chart review was conducted of hypoglycemic and hyperglycemic events and at-target blood glucose occurring before and after institution of the insulin order sets and blood glucose protocols., Setting: The Medical University of South Carolina (MUSC) Medical Center is a 709-bed hospital and tertiary referral center for partnering hospitals in the southeastern United States., Patients: All patients were evaluated who had a documented history of diabetes or who had at least 1 finger-stick blood glucose above 180 mg/dL who were admitted for care to the MUSC adult main hospital (minimum of 18 years-of-age; maximum 100 years-of-age) during June 2004, June 2005, June 2006, and June 2007., Intervention: The intervention involved institution of hospital-wide hypoglycemia, hyperglycemia, subcutaneous insulin, and intravenous insulin treatment protocols., Measurements: Retrospective data on hypoglycemia, hyperglycemia, and at-target blood glucose incidence and frequency were collected via a computerized repository for all inpatients., Results: The percent time in range improved by 10% with no increase in the amount of severe hypoglycemic episodes for the blood glucose results., Conclusions: Implementing standardized insulin order sets including hypoglycemia and hyperglycemia treatment protocols at MUSC produced expected benefits for patient safety for this patient population.

The reliability of structural health monitoring (SHM) systems based on guided ultrasonic waves is improved if pure modes are generated by the transducers. A piezoelectric- based transducer generating high purity A0 mode guided waves at low frequencies (around 20 kHz) was developed. The through-thickness resonance of a piezoelectric element was lowered to the frequency region of interest by use of backing masses and low-stiffness front layers. Soft front layers also reduced significantly the transmission of in-plane displacements caused by Poisson's ratio effects in the piezoelectric element to the structure. Parametric studies were undertaken by varying the backing mass length, the transducer diameter, and the thickness of the front layer. The thickness of the plates on which the transducers were operated was found to be a critical issue and these effects were evaluated. Results obtained by finite-element analysis were validated by experimental measurements and showed that signals with A0/S0 energy ratios substantially above 40 dB can be obtained.

This paper deals with quantifying the performance of a technique for detection, location, and sizing of circumferential crack-like defects in pipelines using synthetically focused guided waves. The system employs a circumferential array of piezoelectric transducer elements. A torsional probing guided wave is excited using the array, which subsequently interacts with the reflecting features of the pipe, such as defects or weld caps. The recorded backscattered signals are synthetically focused to every point of interest in the pipe wall, to form an image of the reflecting features of the pipe. The defect image amplitude is used to estimate the defect depth, and the full width at half maximum of the defect image circumferential profile is used to estimate the circumferential extent of the defect. The imaging system is tested with data from finite element simulations and from laboratory experiments. It is found that reliable sizing of circumferential cracks in finite element simulations and experiments can be achieved if the circumferential extent of the defect is greater than 1.5 lambda(S), where lambda(S) is the shear wavelength at the frequency of inspection. This result is theoretically valid for any pipe size, any axial defect location, and any inspection frequency. Amplitude gains of around 18 dB over an unfocused system have been observed experimentally in an 8-inch pipe with a 9 dB SNR improvement.