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Cite this article as: Chen X, Xu H, Chen S, Gu W, Wang Z, Zhang X. A straw shows which way the wind blows: A successful cannulation of abnormal duodenal papilla. Turk J Gastroenterol. 2026;37(3):406-408.
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The oceanic wet-thermal and chloride salt environment creates extremely harsh service conditions for marine infrastructures. As a green construction material, geopolymer concrete has a promising application prospect in marine engineering due to its excellent durability. The impact resistance of geopolymer concrete subjected to wet-thermal and chloride salt environment is of great significance for the durability and quality of marine engineering structures. This study uses nano-SiO2 (NS) and hybrid fibers (HF) to enhance the impact resistance of geopolymer gel concrete (GPC). Radial basis function (RBF) and back-propagation (BP) composite neural networks are used to predict the impact resistance of NS and HF-reinforced geopolymer gel concrete (NSHFGPC). The impact resistance of NSHFGPC specimens is characterized by two indicators: the cumulative number of repeated impact blows required to initiate the first visible crack (N1) and the cumulative number of impact blows corresponding to ultimate failure (N2). To evaluate the durability of NSHFGPC under oceanic conditions, specimens were exposed to a simulated marine environment within a simulation test chamber for 60 days prior to impact testing. The 60-day duration was selected to achieve a sufficient level of chloride penetration and matrix aging. Based on the resulting experimental database, an RBF-BP neural network was constructed to predict the material's impact resistance. In this study, grid search and K-fold cross-validation were employed to select the optimal hyperparameters. Compared to standalone RBF and BP models, the RBF-BP network demonstrated superior performance, achieving R2 values of 0.900 and 0.922. These results represent improvements of 20.18% and 11.18% over the standalone RBF model, respectively. Consequently, the RBF-BP algorithm serves as an experimental tool for predicting NSHFGPC impact resistance and guiding future mix design optimization.
Rotary press forging (RPF) has been introduced in the last century. Despite its advantages, it produces defects in the forgings such as mushrooming, eccentricity, and twisting. Rotary hammer forging (RHF) is a new process invented by the author to reduce such defects. RHF is considered as a multi-axes compression forging process where the material is subjected to several repeated hammering blows to be deformed incrementally and partially, while the produced deformation zone is swept over the whole area of the workpiece. Previous works showed that the specimen geometry, the inclination angle and the rotational speed affect such defects as mushrooming effect, eccentricity and twisting angle, but they are less severe in RHF than RPF. The present work has studied the effect of the forming degree (FD) on the forgings produced by both RPF and RHF to compare between the two processes. Special set-ups have been used where a die is rotating while either a pressing head or hammering head is used to deform the specimen. Independent variable parameters were chosen such that the specimen geometry H/D = 1, the inclination angle = 4[Formula: see text], the rotational speed N =260 rpm, number of blows per revolution in case of RHF = 1.2. The results showed that FD has its influence on the mushrooming effect, twisting angle, and eccentricity, although they are less in the case of RHF. RHF reduces the defects referred to RPF by 5 to 13% for the mushrooming effect, 0 to 33% for the eccentricity, and 70 to 80% for the twisting angle. Thus, RHF is advantageous than RPF.
Dynamic probes, such as the dynamic probe light (DPL) with a 10 kg hammer weight, are easy to use and enable rapid, in-situ compaction control of embankments. However, the use of these light tools in dense soil is limited because the number of blows can be greatly increased and may even exceed the maximum allowable value. For dense soil types, in order to be able to rely on the test results, heavier tools with hammers of 30–50 kg should be used. This will reduce the speed and ease of testing because of the heavy weight of the tool. In the current study, numerous tests were conducted on soil compacted in a physical model to develop a tool for dense soil. The priority was maintaining speed and ease of testing by modifying the specifications of the DPL tool. The results showed that the efficiency and penetration power of the newly developed tools were higher than those of the DPL tool, even though the hammer weight and energy input remained constant. Statistical analysis of the dynamic probing test results confirmed data repeatability and sufficient confidence for establishing new empirical correlations.
This study presents a detailed statistical optimization methodology for improving the performance of high-strength concrete through the strategic integration of weathered crystalline rock (WCR) fine aggregate. Utilizing Taguchi L5 orthogonal array design, the research assessed the impact of varying WCR replacement levels (0%, 5%, 10%, 15% and 20%) on essential concrete properties, encompassing mechanical strength, fresh properties, durability metrics and impact resistance. The experimental program included 175 specimens tested across seven response variables to find out how they worked together in detail. By using signal-to-noise ratio analysis and grey relational analysis together, the best replacement strategies were found. For example, adding 5% WCR resulted in better multi-objective performance with a grey relational grade of 0.953. Using mechanical property correlations, advanced regression modeling was able to predict compressive strength very well (R² = 0.997). ANOVA statistical validation showed that all response variables had significant factor contributions (> 94%). The optimized mix had a compressive strength of 74.5 MPa, improved workability (66.3 mm slump) and impact resistance (778 blows). The results show that using WCR strategically can help meet both structural performance goals and sustainability goals at the same time. This sets a strong foundation for developing sustainable high-strength concrete for use in infrastructure.
Pediatric cardiac arrest primarily arises from asphyxia in infants and trauma in older children, contrasting with adult etiologies dominated by cardiac events. This underscores prevention as the cornerstone of pediatric basic life support, through injury mitigation like child restraint systems and water supervision, safe sleep practices including supine positioning on firm surfaces with caregiver smoking cessation to reduce sudden infant death syndrome, plus awareness of child abuse and adolescent suicide prevention. In hospitals, pediatric early warning systems (PEWS) enable early deterioration detection via vital sign scoring for timely intervention. Major updates in the 2025 pediatric basic life support guidelines reflect evidence-driven refinements. First, hospitals should implement PEWS to prompt rapid response teams for at-risk inpatients. Second, all rescuers (lay and healthcare providers) should employ the two-thumb encircling hands technique for infant chest compressions for optimal depth (about 4 cm), rate (100-120/min), and recoil; one-hand heel compression serves as backup if infeasible. Third, lay rescuers may apply automated external defibrillators for nontraumatic out-of-hospital cardiac arrest in children aged 1 year or older, prioritizing prompt attachment after initial cardiopulmonary resuscitation (CPR) cycles to address potential shockable rhythms. Fourth, for infant foreign body airway obstruction, alternate five back blows (over the spine between scapulae) with five chest thrusts (using heel-of-hand on sternum) until cleared or unresponsive, then transition to CPR. These updates aim to enhance bystander intervention, CPR quality, and survival with favorable neurologic outcomes in pediatric cardiac arrest.
Maxillofacial injuries are commonly observed among women who have experienced domestic violence. The prevalence and characteristics of these injuries in Jordan remain underexplored. This study aimed to evaluate the frequency and patterns of maxillofacial injuries among females affected by domestic violence in Jordan. A total of 2643 records of domestic violence-related maxillofacial injuries in females were retrieved from the Family Protection and Juvenile Department and the Accident and Emergency (A&E) departments of two major hospitals in Jordan. Descriptive statistics were computed, and associations were evaluated using Chi-square and Kruskal-Wallis tests. Significance was set at p ≤ 0.05. The mean age at the time of injury was 29.19 years (SD: 11.8). The spouse was responsible for violent acts in 20% of cases. In 89.9% of cases, injuries were caused by direct blows. Soft tissue injuries were observed in most cases (98.1%), followed by midfacial fractures (5.6%), dentoalveolar injuries (1.7%), upper face fractures (1.2%), and lower face fractures (0.9%). The vast majority did not require surgical intervention (98.9%). Concomitant injuries to other body regions were identified in 70.6% of cases, with the upper extremities the most frequently affected (50.4%). Trauma to the upper extremities showed a significant inverse association with midfacial fractures (p < 0.001). Recurrent trauma was documented in 7.6% of cases. Individuals with recurrent trauma were more likely to present with concomitant injuries to other body regions (84.2%) than first-time trauma victims (69.5%). Facial soft-tissue injuries were the most frequent. Midfacial fractures were the most common facial fracture type, though they were rare and less likely when an upper-limb injury occurred. Repeated trauma increases the likelihood of multiple fractures, emphasizing the need for early detection, reporting, and referral by healthcare professionals including oral & maxillofacial surgeons and dental health professionals.
Perhaps the most classical diffusion model for chemotaxis is the Keller-Segel system u t = Δ u - ∇ · ( u ∇ v ) in R 2 × ( 0 , T ) , v = ( - Δ R 2 ) - 1 u : = 1 2 π ∫ R 2 log 1 | x - z | u ( z , t ) d z , u ( · , 0 ) = u 0 ⋆ ≥ 0 in R 2 . We show that there exists ε > 0 such that for any m satisfying 8 π < m ≤ 8 π + ε and any k given points q 1 , . . . , q k in R 2 there is an initial data u 0 ∗ of ( ∗ ) for which the solution u(x, t) blows up in finite time as t → T with the approximate profile u ( x , t ) = ∑ j = 1 k 1 λ j 2 ( t ) U x - ξ j ( t ) λ j ( t ) ( 1 + o ( 1 ) ) , U ( y ) = 8 ( 1 + | y | 2 ) 2 , with λ j ( t ) ≈ 2 e - γ + 2 2 T - t e - | ln ( T - t ) | 2 where γ = 0.57721 . . . is the Euler-Mascheroni constant, ξ j ( t ) → q j ∈ R 2 and such that ∫ R 2 u ( x , t ) d x = k m . This construction generalizes the existence result of the stable blow-up dynamics recently proved in [17, 18].
The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24-10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28-7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06-0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04-8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning.
A strong compliance program requires attention, engagement, and active monitoring of pharmacists and pharmacy professionals. Done well, compliance is routine, consistent, even mundane. Yet these very characteristics can create a culture of complacency that pharmacies must actively guard against. This potential risk is only compounded by the wide range of regulatory and contractual rules that bind the practice of pharmacy. Compliance involves tracking everything from state and federal laws-each state's pharmacy act, the Federal Controlled Substances Act, Stark and anti-kickback statute requirements, to name a few-to USP and accreditation standards, and even to government and commercial payor requirements and restrictions. The sheer scope and complexity of regulatory demands can be overwhelming. While pharmacies are watchful for liability warning signs like false claims, kickbacks, and controlled substance risks, inadequate attention to other regulatory requirements can also result in substantial liability to the pharmacy. This article examines two compliance areas that present unique challenges in compounding: USP <800> and OBRA '90. It addresses the potential liabilities and risks of noncompliance associated with each; how pharmacies can effectively leverage employees as compliance assets; and what to do if an employee blows the whistle about alleged violations of USP <800> or OBRA '90.
The American Heart Association (AHA) regularly updates its evidence-based practice recommendations for basic life support, advanced cardiovascular life support, pediatric life support, and neonatal life support. This article reviews the latest AHA guidelines, which were released in October 2025, highlights important changes, and demonstrates how nurses can incorporate these changes into their practice. Examples of new practice recommendations include back blows and abdominal thrusts in the management of severe foreign body obstruction in the conscious adult, use of the two thumbs encircling approach or heel of one hand when providing infant chest compressions, and the administration of an initial 200 Joule synchronized shock in the unstable patient with atrial fibrillation.
Nearly annually, blooms of the dinoflagellate Karenia brevis form along the southwest Florida coast leading to a variety of negative impacts, including respiratory irritation (RI) in humans. To limit these impacts, NOAA's National Centers for Coastal Ocean Science (NCCOS) developed a RI model to provide beach-goers with a category-based estimate of RI risk at individual beaches along Florida's Gulf and Atlantic coasts. The RI model is based on: (a) K. brevis cell counts collected at individual beaches; (b) high resolution wind direction and speed forecasts and observations; and (c) point-based beach shoreline orientation used to designate onshore and offshore winds. To test the model logic, an analysis of modeled RI was compared to same-day RI reports, based on the frequency of coughs at individual beaches from the Beach Conditions Reporting System (BCRS). Overall, the model proved to be 88% accurate when K. brevis was present along the southwest Florida coastline from 2006 to 2022. In addition, validation efforts confirmed model assumptions, including: (a) reports of higher RI correlate with higher K. brevis cell abundances; and (b) when cells are present, onshore winds lead to a higher risk of RI. However, individual model categories ("low," "moderate") were less robust. Furthermore, BCRS was not a direct measure of toxic aerosol presence, so some coughing (modeled false negatives) may result from other environmental factors. Together, results suggest the RI model accurately predicts "very low" and "high" risk, but that additional research is needed to better capture environmental conditions when RI is "low" or "moderate." Nearly every year red tide (Karenia brevis) blooms along the southwest Florida coast lead to a variety of negative impacts, including respiratory irritation (RI) in humans, such as coughing, sneezing, and eye irritation, which is especially harmful to those with underlying respiratory conditions. In order to inform beachgoers of the potential presence and risk‐level of respiratory impacts associated with red tide, NOAA's National Centers for Coastal Ocean Science developed a RI model. The model uses red tide cell abundances collected by regional partners and community scientists coupled with wind speed and direction at individual beaches. In this study, we tested the RI model, using estimates of RI at impacted beaches by trained lifeguards and beach ambassadors through the Beach Reporting Conditions System. Overall, we found that the model was accurate in predicting a very low or high risk of RI due to red tide, but that additional research is needed to better predict instances of low and moderate RI. Specifically, we found that several of the underlying model assumptions were true, including that there was a higher risk of RI with higher red tide cell abundances, especially when winds were blowing onshore.
Respiratory muscle training can be used in conjunction with CPAP or in situations precluding use of CPAP therapy. It should be used as a complimentary measure rather than an alternative to CPAP. https://bit.ly/3JqDDU7.
[Purpose] While forced exhalation with balloon-blowing has been reported to facilitate abdominal muscle activity, few studies have examined its effects using imaging. We aimed to compare abdominal muscle morphology across three conditions, end-inspiration, end-forced expiration, and end-forced expiration with balloon-blowing, between a balloon-blowing exercise expert and a novice with chronic low back pain, assessed using ultrasound imaging. [Participants and Methods] A 61-year-old male expert and a 51-year-old male novice participated. The thicknesses of the transversus abdominis, internal oblique, and external oblique were measured using ultrasound imaging during end-inspiration, end-forced expiration, and end-forced expiration with balloon-blowing. The thickness and contraction ratios, calculated by dividing the thickness at end-forced expiration by that at end-inspiration, were compared within and between participants. [Results] The expert demonstrated a 1.33 mm thicker transversus abdominis and a 4.95 mm thicker internal oblique than those of the novice at end-inspiration. Balloon-blowing increased all muscle thicknesses in both participants compared with end-inspiration. The contraction ratios of the muscles during forced expiration with balloon blowing were 1.14- to 1.80-fold higher than the ratios at end-forced expiration in both participants. [Conclusion] These findings suggest the potential usefulness of balloon-blowing for activating abdominal muscles, especially in individuals with chronic low back pain.
Air-induced separation of flexible rod-like particle mixtures in a specific separator is numerically investigated using a coupled Discrete Element Method (DEM) and Computational Fluid Dynamics (CFD) approach. In the separator, the mixture of flexible rod-like particles of different lengths and material densities deposits under the effect of gravity, and a horizontal airflow stream intersects the particle flow, blowing lighter particles in the mixture to translate horizontally and allowing the heavier ones to fall downwards. The model particles represent flexible biomass materials, specifically tobacco and stem particles. The initial packing density of the particle mixture is 8% by volume. The physical mechanism that causes particle segregation is analyzed. Subsequently, parametric studies are performed to examine the effects of some critical parameters on the extent of segregation, including inflow air velocities, initial particle packing density, volume fraction of heavier particles, particle size distribution, and flow field geometry. Finally, a suggestion is proposed to promote particle segregation in such a type of separator.
The cold temperatures during winter contribute to significant discomfort, causing cold stress to the lives of people. In this study, we investigate the cold stress conditions and their trends over north India during November - February for the period 1982-2020, using Universal Thermal Climate Index (UTCI), a widely recognized biometeorological variable. The onset of cold stress typically initiates in the late evening (18 IST) and gradually spreads across the north India. It then intensifies over night into moderate cold stress, persisting from 20 IST until the early morning hours (7 IST). Cold stress is found to be most intense in January, with UTCI values ranging between 0 °C to -13 °C among winter months. During cold wave events, cold stress reaches its maximum spatial extent and intensity throughout the study region, with the most intense conditions observed in Jammu & Kashmir and Ladakh. Results show a significant increase in slight cold stress hours during the winter season over the period 1982-2020 in north India. This increase reflects a transition from stronger cold stress categories to the slight cold stress category. Such a shift indicates a reduction in the severity of cold stress rather than an intensification of cold conditions. Slight cold stress occurs when UTCI values range between 0 °C and -9 °C and the duration of such conditions has increased at a rate of 33.64 hours per decade. This increase is most prominent in the high-altitude regions of Jammu & Kashmir, Ladakh and Himachal Pradesh. In contrast, moderate cold stress which occurs when the UTCI values are in the range -9 °C to -13 °C shows a significant decreasing trend, particularly in Rajasthan, Punjab, Haryana and Uttar Pradesh. Despite this, cold stress remains a major contributor to cold wave-related mortality in north India. Uttar Pradesh recorded the highest number of deaths of 4449, followed by Punjab (2606) and Bihar (2479). Although these states generally experience only slight cold stress with UTCI values in the range of 0 °C to 9 °C, the impact is amplified by wind chill with a category of 'Tonic- very cold sub comfort' caused by cold, dry northwesterly winds blowing directly into the region. This compound effect of cold stress and wind chill considerably enhances the mortality risk during cold wave events across north India.
Pneumocephalus is the presence of air in the brain parenchyma, ventricular cavities, or epidural, subdural, or subarachnoid spaces. Simple pneumocephalus is often asymptomatic; however tension pneumocephalus can present with the altered sensorium, cardiorespiratory arrest, and the Cushing's triad. The Cushing's triad (widened pulse pressure, bradycardia, and irregular respirations) is known to emergency medicine practitioners to be an ominous sign of increased intracranial pressure and indicates imminent brainstem herniation. Here we present a case of acute pneumocephalus from the patient blowing their nose. The patient was bradycardic, hypertensive, and tachypneic in triage. Her CT was notable for extensive pneumocephalus around the brainstem with a visible tract connecting the external auditory canal, through the internal auditory canal, to the infratentorial space with pressure on the brainstem. Upon further imaging, the patient had a defect in her left round window allowing for this air entry. The etiology of pneumocephalus is discussed as well as management strategies.
This study scrutinizes the effect of thermal radiation and Stefan blowing on the chemical reactive flow of Boger nanofluid across a stretched sheet with Darcy Forchheimer medium and heat generation using an intelligent computational framework based on Artifice neural network-Bayesian regularization. Furthermore, Brownian motion and thermophoresis properties have been examined. The suggested model of how Stefan blowing affects the chemical reactive flow of a Boger nanofluid with thermophoresis effects and Brownian motion has useful applications in a number of industrial and engineering operations. In chemical reactors, nano-coating technologies, and polymer processing, this model is essential for improving heat and mass transport processes. While the Boger nanofluid model accurately depicts non-Newtonian behaviour pertinent to biofluids and complex lubricants, Stefan blowing consideration offers insights on evaporation or suction effects. For the purpose of maximizing nanoparticle dispersion in cooling systems, fuel cells, and medicinal devices like targeted drug delivery systems where exact control over particle motion and chemical reactivity is crucial, Brownian motion and thermophoresis are also critical. The velocity profile improves as the Stefan blowing parameter values rise, but the thermal and concentration profiles decrease.