Rapid and reliable identification of multivariate geochemical anomalies is critical for delineating prospective mineralized zones and reducing uncertainty in mineral exploration targeting. Extended isolation forest (EIF) is a powerful unsupervised ensemble learning algorithm that efficiently isolates anomalies from high-dimensional geochemical datasets using randomly oriented hyperplane partitions. Previous studies have demonstrated the effectiveness of EIF in multivariate geochemical anomaly detection and mineral potential modeling. However, its performance can be significantly affected by stochastic variability arising from random partitioning and random subsampling during isolation tree construction, which may result in unstable anomaly patterns and inconsistent exploration targets in complex geological environments. To mitigate this limitation, we developed a robust unsupervised framework for the identification of multivariate geochemical anomalies associated with gold mineralization in the Southwestern Yilgarn Craton, Australia. The proposed framework integrates robust factor analysis (RFA), a Jaccard-based stability index and EIF to enhance the reliability and reproducibility of anomaly detection. RFA was first applied to compositional soil geochemical data to identify the most significant pathfinder elements associated with gold mineralization, which were subsequently used as input variables for the EIF model. The model was then optimized using a Jaccard-based stability criterion to ensure consistent anomaly detection across repeated independent runs. Model performance was assessed using area under the receiver operating characteristic curve (AUC). The obtained AUC value of 0.82 indicates strong predictive capacity, confirming that the generated anomaly map effectively delineates mineralization-related geochemical patterns and provides a reliable proxy for mineral prospectivity mapping. Overall, the proposed framework offers a robust and reproducible unsupervised approach for multivariate geochemical anomaly detection with strong applicability in both greenfield and brownfield mineral exploration settings.
INTRODUCTION:This study explores maternal perceptions of stunting, food security challenges, and child-feeding efforts in rural Indonesia, where socioeconomic constraints and traditional practices significantly impact child nutritional outcomes. METHOD:Utilizing a descriptive phenomenological approach, the study conducted in-depth interviews with 16 mothers of stunted toddlers to explore their daily experiences regarding food access and family sanitation, achieving data saturation. RESULTS:Three themes emerged. First, mothers view stunting as nutritional deficiency and growth failure causing low immunity. Second, economic barriers and limited knowledge drive food insecurity, forcing reliance on cheap, low-nutrient diets instead of animal proteins. Third, mothers actively attempt food modification and utilize Posyandu for supplementary feeding, preferring face-to-face counselling. DISCUSSION:Maternal care for stunted children is heavily hindered by poverty and low health literacy, despite active engagement with local health services. Interventions must prioritize direct nutritional education and economic empowerment to improve dietary diversity and household food security.
INTRODUCTION:Suicide is the second leading cause of death among the adolescent patient population with limited evidence supporting routine suicide screening. This study sought to assess adolescent suicidal ideation, suicide attempts, and mental wellbeing to inform evidence-based universal suicide screening practice. METHOD:A secondary data analysis of the 2023 Youth Risk Behavior Survey was conducted. Descriptive statistics and ordinal logistic regression were performed, using SPSS v.29, with a significance level of 0.05. RESULTS:The majority of participants were male (50.3%), over 16 years-old (61.3%), and White (49.2%). Compared with participants always reporting poor mental health without suicidal ideation, those with suicidal ideation and better mental health had significantly higher odds of more suicidal attempts (always good: OR = 19.14, 95% CI = 11.69-31.33; sometimes good: OR = 17.68, 95% CI = 13.53-23.09, p < .001). CONCLUSIONS:Consideration of universal suicide screening among adolescents may be warranted; however, the significance of the findings requires further examination.
INTRODUCTION:Abusive head trauma (AHT) is a leading cause of morbidity and mortality in infants and young children. Retinal hemorrhages are important findings in suspected AHT and require timely ophthalmologic evaluation, yet standardized retinal evaluation processes and pediatric ophthalmology access remain inconsistent. METHODS:This evidence-based practice improvement project used the Iowa Model within the SQUIRE 2.0 framework to implement a standardized retinal evaluation pathway at a Level III pediatric trauma hospital. Interventions included a retinal imaging protocol, staff competency training, standardized documentation, and teleophthalmology consultation. Sixty-two pediatric patients with suspected AHT were evaluated (31 pre-intervention, 31 post-intervention). RESULTS:Documented pediatric ophthalmology diagnoses with follow-up recommendations increased from 0% pre-intervention to 77.4% post-intervention (Fisher's exact test, p < .001). CONCLUSION:A standardized retinal evaluation pathway significantly improved ophthalmologic review, documentation, and follow-up planning for pediatric patients with suspected AHT.
Introduction This study describes the psychosocial complexity of rural and remote children and families who accessed a multidisciplinary developmental assessment service in New South Wales, Australia, as well as caregiver perspectives regarding service impact and outcome. Methods This parallel convergent mixed-methods study involved thematic analysis of semi-structured interviews (n = 8) and descriptive analysis of cross-sectional survey responses (n = 154) with caregivers of children involved in a multidisciplinary pediatric developmental assessment service for rural and remote Australian children. Results Survey respondents reported high rates of Adverse Childhood Experiences (ACEs) and related life events, including caregiver mental health issues (61%) and children’s experiences of community violence (35%) and discrimination (31%). Interviewees highlighted the importance of diagnosis for understanding their child's behavior. Discussion Rural and remote children in Australia experience alarming rates of ACEs, financial and other psychosocial stresses. Responsive, family-centered, multidisciplinary diagnostic services are perceived by caregivers as impactful.
INTRODUCTION:The objective was to describe the current practice of pediatric procedural sedation outside the operating room (OR) by advanced practice providers using data from the Pediatric Sedation Research Consortium (PSRC). METHOD:Retrospective analysis of prospectively collected cases in which the responsible provider was an advanced practice provider (pediatric nurse practitioner or physican assistant), from April 27, 2020, to July 31, 2024. Descriptive statistics, adverse events, and interventions were reported. RESULTS:A total of 3,795 (3.6%) cases met inclusion criteria. Median patient age was 6 years (interquartile range: 2, 11) and 49% were male. Ninety-five percent of cases were American Society of Anesthesiologists (ASA) status 1-2. The most common procedure was radiologic (24%). Most procedures took place in a sedation unit (76%). The most common sedative administered was midazolam (50%). Cases with any adverse events and any critical adverse events were infrequent, 3.3%, and 0.1%, respectively. 0.4% of cases were unable to be completed. DISCUSSION:These data demonstrate low frequency of adverse events and discontinued procedures for advanced practice provider-administered sedations.
INTRODUCTION:This article describes a virtual case study initiative to promote collaboration between Acute and Primary Care Pediatric Nurse Practitioner students. The program aimed to enhance clinical reasoning skills and clarify role differences within pediatric healthcare. METHODS:Students in both Acute and Primary Care PNP programs at UTHSC CON were assigned case studies on pediatric neurological and cardiovascular issues relevant to their settings. Each student prepared a 10-minute oral presentation covering: Chief Complaint, History of Present Illness, Review of Systems, Medical/Family/Social History (if applicable), Physical Examination Findings, Differential Diagnosis, Final Diagnosis, Medical Management Plan, and Family Education or Anticipatory Guidance. Presentations were delivered virtually via Zoom to peers, faculty, and clinical experts in neurology and cardiovascular care. After each presentation, students and faculty debriefed, provided feedback, and asked questions. Students then completed a 10-question survey about their experience. RESULTS:Student feedback from the post-activity survey was limited (n=4) but revealed consistent themes. Students valued examining the same diagnosis in different clinical contexts, especially comparing acute presentations in primary care and transitions to the emergency department. They appreciated exposure to diverse clinical perspectives, real-world cases, and involvement of specialty nurse practitioners. DISCUSSION:Through interactive case presentations, faculty-led discussions, and structured feedback, the initiative deepened students' understanding of care transitions across settings. It also fostered advanced diagnostic reasoning and collaborative skills essential for interdisciplinary practice. The project was well received, highlighting the value of case-based learning in competency-based education.
Pediatric feeding disorders (PFDs) affect 1 in 37 children under age 5 in the United States, representing a common yet frequently underrecognized condition in primary care. In 2019, a multidisciplinary expert panel established the first consensus definition of PFD, creating a standardized four-domain framework (medical, nutritional, feeding skill, and psychosocial) that has transformed clinical assessment and management. A recent 2025 consensus further clarified the relationship between PFD and avoidant/restrictive food intake disorder (ARFID), providing guidance on diagnostic overlap and differentiation. This continuing education article provides pediatric healthcare providers with current, evidence-based knowledge to screen, identify, and make appropriate referrals for children with PFDs. The article reviews the consensus definitions, epidemiology, validated screening tools, differential diagnosis, risk factors, assessment strategies, and referral guidelines. A case-based example illustrates the application of the four-domain framework in clinical practice. With appropriate early identification and intervention, most children with feeding difficulties can achieve improved nutritional status, oral-motor development, and positive mealtime experiences.
Water conservancy and hydropower projects enhance regional climate resilience and watershed water security yet inevitably trigger large-scale involuntary reservoir resettlement. As representative involuntarily displaced populations, reservoir resettlees' social identity directly impacts local social stability and regional sustainable socioeconomic development. Based on a ten-year longitudinal qualitative investigation including in-depth interviews and participant observation in Village Y of Wuxikou Reservoir, Jiangxi Province, this paper divides the entire resettlement process into three stages: relocation, stabilization and development. From the dual perspectives of host community identity and out-groups identity, this study explores the dynamic evolutionary rules of resettlees' social identity. The results indicate that resettlees sequentially develop alienated identity, superficial adaptive identity and segregated identity across different phases. On this basis, the core concept of differential identity is proposed, which features a dual structure of vertical temporal differentiation and horizontal spatial differentiation. This paper expands the applicable scope and explanatory power of the “differential mode of association” and social identity theory in involuntary resettlement contexts. Grounding on the differential identity framework, this paper puts forward targeted integrated governance solutions to break intergroup segregation, facilitate cross-group integration and build resilient resettlement communities consistent with Sustainable Development Goals (SDGs) 11 and 13.
The discrimination of ore deposit types is primarily based on geological, geochemical, and isotopic characteristics. Conventionally, these types are identified using specific element diagrams. However, traditional geochemical methods often fail to determine scheelite deposit types of the complex Xuefengshan Sb-Au-W metallogenic belt in China, where mineralization resulted from the superposition of multiphase geological events. Machine learning (ML) methods, have been increasingly applied to identify deposit genesis by establishing relationships between deposit characteristics and genetic types using extensive datasets. However, inaccurate data labels, the limitations of single models, and poor model interpretability lead to decreased accuracy. This study proposes a ML framework based on interpretable ensemble learning. We collects geochemical element data from typical orogenic and magmatic-hydrothermal scheelite deposits globally. Deep clustering is used to filter data and overcome the subjectivity of original data labels. An ensemble learning model is used to construct a classifier to improve the model's robustness and generalization ability. An interpretable model is introduced to analyze the contribution of individual feature elements, revealing the metallogenic genesis. This method demonstrates high accuracy on the test set. According to this method, the scheelite deposit type of the Xuefengshan metallogenic belt is primarily magmatic-hydrothermal in origin, with orogenic superposition. This helps resolve a long-standing controversy in the region and establishes a repeatable and interpretable new paradigm for ML-based discrimination of ore deposit genetic types.
Though volcanogenic massive sulfide (VMS) deposits are major global sources of indium (In), the physicochemical mechanisms and key factors controlling its significant enrichment remain poorly understood. To address the issue, this study investigates the Tiemurt VMS Pb-Zn-Cu deposit, utilizing detailed petrography, in-situ LA-ICP-MS analysis, and thermodynamic modeling to reveal the In enrichment mechanisms in VMS deposits. Petrographic observations identified two distinct generations of sphalerite corresponding to different mineralization stages. The early-stage sphalerite (Sp1) is euhedral-subhedral, associated with pyrite, and displays darker colors (red to brown), whereas the late-stage sphalerite (Sp2) is anhedral, intimately intergrown with chalcopyrite, and shows lighter colors (mainly yellow). The trace element results demonstrate that Sp1 has a significantly higher In content (average 317 ppm) than Sp2 (average 220 ppm). Additionally, In concentrations positively correlate with Fe contents. Because Fe is the primary chromophore that darkens sphalerite, this strong coupled enrichment mechanism allows macroscopic sphalerite color (red > brown > yellow) to serve as a reliable indicator for In concentration. Crystallization temperatures calculated using the GGIMFis thermometer range from 344 to 382 °C for Sp1 and 312 to 355 °C for Sp2, indicating a cooling trend during fluid evolution. Thermodynamic modeling data showed that in the early-stage hydrothermal fluids (≥360 °C), Zn2+ preferentially complexes with Cl−, leaving InCl2+ or In3+ as unstable species, and In efficiently precipitates into Sp1 under the environment of log fO2 = −32 to −26 and pH = 6–8. As the fluids cool at ~340 °C, weakened Zn2+ competition allows In3+ to form stable InCl3, and In precipitates into Sp2 under the conditions of log fO2 = −42 to −32 and pH = 5.5–11. We therefore conclude that the key factor controlling the difference in In content between Sp1 and Sp2 is the precipitation mechanism rather than migration capacity. This may be different from the In enrichment mechanism associated with magmatic hydrothermal systems, where In is mainly present as InCl3 complexes with strong migration capacity. These new findings enable us to understand how the physicochemical conditions of fluids control the enrichment of In in VMS deposits, and also highlight that the color of sphalerite can be used to target potential In resources in PbZn deposits.
BACKGROUND:Social deprivation has been linked to disparities in adult orthopedic care, but its impact in pediatric orthopedics remains less well characterized. We conducted a scoping review to evaluate how multidimensional deprivation indices (e.g., Area Deprivation Index, Child Opportunity Index) have been used to assess disparities in pediatric orthopedic care. METHODS:PubMed, Embase, MEDLINE, and Scopus were searched for English-language studies evaluating social deprivation in pediatric orthopedic populations. Outcomes were categorized into three domains: (1) disease prevalence/risk (2) access to care, and (3) clinical outcomes. RESULTS:Of 41 included studies most found that greater social deprivation was associated with increased disease prevalence and severity, delayed treatment, reduced follow-up, lower use of nonoperative care, poorer clinical outcomes, higher injury severity, recurrence, and poorer psychosocial PROMs. Disparities were frequently compounded by race, insurance status, and geography. CONCLUSION:Social deprivation is associated with increased disease prevalence, delayed access, and worse outcomes in pediatric orthopedic care.
INTRODUCTION:Maintaining optimal blood phenylalanine (Phe) levels in children with phenylketonuria (PKU) depends on dietary, behavioral, and psychosocial factors. This study examined dietary and behavioral determinants of metabolic control in pediatric PKU. METHOD:This cross-sectional study included 50 children with PKU. Participants were categorized according to whether their Phe levels were within or above age-specific therapeutic target ranges. RESULTS:The mean Phe level was 536.3 ± 311.7 µmol/L, and 54% of participants had uncontrolled Phe values. Those with uncontrolled Phe levels more frequently exhibited poor dietary adherence, consumption of protein-rich foods, lack of satiety after meals, and social difficulties (p < .05), whereas no associations were observed for age and gender. Intake of protein-rich foods emerged as the strongest independent predictor of elevated Phe levels. CONCLUSION:Metabolic control in PKU is closely linked to feeding behaviors and psychosocial challenges. Health care providers should address behavioral and social barriers alongside dietary prescriptions to improve long-term Phe control.
BACKGROUND:Intracranial hemorrhage (ICH) is a major cause of infant mortality and neurodevelopmental complications, yet national mortality trends and demographic disparities remain poorly characterized. METHODS:A retrospective analysis using the CDC WONDER Multiple Cause of Death database (1999-2020) identified infant (<1 year) deaths with ICH (ICD-10 P52) as an underlying or contributing cause. Mortality rates per 100,000 live births were calculated by demographic and geographic factors, and Joinpoint regression estimated annual and average annual percent changes (APC, AAPC) with 95% confidence intervals. RESULTS:From 1999 to 2020, 20,544 infant ICH deaths were recorded in the United States, with a crude rate of 23.64 per 100,000 live births. Mortality peaked in 2003 at 31.57 and declined to 17.32 by 2020 (AAPC -2.51%). Among 20,544 ICH infant deaths recorded , mortality declined from 31.57 (2003) to 17.32 (2020) (AAPC -2.51%). Males exceeded females (28.18 vs. 18.88), Non-Hispanic Blacks had the highest racial rate (37.5), and Southern states showed the greatest regional burden. Urban areas declined faster than rural (AAPC -2.53% vs. -1.89%). CONCLUSIONS:Despite substantial overall decline in infant ICH rates, persistent disparities by sex, race, region, and urbanization underscore the need for equitable maternal and infant healthcare.
OBJECTIVES:Evaluate associations between hospital type and clinical outcomes for pediatric lower-extremity open fractures. METHODS:Retrospective study of children ≤17 years with lower-extremity open fractures using HCAI (2016-2021). Fractures were categorized as Type I/II or III. Hospitals were categorized as exclusively children's hospitals (ECH), other hospitals with pediatric surgeon coverage (WPS), or without (NPS). Outcomes included time to surgery, length of stay (LOS), discharge disposition, and complications. Multivariate models evaluated associations between hospital type and outcomes. RESULTS:Among 1,118 admissions, 324 (29%) were treated at ECH, 445 (40%) at WPS, and 349 (31%) at NPS. ECH patients had a shorter time to surgery (p = .02), had shorter LOS (p < .001), and were more frequently discharged home (p < .001). Complication rates were similar. Multivariable regression showed WPS and NPS had lower odds of routine home discharge while WPS had longer LOS for isolated fractures. CONCLUSION:ECH provide more efficient care for pediatric lower-extremity open fractures while maintaining comparable complication rates.
