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Scientific Reports Jun 2024Removing a limited number of large debris can significantly reduce space debris risks. These bodies are generally exposed to extreme environmental disturbance torques or...
Removing a limited number of large debris can significantly reduce space debris risks. These bodies are generally exposed to extreme environmental disturbance torques or consecutive accidents due to their large wet area, which causes them to experience accelerated high-rate tumbling motion. The existing literature has adequately explored the approximation operations with non-cooperative targets exhibiting 3-axis tumbling motion. However, the research gap lies in the lack of attention given to addressing this approximation for targets undergoing accelerated motion. Agile, accurate, and large-angle maneuvers are three common necessities for safely capturing such targets. Changes in the moment of inertia brought on by fuel slushing cannot be disregarded during such a maneuver. To deal with nonlinearities, adverse coupling effects, actuator saturation constraints, time-varying moment of inertia, and external disturbances that worsen during accelerated agile large-angle maneuvers, a novel adaptive control approach is developed in this paper. The controller's main advantage is its adjustable desired acceleration, which maintains its performance even when dealing with accelerated motion. The control law is directly synthesized from the nonlinear relative equations of motion, without any linearization or simplification of the system dynamics, making it robust to a variety of orbital elements and target behaviors. Adaptation laws are extracted from the Lyapunov stability theorem in a way that guarantees asymptotic stability. Moreover, control actuator roles (delay, saturation, and allocation) are accounted for in modeling and simulation. Finally, a comprehensive numerical simulation based on three different realistic and strict scenarios is carried out to demonstrate the effectiveness and performance of the proposed control approach. The controller's robustness against time-varying dynamic parameters (sharp and sudden change, smooth and slow change, and periodic change) is extensively demonstrated through simulation.
PubMed: 38942822
DOI: 10.1038/s41598-024-65807-6 -
BMJ Open Quality Jun 2024Intravenous medication errors continue to significantly impact patient safety and outcomes. This study sought to clarify the complexity and risks of the intravenous...
OBJECTIVES
Intravenous medication errors continue to significantly impact patient safety and outcomes. This study sought to clarify the complexity and risks of the intravenous administration process.
DESIGN
A qualitative focus group interview study.
SETTING
Focused interviews were conducted using process mapping with frontline nurses responsible for medication administration in September 2020.
PARTICIPANTS
Front line experiened nurses from a Japanese tertiary teaching hospital.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome measure was to identify the mental models frontline nurses used during intravenous medication administration, which influence their interactions with patients, and secondarily, to examine the medication process gaps between the mental models nurses perceive and the actual defined medication administration process.
RESULTS
We found gaps between the perceived clinical administration process and the real process challenges with an emphasis on the importance of verifying to see if the drug was ordered for the patient immediately before its administration.
CONCLUSIONS
This novel and applied improvement approach can help nurses and managers better understand the process vulnerability of the infusion process and develop a deeper understanding of the administration steps useful for reliably improving the safety of intravenous medications.
Topics: Humans; Qualitative Research; Medication Errors; Focus Groups; Patient Safety; Infusions, Intravenous; Perception; Female; Administration, Intravenous; Adult; Nursing Staff, Hospital; Male; Japan; Interviews as Topic; Attitude of Health Personnel
PubMed: 38942437
DOI: 10.1136/bmjoq-2024-002809 -
Injury Jun 2024Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not...
Epidemiology and patient-reported measurement outcome of pelvic fractures in children and adolescents - A population-based cohort study from the Swedish fracture register.
BACKGROUND AND PURPOSE
Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not been evaluated yet. The purpose of the study was to describe the epidemiology of pelvic and acetabular fractures in pediatric patients including long-term patient-reported outcomes.
PATIENTS AND METHODS
The Swedish Fracture Register (SFR) was used to identify all patients aged 6-17 years at injury with a pelvic fracture between 2015 and 2021. All patients were invited to answer Patient-Reported measurement instruments in 2021.
RESULTS
The study cohort consisted of 223 patients with a median age at fracture of 15 years and with 62 % boys. 201 sustained a pelvic and 22 acetabular fractures. Falls were the leading cause of fracture, followed by transport accidents. Most fractures (both pelvis and acetabulum) were type A (73 %), and 21 fractures (9 %) could not be classified according to AO. 85 % of fractures were treated non-surgically. All Type C fractures were treated surgically. Seven PROMIS® profile domains were completed by 31 % of the sample at a mean follow-up time of 3.5 years after pelvic/acetabular fracture. Most patients had "no concern" or "mild concern" but those who had surgery had an inferior t-score in most domains.
CONCLUSION
Most fractures occurred in older individuals, with falls during sports activities being the most common cause. This raises important questions about prevention strategies. The PROMIS-Pain-Interference scale indicated that the younger the age at fracture, the more pain was reported at follow-up.
PubMed: 38941910
DOI: 10.1016/j.injury.2024.111700 -
Environment International Jun 2024
Corrigendum to "Coupled modeling of in- and below-cloud wet deposition for atmospheric Cs transport following the Fukushima Daiichi accident using WRF-Chem: A self-consistent evaluation of 25 scheme combinations" [Environ. Int. 158 (2022) 106882].
PubMed: 38942658
DOI: 10.1016/j.envint.2024.108775 -
Health Physics Aug 2024This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are...
This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are conventional explosive devices with radioactive materials incorporated. The objective is to introduce the Expected Mental Model State (EMMS) as a comprehensive evaluation tool for assessing and enhancing the expertise and situational awareness of emergency responders dealing with radiation crises. Through a series of expert focus group sessions using the well-established qualitative methodology of grounded theory, an Expected Mental Model State (EMMS) was developed. The methodology used an influence diagram architecture to conceptually capture and codify key areas relevant to effective emergency response. The research identifies fourteen EMMS key conceptual domains, further elaborated into 301 subtopics, providing a multi-dimensional structure for the proposed mental model framework. Three pivotal notions of mental model emerged within the EMMS framework: Knowledge Topology, Envisioning (Belief), and Response and Operability. These notions were found to align with previous theories of mental models and are vital for understanding how HAZMAT technicians conceptualize and respond to RDD incidents. The study emphasizes the critical role of mental models in enhancing preparedness and effective response strategies during radiation emergencies. The EMMS framework offers a versatile methodology that can be adapted across various kinds of emergency responders and high-risk situations, including the broader Chemical, Biological, Radiological, and Nuclear (CBRN) spectrum. Using this EMMS framework to develop an EMMS Diagnostic Matrix can provide a roadmap for identifying areas for the development of specialized training modules that have the potential to significantly elevate both the quality and efficacy of responder training and preparation.
Topics: Humans; Radioactive Hazard Release; Emergency Responders; Models, Psychological; Disaster Planning
PubMed: 38941518
DOI: 10.1097/HP.0000000000001809 -
Journal of the National Cancer Institute Jun 2024Neurocognitive impairments are sequelae of childhood cancer treatment, however little guidance is given to clinicians on common phenotypes of impairment, or modifiable...
BACKGROUND
Neurocognitive impairments are sequelae of childhood cancer treatment, however little guidance is given to clinicians on common phenotypes of impairment, or modifiable risk factors that could lead to personalized interventions in survivorship.
METHODS
Standardized clinical testing of neurocognitive function was conducted in 2,958 (74.1%) eligible survivors, who were ≥5 years post-diagnosis and >18 years old, and 477 community controls. Impairment was examined across 20 measures and phenotypes were determined by latent class analysis. Multinomial logistic regression was used to estimate risk for phenotype, predicted by cancer diagnosis and treatment exposures, chronic health conditions, and lifestyle, adjusted for sex and age. Associations between phenotypes and social attainment were examined.
RESULTS
Five neurocognitive phenotypes were identified in survivors (global impairment 3.7%, impaired attention 5.0%, memory impairment 7.2%, processing speed/executive function impairment 9.3%, no impairment 74.8%). Risk of global impairment was associated with severe chronic health condition burden (odds ratio [OR]=20.17, 95% confidence interval [95%CI] 11.41-35.63) including cerebrovascular disease (OR = 14.5, 95%CI = 5.47-38.44) and cerebrovascular accident (OR = 14.7, 95%CI = 7.50-26.40). Modifiable risk factors, like quitting smoking reduced risk for global impairment (OR = 0.21, 95%CI 0.06-0.66). Low physical activity increased risk for global impairment (OR = 4.54, 95%CI 2.86-7.21), attention impairment (OR 2.01, 95%CI 1.41-2.87), processing speed/executive function impairment (OR 1.90, 95%CI 1.46-2.48), and memory impairment (OR 2.09, 95%CI 1.54-2.82).
CONCLUSIONS
Results support the clinical utility of neurocognitive phenotyping to develop risk profiles and personalized clinical interventions, such as preventing cerebrovascular disease in anthracycline treated survivors by preventing hypercholesterolemia, smoking, and sedentary lifestyle, to reduce the risk for global impairment.
PubMed: 38941494
DOI: 10.1093/jnci/djae149 -
Medicine Jun 2024Taiwan is an aging society, and the number of people with dementia is rapidly increasing. Due to a decline in cognitive and physical function, older adults with dementia...
BACKGROUND
Taiwan is an aging society, and the number of people with dementia is rapidly increasing. Due to a decline in cognitive and physical function, older adults with dementia not only gradually lose the ability to complete daily living tasks on their own, but are also at a higher risk of falls and injurious falls. It is important to develop interventions that combine cognitive and exercise training for older adults with dementia to promote or maintain their cognitive and physical functions and reduce their risk of falls. This study aimed to investigate the feasibility and effect of cognitive-based board games and multi-component exercise interventions on cognitive function, physical fitness, and fall risk in older adults with dementia.
METHODS
This was a quasi-experimental study with a single-group pretest and post-test design. The study participants were 41 community-dwelling older adults with mild to moderate dementia. They received cognitive-based board games and multi-component exercise interventions once a week for 12 weeks. The interventions included 1 hour of exercise training and 1 hour of cognitive training. Scores for the Taiwan version of the Montreal Cognitive Assessment (MoCA-T), physical fitness, and the St. Thomas Risk Assessment Tool for Falling Elderly Inpatients (STRATIFY) were measured as outcome indicators at baseline and after the 12-week period.
RESULTS
The overall MoCA-T score increased significantly (effect size = 0.402), with participants with mild dementia showing a greater increase (effect size = 0.522) than those with moderate dementia (effect size = 0.310). Participants' physical fitness performance improved. Female participants exhibited significant improvements in the 30-second chair stand test (effect size = 0.483) and 8-foot up-and-go test (effect size = 0.437). The fall risk score decreased by 0.05 points, the change was not significant.
CONCLUSION
The cognitive-based board game and multi-component exercise interventions used in this study are beneficial for improving cognitive function and physical fitness in older adults with dementia. These interventions are feasible and suitable for promotion among community-dwelling and institution-dwelling older adults with mild cognitive impairment or dementia to delay the decline in cognitive and physical function.
Topics: Humans; Female; Male; Aged; Dementia; Feasibility Studies; Exercise Therapy; Accidental Falls; Aged, 80 and over; Taiwan; Cognition; Physical Fitness; Games, Recreational; Independent Living
PubMed: 38941425
DOI: 10.1097/MD.0000000000038640 -
PloS One 2024The reactor coolant pump is a key equipment in a nuclear power plant. If the leakage exceeds a certain threshold, it may cause reactor overheating and shutdown. The...
The reactor coolant pump is a key equipment in a nuclear power plant. If the leakage exceeds a certain threshold, it may cause reactor overheating and shutdown. The reactor coolant pump leakage fault usually has two problems: corrosion and scaling. Accurately and efficiently diagnosing the leakage fault mode as early as possible and predicting its remaining useful life (RUL) are important for taking timely maintenance measures. In this paper, an integrated method is proposed. First, the cross-sectional area of the first seal is extracted as a fault indicator. The motivation is that corrosion may enlarge the cross-sectional area, and scaling may reduce the cross-sectional area. Based on the fluid mechanics theory, an integrated model with several uncertain parameters is established among the cross-sectional area, temperature, and leakage at the inlet and outlet of the first seal. In the diagnosing process, a modified change-detection method is proposed to detect the starting point of degradation. Then, the unknown parameters in the previous relation are estimated, and the degrading data before the starting point of degradation are used to diagnose the leakage fault mode. Second, a time-series model of the autoregressive integrated moving average (ARIMA) is established to predict the remaining useful life based on the degrading data after the starting point of degradation. Finally, the leakage degrading data from six reactor coolant pumps of a nuclear power plant is used to perform the leakage fault mode diagnosis and life prediction with degradation point detection error rates not exceeding 4%, fault mode diagnosis correction rates 100% and practical RUL predicting results, which proves that the proposed integrated method is accurate and efficient. The proposed integrated method combines the advantages of both the physical model diagnosis and the data-driven model diagnosis and innovatively make use of the quantity of flow from the output side of the primary pump as the monitoring indicator and the cross-sectional area as the characteristic index together to diagnose the leakage fault mode happened to the seal and predict its RUL, which can meet the needs of actual operation and maintenance to ensure a healthy and stable operation of the pump and prevent unexpected shutdowns of nuclear power plants and serious accidents.
Topics: Nuclear Power Plants; Models, Theoretical; Nuclear Reactors; Equipment Failure; Equipment Failure Analysis
PubMed: 38941331
DOI: 10.1371/journal.pone.0304652 -
Journal of Primary Health Care Jun 2024Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and...
Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and physiotherapy professions. Advanced musculoskeletal physiotherapy roles in primary health care could address escalating health care costs, challenges to workforce sustainability and inefficient primary/secondary care interfaces. Little is known about how stakeholders perceive the recently introduced Advanced Practice Physiotherapist (APP) scope of practice. Aim This study aimed to explore health professionals' perceptions of the APP scope of practice in NZ and how APPs could influence physiotherapy service delivery for people with musculoskeletal conditions in primary health care. Methods Qualitative, face-to-face, semi-structured interviews were conducted with 15 participants including physiotherapists, general practitioners, medical specialists and Accident Compensation Corporation case managers. Inductive interpretive analysis was undertaken. Results Five themes were identified: perceptions of current musculoskeletal management in primary health care; lack of a career pathway; ways in which APPs might facilitate change and what their role would be; characteristics of an APP; and the implementation of the APP role into practice. Discussion Stakeholders were supportive of the APP scope of practice and thought it has the potential to improve patient pathways, health care delivery and health outcomes for those with musculoskeletal conditions. Stakeholders also thought it would fill an important gap in the physiotherapy clinical career pathway. Successful implementation will require assessment of applicants' personal attributes as well as clinical experience and academic qualifications to ensure all stakeholders have confidence to engage with the service, clear communication, active promotion and specific funding.
Topics: Humans; Primary Health Care; New Zealand; Physical Therapists; Qualitative Research; Attitude of Health Personnel; Male; Female; Scope of Practice; Interviews as Topic; Musculoskeletal Diseases; Adult; Professional Role; Middle Aged; Stakeholder Participation
PubMed: 38941257
DOI: 10.1071/HC24029 -
Journal of Primary Health Care Jun 2024
Substitution of regulated health professionals such as doctors and nurses with unregulated health professionals such as physician assistants gives rise to concerns around patient safety and accountability issues: Yes.
Topics: Humans; Patient Safety; Physician Assistants; Social Responsibility; Physicians; Nurses
PubMed: 38941250
DOI: 10.1071/HC24075