Flowchart Research Articles

Accuracy of Electronic Health Record Documentation of Parental Presence: A Data Validation and Quality Improvement Analysis.

Parental presence in the neonatal intensive care unit (NICU) is known to improve the health outcomes of an admitted infant. The use of the electronic health record (EHR) to analyze associations between parental presence and sociodemographic factors could provide important insights to families at greatest risk for limited presence during their infant's NICU stay, but there is little evidence about the accuracy of nonvital clinical measures such as parental presence in these datasets. A data validation study was conducted comparing the percentage agreement of an observational log of parental presence to the EHR documentation. Overall, high accuracy values were found when combining two methods of documentation. Additional stratification using a more specific measure, each chart's complete accuracy, instead of overall accuracy, revealed that night shift documentation was more accurate than day shift documentation (76.3% accurate during night shifts, 55.2% accurate during day shifts) and that flowsheet (FS) recordings were more accurate than the free-text plan of care (POC) notes (82.4% accurate for FS, 75.1% accurate for POC notes). This research provides a preliminary look at the accuracy of EHR documentation of nonclinical factors and can serve as a methodological roadmap for other researchers who intend to use EHR data.

Processes and principles for producing credible climate change attribution messages: lessons from Australia and New Zealand

Extreme event attribution (EEA) information is increasingly in demand from climate services. EEA messages can: raise awareness about the effect climate change has already imposed, inform climate change liability conversations, and be combined with climate projections to inform adaptation. However, due to limitations in observations, models and methods, there are barriers towards operationalising EEA in practice. Operational services will need EEA to be done transparently and using preset formats. Here we review recent experience and practice in EEA in Australia and New Zealand with a view to inform the design of an EEA component of climate services. We present a flow chart of the processes involved, noting particular care is needed on the trigger, event definition, and climate model evaluation, with effective stage gates. We also promote the use of tailored causal network diagrams as a standard tool to inform an EEA study and communicate results, with particular care needed for messages on events with lower confidence or complex sets of influences, including tropical cyclones and extratropical cyclones. We suggest that extending EEA to impact attribution is essential for making EEA messages salient but requires an uplift in forming interdisciplinary teams and in granular exposure and vulnerability datasets and is likely to raise new interdisciplinary methodological questions. Finally, we suggest communication of EEA messages can learn more from its origins in medical epidemiology.

Performance analysis and optimisation of waste heat recovery system based on zeotropic working fluid

As a new type of energy storage technology utilizing thermal energy, the Carnot battery is one of the most promising large-scale energy storage technologies due to its unlimited geographical conditions, simple structure, and high energy storage density. In this work, a thermodynamic model is established for a Carnot battery energy storage system that makes full use of waste heat resources, and the effects of the heat storage temperature, the components and mass fractions of the zeotropic working fluids on the various performances of the system are investigated. The temperature matching of the working fluids with different temperature glides in the heat exchangers are analyzed by using different mass fractions of R1234ze(E)/ R601a in heat pump and organic Rankin cycle systems, and the exergy flow charts and exergy loss of each component in the system are further investigated. The results show that the selection of the zeotropic working fluid with an appropriate temperature glide can effectively improve the system performance by improving the temperature matching degree and reducing the exergy loss in the heat transfer process. Compared with the evaporator, the temperature match of the condenser plays a more important role in the system performance. The use of R1234ze(E)/R601a in the heat pump improves the cofficient of performance by 4.46%-8.98% compared with that of pure R601a when the heat storage temperature increases from 110.0℃ to 140.0℃, and the use of zeotropic working fluid in the organic Rankin cycle also improves the performance by 8.12%-11.58%. For the power recovery of the whole pumped thermal energy storage system, the power-to-power efficiency improvement of the system using R1234ze(E)/R601a is 12.69%-20.11% and that using R1234yf/R601a is 12.46%-17.73% compared with the use of pure R601a. The power-to-power efficiency of R1234ze(E)/R601a (60/40) and R1234ze(E)/R601a (20/80) in the heat pump and organic Rankin cycle, respectively, are as high as 73.93% at a heat storage temperature of 130.0℃, which is 19.75% higher than the 61.74% for pure R601a.

Three phase microcontroller based automatic change-over selection switch

The significance of electricity in a developed country cannot be underestimated because power instability problem affects the economy growth, productivity and infrastructure development. The issues of phase failure, losses and phase imbalance earth fault are main causes that lead to unstable and erratic power supply. Most homes and office complexes where single-phase supply is needed are supplied with three phases of power supply to allow change from one phase to another when there is fluctuation or complete outage of power supply on a particular phase. This operation is normally done manually and has caused a setback in terms of time wastage, strenuous operation, susceptibility to fire outbreak, electric shock and high maintenance frequency. When voltage supply on a phase is below 220V or above 415V, this system automatically disconnects the load from the phase and connects to another where the required condition is met. Therefore, this paper presents a Microcontroller Based Automatic Transfer Switching System which is made up of voltage sensing circuit, Hall Effect current sensor, relays, LEDs and LCD of PIC16F877A microcontroller. A system flow chart was developed, programmed with MikroC software and simulated using Proteus electrical software design. A 10KVA single phase generator was used as alternate power source. The load capacity of the design was determined by decoupling Maxwell’s Equations of 8KW and power loss using pointing vector equation as 0.25% of the peak load. The switch is tested to have function optimally within ±5% nominal voltage of 220 - 415V supply and produced approximately 20 seconds elapses during the entire process of power supply changeover. Hence this device is suitable for Industrial and Domestic use where 3-phase power supply is available with a stand-by power source.

Flutter generated on a sheet in 3D flow: influence of aspect ratio of sheets on post-critical and hysteretic behavior

Flutter generated on a sheet in 3D flow: influence of aspect ratio of sheets on post-critical and hysteretic behavior

Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia.

Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): "There is a process for storage of medications and nutritional products that require special consideration." Therefore, a "Nutritional Formula Expiry Monitoring" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018. A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations. A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018. This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.

IMG-15. A STRATEGIC FLOWCHART FOR PREOPERATIVE IMAGING IN PEDIATRIC POSTERIOR FOSSA TUMORS

Abstract BACKGROUND This comprehensive study delves into pediatric posterior fossa tumors (PFTs), focusing on both common and rare types, including pseudoneoplasms. The aim is to understand the diagnostic challenges of these less typical tumors, enhancing knowledge beyond usual pathologies. A detailed flow chart has been created to aid in accurate preoperative diagnoses. METHODS The study examines neuroimaging data, primarily from MRI and CT scans, collected from various clinical studies and case reports. It concentrates on identifying unique imaging characteristics of rare PFTs and pseudoneoplasms. The flow chart considers lesion location in various anatomical areas of the posterior fossa and factors such as lesion localization, MRI details (including DWI), and patient age. It also emphasizes the identification of cells in the posterior fossa that can lead to tumors, including osseous tissue cells, dura mater cells, arachnoid cells, pia mater cells, various glial cells, neurons, and choroid plexus cells. RESULTS The study reveals distinct imaging features of less common PFTs and pseudoneoplasms, critical for differentiating them from more common tumors. Advanced imaging techniques are highlighted as essential for improving diagnostic accuracy, impacting clinical management and treatment decisions. The review also discusses the varied presentation of tumors and the challenges this poses to standard diagnostic methods. CONCLUSIONS Understanding the imaging characteristics of rare PFTs and pseudoneoplasms, especially in children, is vital. This thorough analysis enhances diagnostic accuracy and influences treatment approaches, potentially improving patient outcomes. The study underscores the necessity of combining clinical observations with advanced imaging for precise diagnoses in atypical cases. This approach is crucial for healthcare professionals managing pediatric PFTs, leading to better clinical decisions and advancing pediatric neuro-oncology.

Challenges in the Recycling of Battery Casing Materials

AbstractCurrent recycling methods for the very popular lithium‐ion batteries (LIBs) focus mainly on recovering valuable metals such as cobalt and nickel for economic reasons. The cell casing components, which are mainly made of aluminum, can make a significant contribution to achieving political recycling targets. Mechanical processes are used to separate the casing components from the overall LIB material stream. The aluminum, copper, steel, and plastic components are then further concentrated into various potential products by, e.g., magnetic separation, eddy current separation, and air classification. Considering the benefits of additional stress to compact the metal parts, the knowledge gained from the individual sorting steps can be combined to form a process flow chart.

Infiltrating Functional English for Technical Students with the Concomitant of Project Transcripts: A Paradigm in Education

A powerful communication strategy plays a key role in professional settings, all the while demonstrating its ability to garner admiration and respect. Over time, Language is an ever-evolving system from a usage standpoint. Despite several existing methods, the quality of knowledge of technical communication remains a persistent challenge for non-native speakers at the instructional level. This paper explores how engineering students can acquire an understanding of and practice functional technical English by preparing micro and macro projects. This study examined 200 student projects, each comprising 20 pages and approximately 300 lines. These projects serve for statistical analysis and are evaluated based on specific five test areas, such as usage of tense, change of voice, concord, vocabulary, and connectors. The two groups (EG & CG) were offered pretest and post-test. The result of the analysis is interpreted with the help of line graphs that assess the comparability of the two groups. Remedial measures with sequence flow charts were suggested to the participants that served the purpose of mending their deficient areas, which, if believed, would enhance their career progression. This method would assist tertiary-level students in breaking language barriers, enabling them to express their ideas in writing and speaking more effectively using technical language, especially in the ordinary usage of technical means to explain complex technical principles. A language is language, when reflected in the correct sense with the ability to use it functionally rather than learning it for years.

Expert consensus on the diagnosis and management of pollen-food allergy syndrome

Pollen-food allergy syndrome (PFAS) is a unique type of food allergy that specifically affects individuals with pollen allergy. In recent years, pollen allergy is increasingly and shows younger tendency. PFAS has also become a topic of interest in China. The characteristics of PFAS vary across regions and show obviously heterogeneity due to different pollen sensitization profile. Currently, diagnostic methods for PFAS in China are limited, which may lead to underdiagnosed and underrecognized of this syndrome, there are currently no accessible diagnostic criteria and procedures for clinical use. Unlike primary food allergy, the management of PFAS need a combined strategy which involves managing both pollen allergy and food allergy. Therefore, its management is particularly complex and varies among doctors in clinical practice. This consensus has developed a diagnosis and management flow chart based on current domestic and foreign guidelines, as well as relevant research evidence in China. The aim is to improve the standard diagnosis and treatment of PFAS and provide guidance to allergists, healthcare professionals, and general practitioners for accurate understanding, diagnosis, and standardized management of PFAS.

Implementing Continuous Integration and Deployment Strategy: Cloversy.id RESTful API Development

The software development cycle involves testing and deployment stages that can be laborious and time consuming, especially in collaborative projects that involve several developers. Implementing Continuous Integration (CI) and Continuous Delivery (CD) offers a solution to streamline this process. This study presents a case study of the Cloversy.id RESTful API project, highlighting challenges encountered during development and the implementation of a new system using GitHub Actions as the DevOps tool. The research resulted in the adoption of a new system, which replaces the conventional practices previously employed by the Cloversy.id development team. Using flow charts, the study meticulously mapped out the development flow, pinpointing bottlenecks and areas for optimization within the cycle. In particular, the implementation of a CI/CD pipeline resulted in a notable improvement, with a 35% increase in speed for CI and a remarkable 39% enhancement for CD. GitHub Actions played a pivotal role in automating critical tasks, reducing the reliance on manual intervention, and minimizing the dependency on team leaders. The platform's features, including detailed logs and email notifications, empowered team leaders and developers alike to take informed actions swiftly. Furthermore, the study highlights the novelty of integrating CI / CD considering factors such as branching strategy, code review practices, testing methodologies, deployment methods, and infrastructure.

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia.

There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using "smart pumps" or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.

Improving the Rate of Palliative Care Completion in NICU Nurses

Critically ill neonates receive care in the neonatal intensive care unit (NICU). Unfortunately, some neonates pass away in the NICU. Providing comprehensive neonatal palliative care and hospice services is crucial in supporting parents through the loss of their offspring. In our NICU, we identified that only 74.5% of nurses are able to properly recognize the need for palliative care and only 55% are able to implement the necessary procedures. A project was designed and implemented to enhance the ability of nursing staff to recognize the need for and properly implement palliative care to improve the quality of this care in the NICU. We organized an on-the-job education and training program within our NICU with the goals of heightening awareness among nursing staff. In addition, a specialist palliative care operation flow chart, process preparation checklist, and palliative-care-related tools were created to facilitate the care process. After program implementation, among nursing staff in our NICU, the palliative care recognition accuracy rate rose to 100% (from 74.5%) and the implementation rate rose to 94.8% (from 55%). The quality of provided neonatal palliative care and hospice services was significantly improved. The developed program was shown to significantly improve nursing staff recognition and implementation of neonatal palliative care in our NICU. This experience provides a reference for improving palliative care quality and for helping families effectively manage end-of-life challenges.

Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

Total neoadjuvant therapy (TNT) is a novel strategy for rectal cancer that administers both (chemo)radiotherapy and systemic chemotherapy before surgery. TNT is expected to improve treatment compliance, tumor regression, organ preservation, and oncologic outcomes. Multiple TNT regimens are currently available with various combinations of the treatments including induction or consolidation chemotherapy, triplet or doublet chemotherapy, and long-course chemoradiotherapy or short-course radiotherapy. Evidence on TNT is rapidly evolving with new data on clinical trials, and no definitive consensus has been established on which regimens to use for improving outcomes. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews currently available evidence on TNT for rectal cancer. A decision making flow chart is provided for tailor-made use of TNT regimens based on tumor location and local and systemic risk.

Information technology integration implementation in public sector organizations: Exploring challenges, opportunities, and future trends

This paper provides an overview of challenges, opportunities, and future trends in implementing IT integration within public sector organizations. Employing an exploratory research approach, the study conducts a case study and reviews pertinent literature (2019–2023) on IT integration implementation. Following the PRISMA flow chart, electronic searches in various databases used keywords related to IT integration. The study identifies inadequate technical facilities, insufficient technology, infrastructure, and unsupportive policies as primary barriers. Conversely, the digital era prompts opportunities, compelling organizations to adopt innovative technologies for enhanced productivity and quality service delivery. The paper's uniqueness lies in developing a framework assessing the success of technology integration, allowing for the incorporation of remote and hybrid work models. Future trends in IT integration implementation focus on remote and hybrid work solutions. Contributing to existing literature, the framework emphasizes that failure to extend IT integration implementation to include remote and hybrid work solutions may lead to additional constraints, creating gaps in organizational operation. The review analyzes research gaps and suggests future directions, ensuring effective IT integration implementation, especially in developing countries with significant gaps. This review is particularly relevant given the global surge in technology use over the past two years. Fueled by rapid technological advancements and the constraints of COVID-19, a systematic literature review (SLR) is imperative to demonstrate how IT integration implementation helps public sector organizations improve employee performance, financial outcomes, productivity, and service delivery.

Bibliometric Analysis of Philosophical Dimensions in Sport Based on Scopus Data

This study aims to explore the literature on the dimensions of philosophy and sports based on scopus indexed articles. The research method used to conduct the analysis is bibliometric. Search and filtering strategy using PRISMA flow chart. The research review uses data in comma-separated values (CSV) format, which is then exported to Microsoft Excel and to visualize the search results of bibliometric analysis the tool used is VOSviewer. The conclusion of the study resulted in the development of publications with the domain of philosophy and sports dimensions experiencing fluctuating conditions, but in the last 10 years the number of publications has tended to be stable.

Feasibility and efficacy of single-shot PFA technology for redo procedures after a previous atrial fibrillation ablation procedure

Abstract Introduction Despite significant technological advancements and a better understanding of atrial tachyarrhythmia pathophysiology, a non-negligible percentage of atrial fibrillation (AF) patients undergoing catheter ablation experiences arrhythmia relapse. Repeat procedures have been traditionally performed via thermal energy systems, which carry a certain risk of collateral damage to adjacent tissues. Pulsed Field Ablation (PFA) has emerged as an alternative non-thermal energy source for cardiac ablation. The main advantage is its selectivity to cardiac tissue. FarapulseTM is the first PFA technology to have received regulatory approval and includes a pentaspline PFA catheter. Although designed for pulmonary vein isolation, its use for extrapulmonary vein site ablation has been previously documented. Purpose To evaluate the feasibility and efficacy of the pentaspline FarawaveTM for redo procedures. Methods Patients referred for a redo procedure using FarapulseTM system were enrolled in 3 high-volume European centers. A workflow (Figure 1.A) was established based on rhythm at presentation (Group 1: sinus rhythm; Group 2: AFL; Group 3: AF). Results A total of 117 patients were included (64 in Group 1, 18 in Group 2, and 35 in Group 3). The mean number of previous procedures was 1.26, and 23 patients (19.66%) had already undergone ≥2 procedures. Previous ablation targets included PVI, either alone (46.15%) or in combination with other targets, including posterior mitral line (39.32%), posterior wall (6.84%), or anterior mitral line (2.56%). Electroanatomical mapping (EAM) was adopted in 15.38% of the cases. Specifically, in 27.78% (n=5) of group 2, 15.63% (n=10) of group 1 and 8.57% (n= 3) of group 3 cases. Additional focal radiofrequency ablation was required in 4 patients for CTI line ablation. Lesion sets are depicted in Figure 2. Mean procedural and LA dwelling time were 95.2 ± 38.0 and 50.7 ± 36.7 minutes, respectively. There was a total of one major complication (intracranial haemorrhage) and 5 minor complications (two vascular site related, and three reversible ST segment changes, related to applications on the mitral annulus area). A total of 100 patients completed at least 3 months of follow-up (FU), with a median FU time was 7.55 months (IQR 5.18 – 11.85). The total number of recurrences was 20, including 2 during the blanking period. Survival function (excluding blanking period) was 88.6 (95% CI 79.7 – 93.8) at 6 months and 80.0% (95% CI 67.3 – 88.3) 12 months. Atrial arrhythmia free-survival was higher in patients presenting in sinus rhythm, compared to the other two groups (p = 0.0135), as displayed in Figure 1.B. Conclusion The proposed stepwise approach to repeat AF ablation procedures based on the use of the single-shot PFA system (with or without EAM) was feasible, safe, fast and effective at one year follow-up.Flow chart and Kaplan Meier curveLesion sets

Instruments for Evaluating the Nutritional Status of Cancer Patients Undergoing Antineoplastic Treatment: A Scoping Review.

The use of validated tools to evaluate the nutritional status of the cancer patient provides guaranteed precision and reliability in their nutritional evaluation, ensuring that the information is accurate and reflects the patient's situation. The aim of this study was to identify the valid and reliable instruments in the evaluation of the nutritional status of cancer patients with a diagnosis of solid tumor undergoing antineoplastic treatment (chemotherapy and/or immunotherapy). A scoping review was conducted to search for original articles published in scientific journals in English, Spanish, or Portuguese in the past five years. In order to identify potentially relevant documents, searches were performed in the following databases: SCOPUS, WOS, CINAHL, MEDLINE, BVS, and PUBMED. DECS-MeSH descriptors and Boolean operators were used. In addition, the Arksey and O'Malley protocol, the Joanne Briggs Institute (JBI) method, and the flow chart of the Preferred Information Elements for Systematic Reviews and Meta-Analyses, known as PRISMA, were followed. The initial search strategy identified a total of 164 references, which were examined successively, leaving a final selection of ten studies. It was found that the most used instrument for nutritional evaluation was the Patient-Generated Subjective Global Assessment (PG-SGA). Other questionnaires also stood out such as the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening (NRS 2002), and the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The variation in the tools used ranges from subjective assessments to objective measurements, thus underlining the need for a comprehensive and individualized approach.

Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study

BackgroundWe investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel (SAV) patency.MethodsFor this experimental analysis, we created a silicone model of the extracranial and intracranial...

Very elevated hCGβ (≥10 multiple of the median) in maternal marker screening for Down syndrome: Frequency, etiologies, outcomes, and guidelines.

This aim of this study was to detail maternal and fetal anomalies observed on a national scale in a large French cohort of patients presenting high hCG values (≥10 multiple of the median [MoM]) at Down syndrome screening in order to define clear and optimal guidelines. This is a retrospective multicenter study based on a French annual database of all trisomy 21 screenings. Our study targeted and studied cases with hCG or hCGβ values ≥10 MoM. Complementary exams and outcomes were analyzed. The calculated frequency was 0.05% for hCGβ ≥10 MoM in unselected patients. For this series of 289 cases, a complication of the pregnancy or a poor outcome was observed in 145 cases (51%) as follows: 96 (66%) cases of fetal disease, 23 (16%) of maternal disease, 5 (3.5%) of placental anomalies and 21 (14.5%) of systemic disease concerning mother, fetus and placenta. This study establishes the frequency of hCG or hCGβ values ≥10 MoM, presents a flow chart that optimizes follow-up, and gives clear information for patients presenting with such abnormal values at trisomy 21 screening.