High Reliability Research Articles

Validation of the instrument for the evaluation of satisfaction with the quality of educational services

The quality of educational service is defined as the degree to which the educational process meets the expectations and needs of students and society. In this work, the quality of educational services was evaluated through the measurement of satisfaction in students of university centers. The study was instrumental and 1000 students from two universities participated in the validation of the instrument, intentionally selected by quotas. A confirmatory factor analysis was performed under the original model, which confirmed that the instrument has high reliability both for the general scale and for the dimensions (CFI=0.955 and TLI= 0.948, and ideal adjustments in the SRMR= 0.0348, RMSEA= 0.0743, ω= 0.987). These findings reveal that the instrument is ideal for measuring educational quality in university centers.

Liquid-infused nanostructured composite as a high-performance thermal interface material for effective cooling

Effective heat dissipation remains a grand challenge for energy-dense devices and systems. As heterogeneous integration becomes increasingly inevitable in electronics, thermal resistance at interfaces has emerged as a critical bottleneck for thermal management. However, existing thermal interface solutions are constrained by either high thermal resistance or poor reliability. We report a strategy to create printable, high-performance liquid-infused nanostructured composites, comprising a mechanically soft and thermally conductive double-sided Cu nanowire array scaffold infused with a customized thermal-bridge liquid that suppresses contact thermal resistance. The liquid infusion concept is versatile for a broad range of thermal interface applications. Remarkably, the liquid metal infused nanostructured composite exhibits an ultra-low thermal resistance <1 mm² K W-1 at interface, outperforming state-of-the-art thermal interface materials on chip-cooling. The high reliability of the nanostructured composites enables undegraded performance through extreme temperature cycling. We envision liquid-infused nanostructured composites as a universal thermal interface solution for cooling applications in data centers, GPU/CPU systems, solid-state lasers, and LEDs.

Snail Flap for Scalp Reconstruction: Technique and Outcomes.

Local flaps are widely described for scalp reconstruction, but there is minimal literature surrounding the snail flap. The objective of this study was to describe the surgical technique and outcomes of scalp reconstruction with the snail flap. This case series retrospectively evaluated all consecutive patients undergoing scalp snail flap reconstruction from January 1, 2019 to February 1, 2024. The primary outcome measure was incidence and extent of complications. Demographic and intra-operative variables were assessed. A total of 44 patients were included with a median age (range) of 74 years (27-88) with scalp defects ranging in size from 3 x 3 cm to 8 x 8 cm (median defect size 5 cm). The mean (SD) flap base-to-defect ratio was 1.82 (0.31). Forty (91%) of the cases were performed outpatient or with overnight observation only. Complications included 9 (20%) wound infections, 12 (27%) patients with necrosis (all minimal), and 2 (5%) patients with hematoma, which were all managed outpatient. The flap survival rate was 100%. The snail flap is easy to perform with high reliability and allows for hair preservation. The morbidity and need for hospitalization are minimal, making it an ideal reconstructive option for elderly or frail patients with moderate-sized scalp defects.

Analyzing Predictive Factors for the Media’s Impact on the Nursing Profession

Introduction: Mass media play a crucial role not only in informing the public but also in shaping public perception, educating, and enhancing the visibility of various professions, including nursing. Despite being the most populous healthcare profession, nursing remains underrepresented in media coverage. This imbalance affects the social status of the nursing profession and its public perception. Methods: This cross-sectional study utilized a validated questionnaire with high internal reliability (Cronbach’s alpha coefficients) to assess nurses’ perceptions of the media’s role in society and the nursing profession. Data were collected from 203 participants using an online survey employing the snowball sampling method. Statistical analyses included Welch ANOVA, t-tests, and hierarchical regression to predict the importance of media education. Results: Participants demonstrated positive perceptions of the media’s societal influence but identified a lack of adequate representation of nurses. Younger nurses and those with higher education levels emphasized the need for media education. Regression analysis revealed that perceptions of the media’s power and self-assessed media competencies were significant predictors of valuing media education. Conclusions: The findings highlight the need for integrating media literacy training into nursing education to enhance professional visibility and public engagement. This can empower nurses to actively contribute to shaping their professional image and addressing public misconceptions. Future research should expand the sample size and explore diverse healthcare settings to validate these findings.

Reliability and construct validation of the Blended Learning Usability Evaluation–Questionnaire with interprofessional clinicians in Canada : a methodological study

Purpose: To generate Cronbach’s alpha and further mixed methods construct validity evidence for the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q).Methods: Forty interprofessional clinicians completed the BLUE-Q after finishing a 3-month long blended learning professional development program in Ontario, Canada. Reliability was assessed with Cronbach’s α for each of the 3 sections of the BLUE-Q and for all quantitative items together. Construct validity was evaluated through the Grand-Guillaume-Perrenoud et al. framework, which consists of 3 elements: congruence, convergence, and credibility. To compare quantitative and qualitative results, descriptive statistics, including means and standard deviations for each Likert scale item of the BLUE-Q were calculated.Results: Cronbach’s α was 0.95 for the pedagogical usability section, 0.85 for the synchronous modality section, 0.93 for the asynchronous modality section, and 0.96 for all quantitative items together. Mean ratings (with standard deviations) were 4.77 (0.506) for pedagogy, 4.64 (0.654) for synchronous learning, and 4.75 (0.536) for asynchronous learning. Of the 239 qualitative comments received, 178 were identified as substantive, of which 88% were considered congruent and 79% were considered convergent with the high means. Among all congruent responses, 69% were considered confirming statements and 31% were considered clarifying statements, suggesting appropriate credibility. Analysis of the clarifying statements assisted in identifying 5 categories of suggestions for program improvement.Conclusion: The BLUE-Q demonstrates high reliability and appropriate construct validity in the context of a blended learning program with interprofessional clinicians, making it a valuable tool for comprehensive program evaluation, quality improvement, and evaluative research in health professions education.

Evolution of a patient safety program in an academic medical center

Background The Academic Medical Center earned a 1-Star CMS designation and received an F on the Leapfrog Safety Grade in 2015, which led to leadership setting Clinical Quality Improvement as the #1 Strategic Priority. This paper presents the evolution of a structured patient safety program as a component of this plan to direct and motivate employees to succeed in reducing patient harm. Methods Data-driven quality improvement using simple, timely, actionable data drillable scorecards available to all employees was the cornerstone of the above strategic priority. A comprehensive patient safety program was developed utilizing three phases: Error Prevention Training, Improved Event Reporting, and the Chasing Zero Harm initiative. Results Improvement was achieved in Culture of Safety Survey domains of overall safety, event reporting, nonpunitive response to errors, and hand-off communication. Patient safety indicators and hospital-acquired infections improved on the Medical Center's internal scorecard and public reported data by &gt;60%. These resulted in improvement in Leapfrog Safety Score from an F in 2015 to a B in 2023, and increase from CMS 1-Star to 2-Star rank in 2023. Adverse event reports and review with follow up increased by 45% between 2018 and 2023. A Chasing Zero harm program was initiated following establishment of these steps. Discussion A successful patient safety program, predicated on high reliability, can successfully be built with leadership commitment, development of safety culture, and performance improvement.

Research Related to Turbofan Engines

The development of aerospace technology has become a topic of daily concern and discussion for the benefit of all mankind. As the global temperature rises, the living environment of human beings is threatened, and scientists have decided to work on the development of aerospace technology in order to solve this problem and meet people's needs. Looking at the aviation industry, which is currently accessible to most people, aviation scientists are focusing on aircraft engines. There are different types of engines such as turbojet engines, turbofan engines, paddle fan engines and so on, but the type of engine that meets the needs of most people today is the turbofan engine. This paper introduced the basic information of turbofan engine in the context of literature, for example, the characteristics of turbofan engine such as high efficiency, high thrust, low noise, high reliability, and the problem of durability of high-temperature components that it faces, which can be improved from the research and development of advanced materials and innovative cooling technology

Studies on Thermal Separation and the Effects of Geometrical and Operating Parameters on the Performance of Pressure Wave Refrigerators

Abstract Thermal separation in a pressure wave refrigerator (PWR) occurs primarily through the propagation of shock waves and reverse-moving rarefied waves produced by injecting a high-pressure gas into a low-pressure residual gas in a receiving tube or channel. The major advantages of PWRs are simple design, low cost, high reliability, low rotational speed, and efficiency comparable to the conventional turbo-expanders. The objectives of this work are to understand the thermal separation in PWRs and to study the effects of various geometrical and operating parameters on the performance of PWRs. Two-dimensional computational fluid dynamics (CFD) simulation using a finite volume method is adopted for this study. The results indicate that the temperature and pressure profiles of the fluid inside the receiving tube just before the discharge, in the region about half the tube length from the inlet nozzle, strongly govern the performance of a PWR. The operating frequency at which the isentropic efficiency attains the first peak value is determined in a generalized way. Within the chosen geometrical and operating parameters, the optimized tube length, operating frequency, and pressure ratio are 2 m, 50 Hz, and 2.5, respectively. The findings in this article will be useful in designing and operating PWRs optimally.

The Relationship Between Medical Error Attitudes of Surgical Nurses and Evidence-Based Work Environment.

It is important for health care professionals to use evidence-based practice during  surgical procedures to ensure patient safety and prevent medical errors. The aim of this study was to examine the relationship between surgical nurses' perceptions of their work environment's support for evidence-based practice and their attitudes toward medical errors. The descriptive cross-sectional study was conducted between February and May 2023. A total of 105 nurses participated in the study. A personal information form, a medical errors attitude scale, and an evidence-based practice work environment scale were used to collect the data. It was determined that 92 (87.6%) of the participants used evidence-based practice. It was determined that the answers given by the nurses to the scales had very high reliability, and the mean score of the attitude scale in medical errors was 3.90 (Cronbach-α coefficient 0.770), and the mean score of the evidence-based practice work environment scale was 2.90 (Cronbach-α coefficient 0.840). In addition, according to the correlation, a positive, weak, and statistically significant correlation was found between the total scores of the attitude scale in medical errors and the evidence-based practice work environment scale (P<0.05). As a result of the study, it was determined that nurses' attitudes toward preventing medical errors were positive and their perceptions of support for evidence-based practice work environments were high. In this direction, it can be said that the attitudes toward preventing medical errors of nurses whose working environment is supported by evidence-based practice can be positively affected and error tendencies in surgical clinics can be reduced.

An Over-Actuated Hexacopter Tilt-Rotor UAV Prototype for Agriculture of Precision: Modeling and Control

This paper focuses on the modeling, control, and simulation of an over-actuated htr. This configuration implies that two of the six actuators are independently tilted using servomotors, which provide high maneuverability and reliability. This approach is predicted to maintain zero pitch throughout the trajectory and is expected to improve the aircraft’s steering accuracy. This arrangement is particularly beneficial for pa applications where accurate monitoring and management of crops are critical. The enhanced maneuverability allows for precise navigation in complex vineyard environments, enabling the uav to perform tasks such as aerial imaging and crop health monitoring. The employed control architecture consists of cascaded p-pid controllers using the slc method on the five controlled dof. Simulated results using Gazebo demonstrate that the htr achieves stability and maneuverability throughout the flight path, significantly improving precision agriculture practices. Furthermore, a comparison of the htr with a traditional hexacopter validates the proposed approach.

Exploration of Students' Interest Levels in Continuing their Education to Higher Education

This study aims to explore the level of interest of grade XII high school/vocational students in Pohuwato Regency to continue their education to higher education. The study used Rasch Model analysis to evaluate the validity and reliability of the instrument, unidimensionality, assessment scale, distribution of interest based on the Wright Map, and difference in item functionality (DIF). A total of 278 students from various schools were selected as respondents through the proportional random sampling technique. The results of the analysis show that the instruments used have high validity and reliability, both at the item and person levels. The unidimensionality test shows the measurement according to the intended construct. The Wright Map shows a diverse distribution of students' interests, with most being at moderate to high levels, with only a few students showing low and very low interest. DIF analysis shows that several question items have differential functionality based on the demographics of school origin so that it shows that there is a bias and in the future needs to be improved to improve the fairness of the instrument. This research contributes to the development of a valid and reliable instrument to measure student interest and provides input for schools and policymakers to increase student support in continuing to higher education.

A comprehensive assessment of current methods for measuring metacognition

One of the most important aspects of research on metacognition is the measurement of metacognitive ability. However, the properties of existing measures of metacognition have been mostly assumed rather than empirically established. Here I perform a comprehensive empirical assessment of 17 measures of metacognition. First, I develop a method of determining the validity and precision of a measure of metacognition and find that all 17 measures are valid and most show similar levels of precision. Second, I examine how measures of metacognition depend on task performance, response bias, and metacognitive bias, finding only weak dependences on response and metacognitive bias but many strong dependencies on task performance. Third, I find that all measures have very high split-half reliabilities, but most have poor test-retest reliabilities. This comprehensive assessment paints a complex picture: no measure of metacognition is perfect and different measures may be preferable in different experimental contexts.

Educating the future: Serbian healthcare students’ knowledge and attitudes toward urinary incontinence

IntroductionUrinary incontinence (UI) is a growing global health problem that affects both women and men of all ages and can seriously negatively impact quality of life. Healthcare professionals’ knowledge and attitudes significantly influence UI prevention, diagnosis, and treatment. However, there is a notable lack of research exploring healthcare students’ understanding and perceptions of UI. In many countries, they, as future healthcare professionals, must also have continence care competency before graduation. Therefore, the study aimed to assess the knowledge and attitudes of healthcare students toward UI.MethodsThe study was designed as an observational, analytical, and comparative cross-sectional with 378 healthcare students in Serbia during the winter semester of the 2023/2024 academic year. A general questionnaire for obtaining sociodemographic data, the Urinary Incontinence Knowledge Scale (UIKS) and the Urinary Incontinence Attitude Scale (UIAS) were used as students’ report measures. Kuder-Richardson Coefficient (K-R 20) showed high reliability of the UIKS at 0.83, while Cronbach’s alpha coefficient was 0.62 for the UIAS.ResultsThe UIKS score was 16.6 ± 3.9/30. Healthcare students achieved the highest score in the domain of knowledge about the impact of UI on quality of life and the lowest in the domain of UI control. There is a significant difference in students’ knowledge level concerning the study program and whether they had a course focusing on UI. The UIAS score was 45.1 ± 4.6/60, indicating a positive attitude to UI. A statistically significant positive but weak correlation was obtained between knowledge and student attitudes about UI.ConclusionsThe study findings highlight a concerning gap in understanding UI among healthcare students despite their pivotal role as future healthcare professionals and underscore the urgent need for comprehensive educational strategies to bridge the knowledge gap and foster more positive attitudes toward UI and their implementation in clinical practice to improve patient health outcomes.

Psychometric Evaluation of the Scleroderma Skin Questionnaire: A Novel Patient Reported Outcome for Skin Disease in Patients with Systemic Sclerosis.

To evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc) related skin symptoms. The SSQ was administered to 799 adults (mean age 52.7; 82% female) enrolled in the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach's α and McDonald's ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan Skin Score (mRSS), Physician Global Assessment (PGA), Scleroderma Health Assessment Questionnaire (SHAQ), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and Patient Global Assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients' self-reported recall of skin changes over the past six months ("SSQ 6-Month") and six-month change in mRSS. Cronbach's α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r=0.56), with stronger correlations in diffuse (r=0.54) versus limited subtypes (r=0.24; all p<0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical (r=-0.50) and pain interference subscales (r=0.61), strongly with SHAQ's HAQ score (r=0.63) and severity subscale (r=0.62), and moderately with PGA's scleroderma activity score (r=0.48; all p<0.05). SSQ 6-Month correlated weakly with the six-month change in mRSS (r=0.26; p<0.05). SSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ but not SSQ 6-Month to assess skin symptoms in patients with SSc.

Evaluation of the effect of hydrogen plasma treatment on the chemical bonding state and distribution of hydrogen in silicon nitride films by angle-resolved hard X-ray photoelectron spectroscopy

Abstract The presence of hydrogen-incorporated defects in silicon nitride (SiN) films has been reported to degrade device properties, such as NAND flash memory. Therefore, controlling the amount of hydrogen defects in SiN films to achieve high device reliability is important. This study investigated hydrogen desorption using hydrogen plasma treatment to reduce hydrogen-incorporated defects in SiN films. Secondary ion mass spectrometry measurements showed that the hydrogen concentration in SiN films does not change significantly pre- and post-treatment. However, the trap levels in SiN films determined using the Poole–Frenkel analysis of hole currents showed a clear deepening after the plasma treatment. Angle-resolved hard X-ray photoelectron spectroscopy measurements suggested that hydrogen plasma treatment decreases the ratio of silicon to hydrogen or nitrogen to hydrogen bonds as a function of treatment time.

Enhancing intelligent marketing systems: a multi-layer hypernetwork approach integrating evidence theory for influential node identification

PurposeThis study proposes an intelligent marketing system model based on a combination of multi-layer hypernetworks and evidence theory, aiming to address the shortcomings of traditional marketing models in accurately identifying key nodes. We propose a new method to improve the accuracy and response speed of intelligent marketing systems by combining evidence theory with multi-layer hypernetworks. We conducted an experiment using a certain car brand (SUV) as an example, which has a wide customer base in both domestic and international markets and has branches in multiple countries. By analyzing its sales data and user behavior, we evaluated the potential reduction in advertising costs and improvement in user satisfaction that may result from adopting this model.Design/methodology/approachThe proposed model begins with the development of a user interest model, which is subsequently converted into a user label model based on user behavior and a rating matrix. A multi-layer aggregation hypernetwork is then constructed to define the network’s topology. An identification framework is established using evidence theory, and the Dempster–Shafer (D-S) evidence combination method is applied to integrate local, positional and global network indicators. Simulation experiments are conducted to evaluate the model’s performance.FindingsThis study proposes an intelligent marketing system model that integrates multi-layer hypernetworks with Dempster–Shafer evidence theory to address the limitations of traditional marketing models in identifying influential nodes. The proposed model is tested in the automotive industry, specifically using sales and user behavior data from a well-known SUV brand operating globally. This industry provides a complex and competitive environment ideal for validating the model’s ability to improve marketing precision. The results demonstrate that the model significantly enhances the accuracy of key node identification, reduces advertising costs by 10–15% and improves customer satisfaction scores to over 90%. Furthermore, preliminary experiments in the retail and e-commerce sectors highlight the model’s adaptability and potential for broader application. By combining local, positional and global indicators, the model effectively optimizes marketing strategies, providing a novel framework for intelligent decision-making in diverse industries. This study selected a well-known SUV car brand as the experimental subject. This brand mainly sells SUV models and has a wide customer base worldwide. Its products are known for their high performance and reliability. The brand has millions of customers, and its main markets include North America, Europe and Asia. It has branches in multiple countries and has significant international influence. According to publicly available data, the brand’s annual revenue reaches billions of dollars.Originality/valueThe main contribution of the research is the proposal of a novel intelligent marketing optimization framework based on multi-layer hypernetworks and evidence theory, which can effectively solve the problems of data silos and information asymmetry faced in traditional marketing systems.

Evaluating the Reliability and Consistency of Treadmill Gait Analysis Using an RGB-D Camera: Effects of Assistance and No Assistance

This study aimed to assess the intraday reliability of markerless gait analysis using an RGB-D camera versus a traditional three-dimensional motion analysis (3DMA) system with and without a simulated walking assistant. Gait assessments were conducted on 20 healthy adults walking on a treadmill with a focus on spatiotemporal parameters gathered using the RGB-D camera and 3DMA system. The intraday reliability of the RGB-D camera was evaluated using intraclass correlation coefficients (ICC 1, 1), while its consistency with the 3DMA system was determined using ICC (2, 1). The results demonstrated that the RGB-D camera provided high intraday reliability and showed strong consistency with 3DMA measurements regardless of the presence of an assistant. The Bland–Atman analysis indicated no significant systematic bias, with the minimum detectable change remaining within acceptable clinical ranges. These findings highlight the potential of the RGB-D camera for reliable markerless gait analysis in clinical environments in which walking assistance may be needed, thereby expanding its applicability in patients with various impairment degrees. Future research should validate these results in patient populations and explore their utility for measuring kinematic parameters.

Establishment and validation of a nomogram for coronary artery lesions in children with Kawasaki disease

BackgroundThe nomogram is a powerful and robust tool in disease risk prediction that summarizes complex variables into a visual model that is interpretable with a quantified risk probability. In the current study, a nomogram was developed to predict the occurrence of coronary artery lesions (CALs) among patients with Kawasaki disease (KD). This is especially valuable in the early identification of the risk of CALs, which will lead to proper diagnosis and treatment to reduce their associated complications.MethodsRetrospective clinical data of 677 children diagnosed with KD who were treated in the Children's Hospital Affiliated with Shandong University were analyzed. All the participants were divided into the CAL group and no CAL group according to their coronary echocardiography results. Least absolute shrinkage and selection operator (LASSO) regression was applied for the identification of the most informative predictors of CAL. Based on this, a nomogram was developed for accurate risk estimation.ResultsThe data were divided into a training set and a validation set. Receiver operating characteristic analysis, calibration curves, and decision curve analysis all supported the high accuracy and clinical utility of this model. LASSO regression highlighted five key predictors: sodium, hemoglobin, platelet count, D-dimer, and cystatin C. A nomogram based on these predictors was established and successfully validated in both datasets. In the training set, the AUC was 0.819 and in the validation set it was 0.844. The C-index of the calibration curve in the training set was 0.820, while in the validation set it was 0.844. In the decision curve analysis, the predictive benefit of the model was greater than zero when the threshold probability was below 95% in the training set and below 92% in the validation set.ConclusionThe predictive factors identified through the LASSO regression approach and the development of the nomogram are important contributions in this respect. This model had a high predictive accuracy and reliability for identifying high-risk children in the very early stage of disease with remarkable precision, laying the foundation for personalized treatment strategies and targeted treatment and providing a strong scientific basis for precise therapeutic intervention.

Analysis of No‐Load Normal Vibration in Single‐Sided Permanent Magnet Synchronous Linear Motors With Different End Structures

ABSTRACTThis paper investigates the no‐load normal vibrations of single‐sided permanent magnet synchronous linear motors (S‐PMSLMs) with different end structures, addressing a significant gap in the current literature. By employing the Maxwell stress tensor method, analyzes the harmonic orders and frequencies of the no‐load normal force density are analyzed. Comparative research between the comb‐type auxiliary tooth (CTAT) and conventional auxiliary tooth (C‐AT) structures indicates that while the CTAT marginally increases the amplitude of the no‐load normal force density, it significantly reduces harmonic amplitudes and vibration levels. The theoretical and simulation analyses are validated through no‐load vibration experiments, providing valuable insights for the design optimization of S‐PMSLMs, particularly beneficial for high‐speed transportation systems that require high precision and reliability.

TRADUÇÃO, ADAPTAÇÃO TRANSCULTURAL E VALIDAÇÃO DA ESCALA SANE PARA PACIENTES SUBMETIDOS À ARTROPLASTIA TOTAL DE JOELHO

This study conducted the translation, cross-cultural adaptation, and validation of the Single Assessment Numeric Evaluation (SANE) Scale into Brazilian Portuguese, aimed at assessing the functionality of patients undergoing Total Knee Arthroplasty (TKA). The process included translation, back-translation, expert committee review, and semantic validation with patients, following rigorous methodological guidelines. The adapted version of the SANE proved to be understandable, culturally relevant, and appropriate for the Brazilian population, facilitating the accurate collection of data on functional recovery. Psychometric analyses demonstrated high reliability (Cronbach’s alpha &gt; 0.70) and excellent reproducibility (ICC &gt; 0.75). Construct validity was confirmed through significant correlations with established measures such as the KOOS and IKDC. The SANE Scale has shown to be an effective tool for quick and objective assessment, standing out for its practicality in clinical settings. The study concludes that SANE is a valid and reliable alternative for orthopedic practice, with the potential to simplify functional assessment in post-TKA patients.