Main Safety Research Articles

A Complex Intervention to Minimize Medication Error by Nurses in Intensive Care: A Case Study.

Background/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the complexity and critical nature of the care elevate the risks. Nurses play a pivotal role in preventing medication errors and require strategies and methods to enhance patient safety. This study aims to develop a comprehensive and evidence-based intervention to minimize medication errors by nurses in ICUs. Methods: This qualitative case study forms a part of a broader research project that commenced with a scoping review. Building on the review findings, a complex intervention was designed to address nurses' medication errors. A focus group of experts was conducted to validate the intervention designed, evaluating its contextual feasibility and relevance. Results: This study led to the development of a complex intervention whose relevance lies in its potential implementation within the studied context. The resulting intervention was structured around four main components-educational interventions, verification and safety methods, organizational and functional modifications, and an error reporting system-meticulously designed to leverage the ICU's existing resources. Conclusions: In conclusion, the proposed intervention has the potential to positively impact healthcare quality by reducing errors and promoting a culture of safety. Furthermore, this study's findings provide a relevant foundation for future research and practical applications, driving advancements in healthcare service excellence.

Sustavni pregled identifikacije, procjene i ublažavanja sigurnosnih rizika u visokogradnji

The construction industry accounts for a large proportion of the national GDP; however, it is one of the world’s most dangerous industrial sectors. Existing studies have inadequately reviewed safety risk-related research in high-rise building construction. Therefore, this study conducts a systematic review of safety risks in high-rise building construction from 2004 to 2024. First, the paper presents investigates the causes of accidents and risk factors that endanger occupational safety and health, comprising 8 main factors and 60 sub-factors. Second, the paper explores the assessment methods for evaluating and ranking these safety risk factors, of which nine typical methods are elaborated. Finally, a technical framework for mitigating the eight main safety risk factors is established in paper, providing safety practitioners with access to cutting-edge technologies and methods in the construction industry. Furthermore, this study provides suggestions and future directions for addressing the drawbacks of current mitigation measures to sustainably improve building construction safety.

Improving the Process of Managing Psychosocial Risks in Organizations.

Psychosocial risks (PSRs) are identified as one of the main modern occupational safety issues, primarily related to occupational stress, and need to be reduced to safe levels in accordance with international requirements. The research purpose is to improve the process of managing the PSRs in the occupational safety and health management systems of employees, taking into account the impact of psychosocial dangers in accordance with the requirements of ISO 45001:2018 and ISO 45003:2021 standards. To develop the process of managing the PSRs, a system analysis method is applied, which allows determining the structural relationships between the variable elements of dangerous psychosocial factors described in the ISO 45003:2021 standard. The bow-tie model has been improved to determine the relationship between psychosocial dangers and the dangerous event occurrence - experiencing stress by an employee, taking into account the influence of various dangerous psychosocial factors, which provides for an additional risk level assessment for restoring the health of an employee who has experienced stress. The process of psychosocial risk management consisting of ten steps is proposed, which involves identifying the relationship between psychosocial dangers and consequences for human health, taking into account the impact of various dangerous psychosocial factors based on questionnaires, followed by analysis and processing of the duration and intensity of experiencing stress. To reduce the impact of subjective assessments of the duration and intensity of experiencing stress on the psychosocial risk level, it is proposed to take into account the value of individual perception of experiencing stress (stress resistance) and the employees' health condition. The scientific novelty is to determine the psychosocial risk level as the sum of the risk values from the impact of each dangerous psychosocial factor, which are characteristic of aspects of work organization, social conditions at work, working environment, equipment, dangerous tasks and the level of employee health. The practical value is the development of scales for assessing the impact of dangerous psychosocial factors and a form for documenting the process of managing psychosocial risks with the indication of precautionary measures to control them.

Effect of stellate ganglion block on perioperative myocardial injury following thoracoscopic surgery for lung cancer (SGBMI): protocol for a single-centre, randomised controlled trial

IntroductionMyocardial injury is a common complication of thoracoscopic surgery. The stellate ganglion block is believed to affect myocardial oxygen consumption. The Stellate Ganglion Block and Myocardial Injury (SGBMI) trial aims...

Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma

BackgroundThe effect of embolization of the middle meningeal artery in patients with subacute or chronic subdural hematoma is uncertain.MethodsWe performed a multicenter, open-label, randomized trial in China, involving patients with symptomatic nonacute subdural hematoma with mass effect. Patients were assigned to undergo burr-hole drainage or receive nonsurgical treatment at the surgeon’s discretion, and patients in each group were then randomly assigned, in a 1:1 ratio, to undergo middle meningeal artery embolization with liquid embolic material or to receive usual care. Patients whose condition warranted craniotomy were excluded. The primary outcome was symptomatic recurrence or progression of subdural hematoma within 90 days after randomization. Secondary outcomes included clinical and imaging outcomes. The main safety outcome was any serious adverse event (including death).ResultsThe analysis included 722 patients, of whom 360 were assigned to the embolization group and 362 to the usual-care group. Burr-hole drainage was performed in 78.3% of the enrolled patients; among the patients who underwent burr-hole drainage, the procedure occurred after embolization in 99.6%. Symptomatic recurrence or progression of subdural hematoma within 90 days occurred in 24 patients (6.7%) in the embolization group and in 36 (9.9%) in the usual-care group (between-group difference, −3.3 percentage points; 95% confidence interval, −7.4 to 0.8; P=0.10). The incidence of serious adverse events was lower in the embolization group than in the usual-care group (6.7% vs. 11.6%, P=0.02).ConclusionsAmong patients with symptomatic nonacute subdural hematoma (of whom 78% underwent burr-hole drainage), middle meningeal artery embolization resulted in a 90-day incidence of symptomatic recurrence or progression similar to that with usual care but was associated with a lower incidence of serious adverse events. (Funded by Shanghai Shenkang Hospital Development Center and others; MAGIC-MT ClinicalTrials.gov number, NCT04700345.)

CANBERRA: A Phase 2 Randomized Clinical Trial to Test the Therapeutic Potential of Oral Vicasinabin in Diabetic Retinopathy

ObjectiveNon-proliferative diabetic retinopathy (NPDR) is a progressive disease that can lead to blindness. Current therapies for NPDR are invasive and not extensively used or accessible until the disease progresses, pointing to the need for an early non-invasive treatment.The objective of CANBERRA was to assess the safety, tolerability, and efficacy of oral administration of vicasinabin (RG7774) on the severity of diabetic retinopathy (DR) in participants with moderately severe to severe NPDR and good vision. DesignCANBERRA was a global, multicentric randomized, double-masked, parallel-group, placebo-controlled, phase 2 study. The study duration was 36 months. 139 treatment-naïve participants with type 1 or type 2 diabetes mellitus and Diabetic Retinopathy Severity Scale (DRSS) levels of 47 or 53 in at least one eye. Eligible participants were randomized 1:1:1 to 36 weeks of daily oral placebo, vicasinabin 30mg, or vicasinabin 200mg. Participants were followed for an additional 12 weeks. Main OutcomeThe primary safety objective was to evaluate the safety and tolerability of vicasinabin by the frequency and severity of adverse events. The primary efficacy objective was to assess the effect of vicasinabin on the severity of DR, assessing the proportion of participants with at least 2-steps improvement in DRSS from baseline at week 36 in the study eye. ResultsResults are presented in the following order: placebo, vicasinabin 30mg, vicasinabin 200mg. 47, 48, and 44 participants were enrolled. Baseline characteristics were balanced. Adherence to treatment was approximately 90%, and pharmacokinetic analysis showed dose-dependent plasma exposure to vicasinabin. The primary efficacy endpoint was not met: the percentage of participants who improved their DRSS by at least two steps at week 36 from baseline were 7.9, 9.5, and 5.7, without statistically significant differences. The systemic and ocular safety profiles of vicasinabin were favorable, and adverse events distributed evenly across arms. Vicasinabin did not induce changes in glycemic control or any kidney function or cardiovascular parameters. Three patients in the placebo arm discontinued the study due to serious adverse events ConclusionsAt the doses tested, vicasinabin did not improve DRSS in participants with NPDR. The role of the cannabinoid system in diabetic retinopathy remains elusive

Direct Oral Anticoagulants Versus Aspirin for Stroke Prevention After Embolic Stroke of Undetermined Source: An Updated Meta-Analysis of Randomized Controlled Trials.

Background: Four randomized controlled trials (RCTs) did not show a benefit of direct oral anticoagulant (DOAC) treatment compared with antiplatelet therapy for the prevention of recurrent strokes in patients with embolic stroke of undetermined source (ESUS). However, the balance between efficacy and safety in subgroups needs to be better defined. We aimed to assess the relative benefits of DOACs in key subgroups of adult patients with ESUS. Methods: We searched major databases (PubMed, Embase, CENTRAL, and Web of Science) for RCTs published from inception to 16 June 2024. The primary outcome was recurrent stroke, and the main safety outcomes were major bleeding and clinically relevant non-major bleeding (CRNB). We assessed the risk of bias using the Cochrane Risk of Bias tool 2. Results: We identified four RCTs, involving a total of 13,970 patients with ESUS. Compared to antiplatelet therapy, treatment with DOAC did not reduce the risk of recurrent stroke (RR 0.95, 95% CI 0.83-1.08, p = 0.45) or ischemic stroke (RR 0.92, 95% CI 0.80-1.05, p = 0.22) or increase major bleeding (RR 1.57, 95% CI 0.87-2.83; p = 0.14). DOAC treatment was associated with a significantly higher risk of CRNMB compared to aspirin (RR 1.52, 95% CI: 1.22-1.90; p = 0.0002). The subgroup analysis demonstrated that use of DOACs was associated with a significant protective effect in patients aged 75 or older (RR 0.76, 95% CI 0.60-0.97, p = 0.03) and when the time from index stroke to randomization was ≥8 days (RR 0.80, 95% CI 0.66-0.97, p = 0.02) in preventing recurrency of any type of stroke. Conclusions: Our meta-analysis showed lack of overall benefit of anticoagulation with DOAC compared to antiplatelet therapy for recurrent stroke prevention in adult patients with ESUS. However, the subgroup analyses suggest the possibility of interactions between age and timing of randomization since stroke and treatment with an DOAC in terms of recurrent stroke prevention. Further research toward tailoring the antithrombotic strategy according to patient characteristics is needed.

Analysis of Children's Road Crashes in Hungary

In the EU, more than 6,000 children died in road accidents between 2011 and 2020. Children are particularly vulnerable road users, and they need to be protected. This underlines the importance of the Safe System approach. The Safe System approach is a holistic view of road safety, which integrates the different elements of the traffic system and takes human vulnerability and fallibility into account. Children are still in the phase of developing the cognitive and physical skills necessary to travel safely in traffic. Because of their small size, children are less visible than other road users and less experienced; they can easily become innocent victims in collisions. Despite significant improvements in vehicle safety in recent years, almost half of all child road deaths occur while traveling in cars. Limited data is available on the correct use of child seats in cars across the EU, but studies have shown that misuse remains a significant problem. Several measures have been taken in recent years to make it safer for children to travel on the roads, but many more interventions are needed to further improve their safety. Our research aimed to examine the characteristics of child accidents in Hungary and to highlight the main road safety problems affecting children in Hungary.

Attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals: a cross-sectional survey

ObjectivesTo assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.DesignAn institution-based, cross-sectional survey...

The role of alemtuzumab in the development of secondary autoimmunity in multiple Sclerosis: a systematic review

BackgroundSecondary autoimmune disease (SAID) in the context of alemtuzumab treatment is one of the main safety concerns that may arise following administration in people with multiple sclerosis (pwMS). Contributing factors underlying this adverse event are not well understood. The purpose of this systematic review was to appraise the literature investigating the role of alemtuzumab in the development of SAID in pwMS following treatment and identify potential biomarkers/ risk factors that may be predictive of onset of this manifestation.MethodsRelevant publications were retrieved from PubMed, Embase, and Web of Science using a three-pronged search strategy containing the following keywords: “multiple sclerosis”; “alemtuzumab”; and “autoimmunity”. Studies that fulfilled the specified eligibility criteria and investigated SAID development after alemtuzumab in pwMS were included in the final analysis.Results19 papers were included in the final review. Approximately, 47.92% of pwMS treated with alemtuzumab experienced SAID. A variety of biomarkers and risk factors were noted in the development of SAID, with a focus on immunological changes, including: increased homeostatic proliferation and T cell cycling, along with consistently elevated baseline serum IL-21 levels and thyroid autoantibodies. There was no significant association between known human leukocyte antigen (HLA) risk alleles, lymphocyte profile or dynamics and SAID development.ConclusionsWhile the mechanism underlying SAID following alemtuzumab is not fully understood, potential biomarkers and risk factors that may assist in elucidating mechanisms underlying this phenomenon have been documented in several independent studies. Following immunodepletion from alemtuzumab, an IL-21 driven increase in homeostatic proliferation and T cell cycling may disrupt tolerance mechanisms leading to an increase in the propensity toward alemtuzumab-induced autoimmunity. Further research is necessary to clarify the physiological changes after alemtuzumab therapy that trigger SAID in pwMS.

A European, Observational, 3-Year Cohort Comparative Study on the Safety of the Fixed Dose Combination Pravastatin 40 mg/Fenofibrate 160 mg vs. Statin Alone in Real Clinical Practice: The POSE Study.

The aim of the study was to provide valuable real-world long-term safety data of the fixed pravastatin 40 mg/fenofibrate 160 mg combination in comparison of monotherapy with statins of moderate intensity. POSE study was an observational, comparative study conducted in three European countries. Patients treated or planned to be treated with pravastatin 40 mg/fenofibrate 160 mg or with a moderate-intensity statin in monotherapy were assessed over 3 years. The main safety endpoints included the incidence of renal or urinary disorder, musculoskeletal or connective tissue disorder, hepatobiliary disorder and cardiovascular events. The study included 3075 patients treated for dyslipidaemia, with diabetes mellitus (47%), hypertension (56%) and/or established cardiovascular disease (61%). Over the 3 years of follow-up, the difference in incidence rate of safety events between the pravastatin 40 mg/fenofibrate 160 mg group and the statin group was not statistically significant (RR = 1.366 [95% CI = 0.967-1.929]). The most frequently occurring events were musculoskeletal and connective tissue disorders (AR = 0.030 in the pravastatin 40 mg/fenofibrate 160 mg group and 0.024 in the statin group), renal and urinary disorders (AR = 0.019 vs. 0.016, respectively) and aggravated diabetes mellitus (0.021 vs. 0.014). Most events occurred during the first year, then incidence decreased over the 3-year period. No statistically significant difference was observed between treatment groups regarding the cardiovascular events (RR = 1.209 [95% CI = 0.596-2.453]) and no new signal emerged from the long-term follow-up. This study demonstrates a reassuring long-term safety profile of the fixed pravastatin 40 mg/fenofibrate 160 mg combination in routine clinical practice, with low and similar incidence of events over the 3 years follow-up compared to a monotherapy with statins of moderate intensity.

Effectiveness and Safety of GLP-1 Receptor Agonists in Patients with Type 1 Diabetes.

Background: GLP-1 receptor agonists (GLP-1RA) are used in the management of type II diabetes mellitus or obesity, although its role in patients with type I diabetes mellitus (T1DM) has been debated. This study aimed to investigate the efficacy and safety of GLP-1RA in patients with T1DM using real-world data. Methods: This multicenter, retrospective study was conducted at three tertiary medical centers in Riyadh, Saudi Arabia. The study followed up patients (>16 years old) with T1DM treated with insulin followed by GLP-1RA add-on therapy. The efficacy outcomes included changes in HbA1c, body weight, and insulin requirements from baseline to each follow-up visit. The main safety outcomes assessed included hypoglycemic events and gastrointestinal (GI) adverse events. Results: The study included 144 patients with a mean age of 33.0 ± 10.1 years. Semaglutide was the most used GLP-1RA (63.9%) followed by liraglutide (34.0%). From baseline to 3-month follow-up, HbA1c (mean difference (MD) = -0.8%; p = 0.0053), weight (MD = -2.4 kg; p = 0.0253), and daily basal insulin dose (MD = -2.1 units; p = 0.0349) were significantly reduced. Likewise, HbA1c (MD = -0.5%; p = 0.0004), weight (MD = -3.6 kg; p < 0.0001), and daily basal insulin (MD = -2.4 units; p = 0.0282) were significantly reduced at the 4-6-month follow-up. The significant reductions in HbA1c, weight, and daily basal insulin levels were consistent for up to 18-month follow-up. Only one patient had a major hypoglycemic event, whereas 8.3% of the patients had GI adverse events. Conclusions: Overall, significant improvements in glycemic control, weight loss, and insulin requirements were observed with the use of GLP-1RA in patients with T1DM, with a limited number of GI adverse events.

Transoesophageal echocardiography-guided cardioversion and thromboembolism

Abstract Background To perform electrical cardioversion of atrial fibrillation or atrial flutter with a duration of more than 48 hours, it is recommended to initiate anticoagulation therapy for at least three weeks beforehand. In cases where cardioversion is necessary earlier, it is suggested to precede the procedure with a transoesophageal echocardiography to rule out the presence of a thrombus in the left atrium (referred to as TOE-guided cardioversion). This strategy is outlined in current ESC guidelines for atrial fibrillation. However due to limited evidence, no specific level of recommendation for its use is provided. Purpose This study aimed to characterize patients treated by TOE-guided cardioversion in two hospitals and to conduct a safety analysis of the procedure. The 30-day incidence of thromboembolic events was chosen as the main safety objective, the 30-day mortality as the secondary. Method This was a retrospective, two center, cohort register study where information was obtained from patients medical records. All patients who underwent TOE-guided cardioversion between 2012-2020 in the first institute, and between 2015-2020 in the second were included. From the medical records all the patient characteristics and the clinical outcomes were identified. Result A total of 259 patients, with TOE-guided cardioversions, arrhythmia duration over 48 hours and without adequate anticoagulation therapy were included. Patient characteristics are shown in table 1. It was equal incidence of a 30-day thromboembolic event (n=6) and the 30-day mortality (n=6), 2,3% respectively. Three of the six patients died of non-cardiovascular cause. One of the 30-day thromboembolic event resulted in mortality at day 31. Table 2 summarize the data related to the thromboembolic events. There was no statistically significant predictor of any of the two endpoints when comparing the patients with event and patients without. Conclusion This study shows that the risk of thromboembolic events after TOE-guided cardioversion is not negligible, 2,3% within a 30-day follow up. The 30-day mortality was 2,3%, half of which were non-cardiovascular. To analyse potential clinical predictors for any events, larger studies specifically powered for such a question is needed.

ELSMOR - towards European Licensing of Small Modular Reactors:Methodology recommendations for light-water small modular reactors safety assessment.

Decarbonization of energy production is key in today's societies and nuclear energy holds an essential place in this prospect. Besides heavy-duty electricity production, other industrial and communal needs could be served by integrating novel nuclear energy production systems, among which are low-power nuclear devices, like small modular reactors (SMRs). The ELSMOR (towards European Licensing of Small Modular Reactors) European project addresses this topic as an answer to the Horizon 2020 Euratom NFRP-2018-3 call. The consortium includes 15 partners from eight European countries, involving research institutes, major European nuclear companies and technical support organizations. The 3.5-year project, launched in September 2019, investigates selected safety features of light-water (LW) SMRs with focus on licensing aspects. Providing a comprehensive compliance framework that regulators can adopt and operate, the licensing process of such SMRs could be optimized, helping their deployment. In this prospect, as a result of ELSMOR's work, this article gives an overview of the specific issues that LW-SMRs may bring about in the different domains of nuclear safety, in terms of: •Methodological standpoints: safety goals, safety requirements, safety principles (defence-in-depth implementation);•Main safety functions of reactivity control, decay heat removal and confinement management;•Severe accident management;•Other safety issues particular to SMRs: use of shared systems; performing of multi-unit probabilistic safety assessment (PSA); spent fuel management, transport and disposal management. In this article, adequate methodologies are developed to deal with these issues and to help assess the safety of LW-SMRs. This work gives a precious synthesis of the safety assessment issues of LW-SMRs and of the associated methodologies developed in the context of the ELSMOR European project.

SLOPE: Safety LOg PEripherals implementation and software drivers for a safe RISC-V microcontroller unit

The focus of this manuscript is related to the main safety issues regarding a mixed criticality system running multiple concurrent tasks. Our concerns are related to the guarantee of Freedom of Interference between concurrent partitions, and to the respect of the Worst Case Execution Time for tasks. Moreover, we are interested in the evaluation of resources budgeting and the study of system behavior in case of occurring random hardware failures. In this paper we present a set of Safety LOg PEripherals (SLOPE): Performance Monitoring Unit (PMU), Execution Tracing Unit (ETU), Error Management Unit (EMU), Time Management Unit (TMU) and Data Log Unit (DLU); then, an implementation of SLOPE on a single core RISC-V architecture is proposed. Such peripherals are able to collect software and hardware information about execution, and eventually trigger recovery actions to mitigate a possible dangerous misbehavior. We show results of the hardware implementation and software testing of the units with a dedicated software library. For the PMU we standardized the software layer according to embedded Performance Application Programming Interface (ePAPI), and compared its functionality with a bare-metal use of the library. To test the ETU we compared the hardware simulation results with software ones, to understand if overflow may occur in internal hardware buffers during tracing. In conclusion, designed devices introduce new instruments for system investigation for RISC-V technologies and can generate an execution profile for safety related tasks.

Performances of the ITER Pressure Suppression System during unstable steam condensation regimes

Abstract The paper deals with the qualification of the main safety system of the nuclear fusion reactor ITER: the Vacuum Vessel Pressure Suppression System (VVPSS). This safety system manages the Loss of Coolant Accident (LOCA), that could occur in the Vacuum Vessel (VV), avoiding a significant increase of the internal pressure that could breach the primary confinement barrier. Steam condensation occurs at sub-atmospheric pressure. This condition is original respect the usual applications of steam direct condensation in nuclear fission reactors. An extensive experimental research program, funded by ITER Organization, on reduced scale experimental rigs (scale 1/22 and 1/10) have been carried out at the University of Pisa. Unstable condensation regimes occurred during some tests at about 500 g/s of steam mass flow rate (10 % of the maximum steam mass flow rate foreseen for the relevant accidental scenarios). In these conditions, high intensity vibrations of the whole experimental rig occurred. These events can be classified as ‘Chugging’ or Condensation Induced Water Hammer (CIWH). &amp;#xD;The performed tests have been analysed elaborating the images of the video-cameras located in the pool and comparing the steam jet shape with the acceleration values recorded by an accelerometer mounted on the sparger structure.&amp;#xD;These elaborations permitted to evaluate the dynamic of bubble collapse, the volume of the developed external bubbles, the collapse frequency as function of thermal-hydraulic parameters. &amp;#xD;Moreover, the paper emphasizes the beneficial effects of non-condensable gases on the unstable condensation regimes. In fact, the non-condensable gas inhibits the occurrences of Water Hammer inside the sparger and eliminates the thermal stratification inside the water pool increasing the turbulence.&amp;#xD;

Research on mine water source classifications based on BO-CatBoost.

Mine water surge is one of the main safety risks in coal mines. This research offers a novel mine water source identification model (BO-CatBoost) to successfully avoid and control mine sudden water catastrophes by properly identifying the sources of mine water. First, the classification model is trained and built using the Categorical Boosting (CatBoost) algorithm. The Gaussian process Bayesian optimization (BO) algorithm is used to optimize parameters, and the optimal parameter combination is integrated into the CatBoost algorithm to build the BO-CatBoost mine water source identification model, which further improves the accuracy of mine water source identification. The model was also applied to the Pingdingshan mine to verify the practicality of the model. Then, 29 groups of unknown water sources in Pingdingshan were selected as validation samples for the model and compared with the conventional CatBoost, Light Gradient Boosting Machine (LightGBM), and Extreme Gradient Boosting (Xgboost) models. The comparison results demonstrate that the accuracy of LightGBM, Xgboost, CatBoost, and BO-CatBoost models can reach 69%, 79.3%, 79.3%, and 100% respectively, and the RMSE is 0.947, 0.643, 0.719, and 0.0 respectively. The comprehensive analysis shows that, when it comes to mine water source detection, the BO-CatBoost model performs noticeably better than other models in terms of discriminative accuracy and generalization capacity. Lastly, the multi-output prediction and decision-making process of the BO-CatBoost water source identification model is visualized by the interpretability analysis performed with the SHAP approach. The research demonstrates that the BO-CatBoost model can more precisely and impartially identify mine water sources, offering fresh concepts for mine water source detection.

Safety and Immunogenicity of the Intranasal Vaccine Candidate Mambisa and the Intramuscular Vaccine Abdala Used as Booster Doses for COVID-19 Convalescents: A Randomized Phase 1-2 Clinical Trial.

A phase 1-2, prospective, multicenter, randomized, open-label clinical trial (Code RPCEC00000382), with parallel groups, involving 1161 participants, was designed to assess the safety and immunogenicity of two Cuban COVID-19 vaccines (Mambisa and Abdala) in boosting COVID-19 immunity of convalescent adults after receiving one dose of either vaccine. The main safety outcome was severe vaccination adverse events occurring in <5% of vaccinees. Main immunogenicity success endpoints were a ≥4-fold anti-RBD IgG seroconversion or a ≥20% increase in ACE2-RBD inhibitory antibodies in >55% of vaccinees in Phase 1 and >70% in Phase 2. Neutralizing antibody titers against SARS-CoV-2 variants were evaluated. Both vaccines were safe-no deaths or severe adverse events occurred. Mild intensity adverse events were the most frequent (>73%); headaches predominated for both vaccines. Phase 1 responders were 83.3% (p = 0.0018) for Abdala. Mambisa showed similar results. Phase 2 responders were 88.6% for Abdala (p < 0.0001) and 74.2% for Mambisa (p = 0.0412). In both phases, anti-RBD IgG titers, inhibition percentages and neutralizing antibody titers increased significantly after the booster dose. Both vaccines were safe and their immunogenicity surpassed the study endpoints.

Separate effect experimental test and theoretical investigate of pressure wave propagation and pressure rising process upon SGTR accident in advanced LFRs

Steam Generator Tube Rupture accident (SGTR) accident is one of the main safety events to the industrial application of Lead-cooled Fast Reactors (LFRs). This paper presents a separate effect test facility, called Lead-bismuth Eutectic Steam generator tube rupture Test facility (LEST), for testing high-pressure subcooled water jetting into a Lead Bismuth Eutectic (LBE) pool, and analyzes experimental data of maximum initial pressure peak, dynamic pressure attenuation together with the pressure rising process upon SGTR. The experimental analyses put forward a general equation form together with a dimensionless number of the initial pressure peak associated with a high-pressure Newtonian fluid injecting into another low-pressure Newtonian fluid, and the derivation of the general equation form is specifically applied to match a further semi-empirical equation for an initial maximum pressure peak with 5–10 MPa water injection in SGTR. The attenuation curve of dynamic pressure wave in each experiment is matched, and more weakening conditions can change the pressure peak from concentrated and non-period peak group to approximate period 1.4–3.7 s pulse group. The size relationship between pipe length L and nozzle diameter D, which L/D=12, is set to divide SGTR into small wall rupture and tube shear fracture, further three stages of pressure rising are distinguished in the tube shear fracture. This work provides experimental data to help determining the severity of SGTR and assessing the consequences of this event as part of the safety case for the industrial application of LFRs.

Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil

ObjectiveTo investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil. DesignThis is a retrospective cohort study. SettingA Brazilian educational and research-intensive care unit (ICU). ParticipantsA total of 1047 patients were hospitalized from May 2016 to April 2018. InterventionsImplementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP). Main Outcome MeasuresClinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP. ResultsThere was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40). ConclusionsEarly mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.