Safe Performance Research Articles

Tri-monomer polyamide acid nanofiber separator for safe and high performance lithium-ion batteries

The separators play a crucial role in ensuring the safety of lithium batteries and greatly affect the electrochemical performance of the battery. However, the weak thermal stability and non-polar surface of commercial polyolefin separators severely restrict the development of the high-performance lithium batteries. In this work, we initially proposed polyamide acid (PAA) nanofiber separator with three monomers through a two-step synthesis method, which was prepared by electrospinning. By controlling different processing temperatures, PAA separators containing different amount of carboxyl groups were obtained. PAA separator had better wettability and thermal stability than PE separator. Meanwhile, the electrospinning method brings ultra-high porosity (95.3 %) to the membrane, resulting a much higher electrolyte absorption and retention rate of PAA (initially 3214 %, 240 % at 50 min) compared to PE separator. In particular, carboxyl groups serve as functional groups to provide an electronegative atmosphere, promoting the transport of lithium ion between the anode and cathode, and playing an important role in improving ionic conductivity. Consequently, batteries with PAA-SOH-50 separator showed the best rate charging/discharging performance, maintaining 87.7 % and 73.6 % of its initial capacity at 2.0 C. Moreover, cells with PAA separator exhibited much higher initial discharge capacity (164.3 mAh g−1) than that with PE separator (126.8 mAh g−1). After 100 cycles at 0.5 C, the PAA nanofiber separator achieved an ultralow attenuation rate of only 0.04 % per cycle, which was less than half of the commercial PE separator (0.10 % per cycle). This work provides a new vision for the development of separator materials, revealing the great influence of functional groups, such as carboxyl groups, on the performance of separators, which provides a strong basis for the further research of high-performance separators.

Bi-lingual content validation of the Non-Technical Skills for Operating Room Nurses (NOTSORN) tool: A Delphi study

BackgroundThe primary responsibility of the operating room nurse is to prevent adverse events and patient harm during surgery. Since most preventable adverse events are the result of breakdowns in communication and teamwork, or non-technical skills, training such skills should strengthen the operating room nurses’ error prevention abilities. Behavioural marker systems operationalise non-technical skills; however, previous systems for operating room nurses do not cover the full extent of non-technical skills used by operating room nurses. Thus, the Non-technical Skills for Operating Room Nurses (NOTSORN) behavioural marker system was developed. ObjectiveThe objective of this study was to establish face and content validity of the Non-Technical Skills for Operating Room Nurses behavioural marker system. This multi-item scale measures individual non-technical skills in operating room nursing. ParticipantsA purposive sample of operating room nursing researchers, educators, and senior clinicians from nine countries worldwide. MethodsA two round, Delphi panel with international experts in operating room nursing. The survey was administered online. Content validity index (CVI) was used to measure agreement among panel members. Results25 operating room nurse experts participated in the online Delphi study. After round 1, 56 items were accepted, 26 items were revised, and 1 item was dropped. Following round 2, all items (6 with minor revisions) were accepted. Thus, the Non-technical Skills for Operating Room Nurses tool comprise 81 items. The scale level CVI score for the final 81 item tool was 0.99. The individual item level CVI scores ranged from 0.9 to 1.0. ConclusionsThe Non-Technical Skills of Operating Room Nurses behavioural marker system is a nuanced tool with a myriad of non-technical skills operating room nurses need to undertake their work safely. The tool's intended use includes student/trainee supervision, supervision of novice operating room nurses, self-reflection for performance reports, and in operating room nursing education. Over time, use of the tool has the potential to contribute to patient safety in the operating room. Tweetable abstractThe NOTSORN tool provides a comprehensive and holistic evaluation of OR nurses' non-technical skills for safe surgical performance

Experience with flexible bronchoscopy for noncoronavirus disease of 2019indications in pediatric patients during the coronavirus disease of 2019pandemic.

Flexible bronchoscopy (FB) poses a risk ofsevere acute respiratory syndrome coronavirus 2(SARS-CoV-2) transmission due to aerosol generation. This study aimed to assess the utilization, indications, outcomes, and safety of FB in pediatric patients for noncoronavirus disease of 2019 (COVID-19) reasons during the pandemic. We retrospectively analyzed pediatric patients who underwent FB for non-COVID-19 indications at a tertiary children's hospital's pulmonary clinic during the COVID-19 pandemic. Patients showed no COVID-19 symptoms and tested negative for SARS-CoV-2 by real-time polymerase chain reaction (PCR) of nasopharyngeal and throat swabs within 24 h before the procedure. FBs were conducted in the operating room, with healthcare professionals (HCPs)wearing personal protective equipment, including medical N95 masks, gloves, gowns, and eye protection. Between March 2020 and April 2022, 167 pediatric patients underwent FB for non-COVID-19 indications. Common indications included foreign body aspiration (22.7%), stridor (10.1%), and atelectasis (8.9%). No COVID-19 symptoms were observed in patients on the 1st and 10th days post-FB. During the 1-month follow-up, 52 patients underwent SARSCoV-2 PCR testing, and one patient tested positive in the third week after the procedure. None of the HCPs in the FB team experienced COVID-19 symptoms or tested positive for SARS-CoV-2. A bronchoscopy protocol with safety precautions minimized the risk of COVID-19 transmission, allowing safe FB performance for non-COVID-19 indications in pediatric patients during the pandemic. The experience gained in FB during COVID-19 is valuable for similar situations in the future.

Influence of proficiency in conventional laparoscopic surgery in colorectal cancer on the introduction of robotic surgery.

Although there have been many reports on learning curves for robotic surgery, it is unclear how surgeons' conventional laparoscopic surgical skills influence their ability in performing robotic surgery for colorectal cancer (CRC). The aim of this study was to determine the surgical outcomes of robotic surgery for CRC during the induction phase by skilled laparoscopic surgeons. Surgical outcomes of consecutive CRC cases between January 2021 and March 2023 following the skilled phase of laparoscopic surgery and introductory phase of robotic surgery performed by three skilled laparoscopic surgeons were compared. Overall, 77 consecutive patients diagnosed with sigmoid colon or rectosigmoid cancer were analysed, including 50 in the laparoscopy group (LAP) and 27 in the robotic group (Ro). Patient characteristics, including age, sex, body mass index, and tumour progression, did not differ between the groups. The median operation time was 204min in the robotic group and 170min in the laparoscopic group (p < 0.001). Blood loss was significantly lower in the robotic group (p = 0.0059). The incidence of grade 2 or higher complications did not differ between the two groups (LAP, 10.0% vs. Ro, 7.4%, p = 1). In the robotic group, the time required for lymph node dissection had a greater impact on operative duration. Skills acquired from performing conventional laparoscopic surgery may contribute to the safe and reliable performance of robotic surgery for CRC. UMIN000050923.

The current state and future perspectives of radiotherapy for cervical cancer.

Radiotherapy is an effective treatment method for cervical cancer and is typically administered as external beam radiotherapy followed by intracavitary brachytherapy. In Japan, center shielding is used in external beam radiotherapy to shorten treatment time and reduce the doses delivered to the rectum or bladder. However, it has several challenges, such as uncertainties in calculating the cumulative dose. Recently, external beam radiotherapy has been increasingly performed with intensity-modulated radiotherapy, which reduces doses to the rectum or bladder without center shielding. In highly conformal radiotherapy, uncertainties in treatment delivery, such as inter-fractional anatomical structure movements, affect treatment outcomes; therefore, image-guided radiotherapy is essential for appropriate and safe performance. Regarding intracavitary brachytherapy, the use of magnetic resonance imaging-based image-guided adaptive brachytherapy is becoming increasingly widespread because it allows dose escalation to the tumor and accurately evaluates the dose delivered to the surrounding normal organs. According to current evidence, a minimal dose of D90% of the high-risk clinical target volume is significantly relevant to local control. Further improvements in target coverage have been achieved with combined interstitial and intracavity brachytherapy for massive tumors with extensive parametrical involvement. Introducing artificial intelligence will enable faster and more accurate generation of brachytherapy plans. Charged-particle therapies have biological and dosimetric advantages, and current evidence has proven their effectiveness and safety in cervical cancer treatment. Recently, radiotherapy-related technologies have advanced dramatically. This review provides an overview of technological innovations and future perspectives in radiotherapy for cervical cancer.

Accident tolerant fuel design optimization for SMART reactor

Fully Ceramic Microencapsulated (FCM) fuel is one of the most advancedfuel types for the next nuclear reactor generations. The use of uranium carbide fuel in FCM offers multiple benefits such as high fuel density, improved thermal conductivity and enhanced mechanical stability. Both UC and conventional fuel (UO2) have the same melting point. As a result, under reactor operating conditions, UC has better safety margins. In addition, FeCrAl is a promising cladding material. However, because of its greater thermal neutron absorption cross section, FeCrAl has a neutronic penalty when compared to Zircaloy leading to an annual reload requirement with high fuel enrichment. Owing to their low power density and excellent design, small modular reactors (SMRs) have exceptional inherent safety. In this work, we determined the optimum design of an accident tolerant fuel (ATF), with respect to neutronics, in SMART reactor using dense UC FCM (in contrast to the conventional UO2 fuel) and a combination of zircalloy and FeCrAl (FCM -Zircaloy, FCM -FeCrAl, FCM -combining of zircaloy and FeCrAl) as cladding to achieve better thermal conductivity as well as safer performance, while considering the required fuel enrichment for the proposed designs. The effective multiplication factor and burnup were calculated for neutronic assessment of the SMART core, the outcomes are showcased alongside a comprehensive assessment of the characteristics and prospective. The neutronic parameters were estimated using the stochastic MCNPX 2.6 code. We found that Fully Ceramic Microencapsulated -Uranium Carbide (FCM-UC) fuel type was more attractive than conventional UO2. The optimum cladding design as compared to the reference case and the other cases of (FCM-UC), was determined. When 50% FeCrAl cladding was employed, case 15 in our study emerged as the superior design, demonstrating maximum production of 239Pu due to higher initial concentrations of 235U and quantities of 238U. This work may offer recommendations for future optimized designs of the SMART reactor parameters.

Attention Pyramid Convolutional Neural Network Optimized with Big Data for Teaching Aerobics

Aerobics has emerged as a widely embraced cardiovascular exercise, fostering improved fitness through rhythmic movements that enhance heart rate, stamina, endurance, and cardiovascular health. Effective instruction by skilled professionals is crucial for maximizing the benefits of aerobics, ensuring participants' correct and safe performance. This study introduces the concept of Aerobics Movement Teaching, emphasizing its pivotal role in college physical education. The proposed method, Attention Pyramid Convolutional Neural Network optimized with big data for teaching Aerobics (AP-CNN-BTA), focuses on enhancing aesthetic ability and overall human development. Data from the Simple Ocean Data Assimilation Data Set are collected, preprocessed, and utilized in the teaching process using the Attention Pyramid Convolutional Neural Network, specifically designed for efficient aerobics instruction in coastal areas. The resulting data are stored in the cloud and accessed through a human interface unit. The implementation, carried out in Python, undergoes evaluation using various metrics, including accuracy, computational time, sensitivity, specificity, precision, and ROC analysis. The simulation results demonstrate a remarkable improvement, with the proposed technique achieving 36.52%, 39.55%, and 43.75% higher accuracy compared to existing methods such as Exploration on and thinking about aesthetic infiltration in aerobics teaching in colleges and universities(ETAI-AT-CU), sea level height depending on big data of the Internet of Things along aerobics teaching in coastal regions(SLH-BD-IOT-ATC), and impact of deep learning-based curriculum's ideological and political integration on sports aerobics instruction design(IP-CDL-TDTA), respectively. This research contributes to advancing the efficacy of aerobics instruction, particularly in coastal regions, and underscores the significance of comprehensive student development through high-quality education.

Mitigating Geohazards: CFD-Driven Analysis of Viscoplastic Debris Flow Impact on Resilient Oil and Gas Pipeline Design in Alpine Terrains

Debris flow is one of the catastrophic geohazard, poses significant threat to all system of infrastructure including buildings, bridges, pipelines and retaining walls. For the sustainable design of oil and gas pipeline prone to debris flow hazard, It is crucial to consider the expected debris flow impact forces to ensure the safe and effective performance of pipeline. This study numerically investigates the dynamic impact of viscous debris flow on exposed pipeline. Altair Hyperwork CFD software was utilized to perform numerical investigation in CFD environment, simulating two-phase debris flow. Hershel Bulkley rheology and Spalart-Allmaras turbulence model was adopted to simulate the complex interaction of debris flow on pipeline. The results revealed that debris flow dynamics are highly dependent on sediment composition, fine content, and flow volume. These factors significantly influence the flow behavior and its potential impact on pipeline infrastructure. Furthermore, this study highlights the critical role of impact forces due to debris flow in pipeline design to enhance the safe and longevity of pipeline system in alpine terrain. The findings underscore the need for comprehensive approach of pipeline design that integrate the advanced numerical techniques with thorough understanding of local geological conditions.

Selective Use of Positive-Pressure Ventilation for Preoxygenation During Air Medical Rapid Sequence Intubation

BackgroundPreoxygenation is critical to safe performance of rapid sequence intubation (RSI). The use of positive-pressure ventilation (PPV) has been advocated during preoxygenation but may increase the risk of aspiration. ObjectiveTo explore the risk-benefit analysis of using PPV during air medical RSI. MethodsWe performed a retrospective analysis of the Air Methods Airway Registry using patient data from over 175 bases across the U.S. over a 5-year period. Patients were separated into normoxemic (SpO2 ≥93%) and hypoxemic (SpO2 <93%) and compared in regard to demographics, clinical data, and use of PPV. Primary outcomes were first-attempt intubation success (FAS) and FAS without desaturation (FASWD). Chi-square, t-test, and logistical regression were used to analyze the data. ResultsThere were 9778 patients who underwent intubations during the study period. FAS was 92% (8966 patients). FASWD was 90% (8775 patients). Mean SpO2 was 94.9%. There were 42% (4118 patients) of patients who received PPV prior to intubation and 1% (94) aspirated during RSI. Multivariate logistical regression showed an association between use of PPV and reduced intubation success for normoxemic patients but improved intubation success for hypoxemic patients. The use of PPV was associated with higher risk of aspiration events (p = 0.007). ConclusionThe use of PPV during preoxygenation prior to RSI appears beneficial for hypoxemic but not normoxemic patients due to lower intubation success and increased aspiration risk with PPV. This data supports selective use of PPV prior to the initial intubation attempt in patients undergoing RSI.

Experimental and numerical investigations of the impact resistance of socket and pocket connections for precast bridge columns

This study investigates the dynamic performance of precast bridge columns under pendulum impact testing, including socket connection, pocket connection, and cast-in-place (CIP) columns. The study focuses on comparing the impact behavior of CIP and precast columns regarding failure modes, impact force-time, and deflection-time histories. Furthermore, the mechanism by which the socket or pocket connection configurations affect the impact resistance of the precast columns is discussed. The results indicate that the development of cracks in the precast and CIP columns is consistent under the same impact conditions. Notably, the shear resistance mechanisms and failure modes vary significantly at the bottom of the two columns. For the precast specimens, substantial local damage occurs at the connections with consecutive impacts. Specifically, punching shear failure is observed at the pocket connections, whereas the connection sections of the socket columns may pull out from the grooves. Local damage to the column-footing connections reduces the global stiffness of precast columns, leading to higher deformation, greater residual displacements, and lower impact forces than those of CIP columns. A simplified finite element modelling method is proposed to simulate the characteristics of precast column connections, and its accuracy is verified using the test results. The numerical findings show that increasing the friction coefficient at the connection interface promotes the formation of diagonal compression struts within the connection, effectively resisting impact loads and preventing excessive shear stress produced by sliding at the interface. Furthermore, amplifying the minimum embedment depth of the socket-connected precast column to 1.0 D is recommended to ensure safe performance under impact loading.

Searching for a Cheap Robust Steering Controller

The study of lateral steering control for Automated Driving Systems identifies new control solutions more often than new control problems. This is likely due to the maturity of the field. To prevent repeating efforts toward solving already-solved problems, what is needed is a cohesive way of evaluating all developed controllers under a wide variety of environmental conditions. This work serves as a step in this direction. Four controllers are tested on five maneuvers representing highways and collision avoidance trajectories. Each controller and maneuver combination is repeated on five sets of environmental conditions or Operational Design Domains (ODDs). The design of these ODDs ensures the translation of these experimental results to real-world applications. The commercial software, CarSim 2020, is extended with Simulink models of the environment, sensor dynamics, and state estimation performances to perform highly repeatable and realistic evaluations of each controller. The results of this work demonstrate that most of the combinations of maneuvers and ODDs have existing cheap controllers that achieve satisfactorily safe performance. Therefore, this field’s research efforts should be directed toward finding new control problems in lateral path tracking rather than proposing new controllers for ODDs that are already solved.

Effects of postural control by personal mobility on human joint movements-prototype of a new alert system for personal mobility devices

Purpose: This study aimed to develop a prototype Personal Mobility (PM) system with human-robot synchronous motion measurement and sensory feedback as an attention reminder to ensure the safe performance of sustained, step-by-step rehabilitation tailored to the daily living conditions of elderly individuals. Methods: Five healthy adults were fitted with a simulation tool to experience the elderly, and inertial measurement unit sensors were placed on the subjects and the PM device to measure joint movements during two postural movements (sitting to supine and supine to standing). In addition, vibration stimulation and voice guidance were implemented as alerts at a certain set threshold of the joint motion angle. We analyzed the deviation of each joint motion between the subject and the PM device regarding the angle measurements of the trunk, hip, knee, and ankle joints. Results: Trunk angle misalignment was high in the sitting-to-supine position. Hip angle misalignment was greater in the supine to standing position. As an alert system, vibration and voice guidance could be presented to the subject with a 0.3-second delay after the set threshold was reached. Conclusion: The misalignment between a human and a motorized wheelchair in contact with the human is more than several tens of degrees when expressed as the angle change value of the joint motion. We believe that a system that can constantly sense and alert the user regarding whether the user and the PM device are in sync is necessary for PM devices being used in rehabilitation or as daily life support.

Characterization of curing status of commercial tire compounds with vein graphite powder and its particle sizes—Experimental and computational study

AbstractThe use of solid tires in demanding industrial applications, subjected to substantial mechanical loads, poses significant challenges due to heat generation from hysteresis and tread friction. Managing this heat is crucial to mitigate the risk of tire blowouts and layer separation. This research investigates the impact of introducing vein graphite powder, varying in particle size, into a commercially used solid tire compound, both experimentally and computationally. The research findings presented in this paper reveal substantial changes in thermal conductivity, specific heat capacity, rate constant, induction time, and the order of reaction in solid tires. Contemporary industry trends involve predictive methods for monitoring the curing process in tire manufacturing. A tire curing simulation model based on finite (FE) element analysis is developed. FE modeling is favored due to its accuracy and adaptability, especially when dealing with the intricate geometry and multi‐layered, multi‐compound structure of tires. The complex interplay between heat transfer and curing processes is effectively addressed using user subroutines (UMATHT) in commercial FE software like ABAQUS. In this analysis, thermal conductivity, heat capacity, order of reaction, rate constant, and induction time of the commercial tire compound are considered as temperature‐dependent variables. The computational model not only demonstrates its potential to significantly enhance the efficiency and quality of tire manufacturing processes but also contributes to a deeper understanding of the curing behavior of graphite powder‐based solid tire compounds. Consequently, it provides a valuable tool for optimizing tire manufacturing procedures and ensuring the safe and reliable performance of solid tires under demanding operational conditions. This research bridges the gap between the traditional commercial tire compound and the use of vein graphite powder in tire manufacturing and advanced computational methods, facilitating improvements in tire quality and safety.

Rapid Approximation of Low-Thrust Spacecraft Reachable Sets within Complex Two-Body and Cislunar Dynamics

The reachable set of controlled dynamical systems is the set of all reachable states from an initial condition over a certain time horizon, subject to operational constraints and exogenous disturbances. In astrodynamics, rapid approximation of reachable sets is invaluable for trajectory planning, collision avoidance, and ensuring safe and optimal performance in complex dynamics. Leveraging the connection between minimum-time trajectories and the boundary of reachable sets, we propose a sampling-based method for rapid and efficient approximation of reachable sets for finite- and low-thrust spacecraft. The proposed method combines a minimum-time multi-stage indirect formulation with the celebrated primer vector theory. Reachable sets are generated under two-body and circular restricted three-body (CR3B) dynamics. For the two-body dynamics, reachable sets are generated for (1) the heliocentric phase of a benchmark Earth-to-Mars problem, (2) two scenarios with uncertainties in the initial position and velocity of the spacecraft at the time of departure from Earth, and (3) a scenario with a bounded single impulse at the time of departure from Earth. For the CR3B dynamics, several cislunar applications are considered, including L1 Halo orbit, L2 Halo orbit, and Lunar Gateway 9:2 NRHO. The results indicate that low-thrust spacecraft reachable sets coincide with invariant manifolds existing in multi-body dynamical environments. The proposed method serves as a valuable tool for qualitatively analyzing the evolution of reachable sets under complex dynamics, which would otherwise be either incoherent with existing grid-based reachability approaches or computationally intractable with a complete Hamilton–Jacobi–Bellman method.

Comprehensive analysis of contaminants in Brazilian infant formulas: Application of QuEChERS coupled with UHPLC-QqQ-MS/MS and suspect screening-unknown analysis by UHPLC-Q-Orbitrap-MS

Infant formulas (IF) can contain harmful chemical substances, such as pesticides and mycotoxins, resulting from the contamination of raw materials and inputs used in the production chain, which can cause adverse effects to infants. Therefore, the quick, easy, cheap, effective, rugged, and safe (QuEChERS) methodology prior ultra-high performance liquid chromatography coupled to triple quadrupole mass spectrometry (UHPL-QqQ-MS/MS) analysis was applied for the determination of 23 contaminants, in 30 samples of Brazilian IF. The method was validated in terms of limit of detection (0.2 to 0.4 μg/kg), limits of quantification (1 and 10 μg/kg), and recovery (64 % to 122 %); precision values, in terms of relative standard deviation (RSD), were ≤ 20 %. Fenitrothion, chlorpyrifos, and bifenthrin were the pesticides detected in the samples, but the values did not exceed the limit set by the European Union (EU), and ANVISA, and they were detected under their limits of quantification. Additionally, suspect screening and unknown analysis were conducted to tentatively identify 32 substances, including some compounds not covered in this study, such as pesticides, hormones, and veterinary drugs. Carbofuran was identified, confirmed and quantified in 10 % of the samples.

Minimally Invasive Vitreoretinal Surgery (25G, 27G) with High-speed Vitrectomy Cutter – Case Series

Introduction:The development of vitreoretinal surgery is inseparably linked to the gradual miniaturization and decreasing invasiveness of the procedure. The smallest available systems are 23G, 25G, and 27G, which are referred to as minimally invasive vitreoretinal surgery techniques. This paper presents the preoperative and postoperative results of three patients undergoing posterior vitrectomy using the 25G or 27G systems with the HIPERVIT probe (Alcon, USA). The effects were retrospectively analyzed in terms of changes in best corrected visual acuity, intraocular pressure, occurrence of complications, and changes in optical coherence tomography images of macular edema. Examinations were performed before and one day, two weeks, three months, and six months after vitrectomy. The potential benefits and drawbacks of using these systems in practice were analyzed.Case report:The analysis concerns the results of the performed posterior vitrectomy procedure in patients with full-thickness macular hole, tractional retinal detachment due to diabetic retinopathy, and vitreomacular traction syndrome.Conclusions:The performed procedures allowed for improvement in both anatomical and functional conditions of the macula. All analyzed patients showed an improvement in visual acuity. None of the analyzed patients required the use of scleral sutures. Serious complications were not observed during the surgery or during the 6-month observation period. 25G and 27G HYPERVIT vitrectomy can be successfully used in the discussed vitreoretinal diseases. In the discussed cases, it enabled the effective and safe performance of the procedure.

CIRSE Standards of Practice on Carotid Artery Stenting

BackgroundCarotid artery stenting has been used effectively to treat internal carotid artery stenosis since 1989 (Mathias et al. in World J Surg. 25(3):328-34, 2001), with refined and expanded techniques and tools presently delivering outstanding results in percutaneous endoluminal treatment of carotid artery stenosis.PurposeThis CIRSE Standards of Practice document is directed at interventional radiologists and details the guidelines for carotid artery stenting, as well as the different implementation techniques. In addition to updating all previously published material on the different clinical indications, it will provide all technical details reflective of European practice for carotid artery stenting. CIRSE Standards of Practice documents do not aim to implement a standard of clinical patient care, but rather to provide a realistic strategy and best practices for the execution of this procedure.MethodsThe writing group, which was established by the CIRSE Standards of Practice Committee, consisted of five clinicians with internationally recognised expertise in carotid artery stenting procedures. The writing group reviewed existing literature on carotid artery stenting procedures, performing a pragmatic evidence search using PubMed to select relevant publications in the English language from 2006 to 2022.ResultsCarotid artery stenting has an established role in the management of internal carotid artery stenosis; this Standards of Practice document provides up-to-date recommendations for its safe performance.

Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty.

One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature. A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted. In our cohort, six patients were identified with a preoperative FM diameter < 6mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies. Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.

International Alliance of Urolithiasis (IAU) guideline on retrograde intrarenal surgery (Russian adaptation)

Introduction. The emergence of new scientific and clinical evidence on the use of retrograde intrarenal surgery (RIRS) for the management of kidney stones has prompted periodic systematisation, analysis, and evaluation of outcomes to standardise its application and determine future directions for research and development.Objective. To present the Russian adaptation of a guideline on retrograde intrarenal surgery from the International Urolithiasis Alliance guideline series to provide a theoretical basis for urologists performing RIRS.Materials &amp; Methods. A systematic review was conducted on the RIRS-associated publications available in the PubMed database to prepare a set of recommendations during the period from 1 January 1964 until 1 October 2021. The recommendations were evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system, which classifies, evaluates, develops, and examines recommendations. The modified Oxford Centre for Evidence-Based Medicine's (OCEBM) system for categorising the level of evidence and relevant comments have been applied to assess the strength of the conclusions.Results. The research team conducted a comprehensive analysis of 36 published clinical guidelines on the following topics: 1. Indications and Contraindications 2. Preoperative Imaging 3. Preoperative Ureteral Stenting 4. Preoperative Medications 5. Perioperative Use of Antibiotics 6. Use of Antithrombotic Therapy 7. Anesthesia Issues 8. Intraoperative Positioning 9. Equipment 10. Complications.Conclusion. A series of recommendations for RIRS, offered here should help provide safe and effective performance of RIRS.

An innovative sanitary fixture for performing ablution in public facilities

PurposeThis study aims to introduce the design and the design process for an innovative sanitary fixture to be used in public facilities for the purpose of ablution. This purpose-made fixture is needed to support the hygienic, safe and comfortable performance of this essential function in public facilities in many parts of the world. The study also clarifies the need for this function and critically reviews current designs to address it.Design/methodology/approachThe study started by critically reviewing the standard built-in models for ablution. It also identified and analyzed new approaches to designing standalone ablution fixtures. The study then specified the characteristics of a better ablution fixture and involved drafting a design based on these characteristics, making a wooden prototype to test the design and receiving users’ feedback. The design was adjusted and tested again for more feedback. Finally, the study resulted in the development of a final design. It used digital fabrication to create the design prototype with improved aesthetics, tested it again and received user feedback.FindingsA survey of users showed that they found the innovative fixture more comfortable and safer than the commonly used built-in models. The main concern was the potential for water to splash on clothes from the high faucet.Originality/valueIn addition to showing an innovative design for a purpose-made sanitary fixture for ablution, the study makes the reader aware of the various challenges of providing a hygienic, safe and comfortable facility for users to perform this function. This is very useful for the many designers and facility managers who deal with the issue.