Safe Transfer Research Articles

72 Criteria for Discharge of Preterm Infants in Canadian Neonatal Intensive Care Units

Abstract Background Discharging to home is a milestone that impacts preterm infants, their parents, and the neonatal intensive care units (NICU). Standardized discharge programs that are individualized for family needs can ensure a safe transfer of care to parents, decrease the length of hospital stay and costs, and improve parental satisfaction. Objectives To assess the degree of variability in discharge criteria for preterm infants <34 weeks’ gestation across Canadian NICUs, explore different institution-specific guidelines, and evaluate the degree of adherence to Canadian Paediatric Society (CPS) guidelines. Design/Methods A clinical representative for each of 117 level 2, 3 and 4 Canadian NICUs was contacted via email to participate in an anonymous survey link (OPINIO) regarding their discharge criteria for preterm infants. French and English versions of the survey were available. Results Ninety-eight respondents (83.7%), representing all Canadian provinces and the NWT, completed the survey (Figure 1). The majority of the responders were nurse practitioners (42.8%) and neonatologists (30.7%) with >5 years of experience (87%). 63% of responses came from level 3 and 4 NICUs. Most respondents (80.6%) lacked written guidelines in their units for discharging preterm infants. 60.2% did not have a dedicated discharge coordinator, and 45% did not have a post-discharge clinic. Table 1 summarizes the different discharge practices. Conclusion There is a significant heterogeneity in discharge practices for preterm infants in Canadian NICUs, despite the presence of CPS guidelines. This survey provides a basis for benchmarking and knowledge-sharing, but more research is needed to guide best evidence-based practice. Potential competing interests Dr. El-Naggar served as a consultant for Aerogen Pharma Limited and is a site investigator of its funded study: A Partially-Blind, Randomized, Controlled, Parallel-Group, Dose-Ranging Study to Determine the Efficacy, Safety and Tolerability of AeroFactTM (SF-RI 1 surfactant for inhalation combined with a dedicated drug delivery system) in Preterm Infants at Risk for Worsening Respiratory Distress Syndrome.

Transforming the transfer process: A quality improvement project to assess and improve transfer notes.

Transfer notes (TNs) standardize handoffs from one inpatient unit to another to optimize patient safety. They are especially important when patients are downgraded from high acuity settings such as intensive care units (ICU). Despite this, there is a paucity of evidence around safe transfers. The study objective was to assess the impact of a quality improvement initiative on the completion rate and quality of TNs. A retrospective chart review of TNs was conducted at a single academic center in Baltimore, MD. We analyzed 76 MICU to floor transfers pre-intervention and 73 transfers during the intervention period. Note quality was determined using a novel TN assessment tool; validity evidence was established. Chi-square analysis was used to compare the presence and quality of TNs. There was a statistically significant increase in note completion rate from 19.7% to 42.5 % during the study (p<0.003). There was a statistically significant increase in mean quality of completed TNs (10.3 pre-intervention vs. 12.3 intervention period: maximum score 15, p = 0.005). This QI intervention appears to have translated into more consistent and higher quality TNs. These improvements should facilitate better and safer care of patients moving from MICU to medical floors.

Tyrosine-Mutant AAV8 Vector Mediated Efficient and Safe Gene Transfer of Pigment Epithelium-Derived Factor to Mouse Lungs.

Recombinant adeno-associated viruses (rAAV) are an important tool for lung targeted gene therapy. Substitution of tyrosine with phenylalanine residues (Y-F) in the capsid have been shown to protect the AAV vector from ubiquitin/proteasome degradation, increasing transduction efficiency. We tested the mutant Y733F-AAV8 vector for mucus diffusion, as well as the safety and efficacy of pigment epithelium-derived factor (PEDF) gene transfer to the lung. For this purpose, Y733F-AAV8-PEDF (1010 viral genome) was administered intratracheally to C57BL/6 mice. Lung mechanics, morphometry, and inflammation were evaluated 7, 14, 21, and 28 days after injection. The tyrosine-mutant AAV8 vector was efficient at penetrating mucus in ex vivo assays and at transferring the gene to lung cells after in vivo instillation. Increased levels of transgene mRNA were observed 28 days after vector administration. Overexpression of PEDF did not affect in vivo lung parameters. These findings provide a basis for further development of Y733F-AAV8-based gene therapies for safe and effective delivery of PEDF, which has anti-angiogenic, anti-inflammatory and anti-fibrotic activities and might be a promising therapy for lung inflammatory disorders.

Experimental study of innovative bolted shear connectors in demountable cold-formed steel–concrete composite beams

Although cold-formed steel (CFS) members have been widely used in structures, their application is limited due to the buckling and instability of these members. To enhance their strength and stiffness, they are often combined with other materials like concrete or timber. One of the main challenges in composite structures is ensuring proper connection between different components to facilitate safe shear load transfer. This is achieved through various types of shear connectors. Bolted shear connections are preferred over headed shear studs because they offer greater strength and can be easily dismantled. Headed shear studs welded onto a steel section are unsuitable for CFS members due to their low thickness.In this paper, we propose a novel demountable composite connection specifically designed for prefabricated CFS structures. The behavior of this connection was evaluated through fifteen push-out test specimens, with key variables including CFS section thickness and bolt diameter/strength. The ultimate load, stiffness, ductility, and failure modes of all specimens were determined. The results revealed that specimens with a higher thickness of CFS members experienced bolt fracture, exhibiting superior effective stiffness, strength, and ductility. Conversely, specimens with a lower thickness of CFS members failed due to distortional buckling of the CFS members. The test results underscore the importance of carefully designing and providing a proportionate CFS section thickness to ensure shear connectors fracture before the CFS members. This significantly improves the shear strength capacity of the composite connection with CFS sections and precast concrete slabs. Furthermore, the deconstructability of the connection at the end of its service life was investigated. The steel–concrete composite connection with precast concrete slabs and demountable bolted shear connections was also modeled using a 3D finite element method. The numerical model’s accuracy in simulating the observed structural behavior was confirmed against experimental data. Finally, appropriate and straightforward formulations for predicting the ultimate load of the CFS-concrete composite connection were proposed. It was concluded that the predictions of ultimate shear load capacity values by EC4, AISC, and AISI provisions for this composite connection are significantly less accurate.

High performance rocking timber wall with innovative low-damage floor connections

While mass timber structures are gaining more share of the new build structures considering their well-known advantages, rocking timber walls have been particularly popular with engineers and researchers due to their reliable and efficient seismic performance. With the current conventional approach of using rigid bracket plates and fasteners on rocking timber walls, not only floors and connections are prone to damage, but also the rocking motion is compromised. This paper proposes an innovative wall-to-floor and wall-to-beam mechanism that eliminates bulky rigid bracket connections and allows safe transfer of lateral loads, while dissipating seismic energy without damage as well as providing full self-centring. Numerical results present a few key advantages of this system, such as reduced drifts and seismic base shear and an increase in damping and seismic energy dissipation. The findings of this study demonstrate the significant potential of the proposed system for further developments and application in real structures.

Blockchain-based Electronic Health Record Management System

The Blockchain-based Electronic Health Record (B-EHR) system represents a significant advancement in healthcare data management. Concerns over data confidentiality and security have become increasingly critical in the healthcare sector, given the need for immediate data accessibility. Traditional centralized systems face accessibility issues, necessitating a transformative solution, and blockchain technology emerges as a promising candidate. This research introduces a patient-controlled, blockchain-based system that efficiently manages and safeguards individuals' health-related data. By harnessing the Ethereum network and utilizing tools such as Ganache, Solidity, and web3.js, this system takes a systematic approach to overcome the limitations of centralized systems. Smart contracts, the basis of blockchain technology, serve as the backbone for storing and processing patients' data in a decentralized manner. Transactions are conducted securely through these smart contracts, ensuring patient privacy and data security. Notably, any modifications to transactions can be verified and propagated across the entire distributed network, enhancing data integrity. Complementing this system is a cryptocurrency wallet like MetaMask, providing a centrally controlled repository where records can be swiftly accessed and secured by authorized individuals, including doctors and patients. This integration significantly improves data accessibility and security within the healthcare domain. Ultimately, this research aims to leverage blockchain technology for simultaneous data retrieval, enhancing efficiency, credibility, and accessibility. It offers a robust framework for securely storing data with tailored access permissions and facilitates the safe transfer of patient medical records. In essence, it introduces a swift and secure health record system and an innovative protocol, promoting greater transparency and ownership of sensitive data in the healthcare sector through blockchain integration.

Full‐scale studies of stiffening walls made of autoclaved aerated concrete

AbstractAutoclaved aerated concrete is successfully produced as masonry units to construct single and multi‐family houses. Residential buildings are often erected as load‐bearing structures. Although designers are used to verifying the masonry structure for mainly vertical loads, some elements must act as a stiffening of the building. Horizontal loads of the building can be caused not only by wind pressure and suction but also by uneven subsidence of the ground or mining influences. The role of the stiffening walls is to ensure the geometric invariability of the building and the safe transfer of horizontal loads to the foundations. The Silesian University of Technology conducts extensive research on stiffening walls on full‐scale models of single‐storey buildings. Experimental analyzes enable the description of the propagation and morphology of cracks. Designation of the behavior phases of the stiffening walls is the basis for developing the calculation methodology for stiffening elements.

649 Closed Loop Audit: Improving Surgical Handover in a Major Trauma Centre (RSCH)

Abstract Aim The goal of handover is the accurate reliable communication of task-relevant information across shift changes or between teams. Effective and safe transfer of clinical information is critical for patient safety. The aim of this study to assess Surgical handover in Royal Sussex County Hospital comparing it to the RCS guidelines as standard as well as improving the current practice. Method We undertook two cycles each cycle lasted for 6 weeks. These cycles aimed to assess the surgical handover and comparing them with RCS guidelines using checklists. A teaching session was conducted between the two cycles. In addition, RCS guidelines were handed over to all surgical doctors. Results we discussed a total of 2348 patients in morning surgical handover, over a period of 12 weeks (first cycle: 1203, second cycle:1145). Following conduction of teaching sessions and handing over guidelines, there was a significant improvement in documentation of patients age (from 73% to 97%), responsible consultant (from 92% to 98%), significant investigations (from 60% to 93%) and management plan (from 64% to 96%). Conclusions Education about proper handover was proven to be successful in improving the quality of surgical handover in a major trauma center.

HPC Platform for Railway Safety-Critical Functionalities Based on Artificial Intelligence

The automation of railroad operations is a rapidly growing industry. In 2023, a new European standard for the automated Grade of Automation (GoA) 2 over European Train Control System (ETCS) driving is anticipated. Meanwhile, railway stakeholders are already planning their research initiatives for driverless and unattended autonomous driving systems. As a result, the industry is particularly active in research regarding perception technologies based on Computer Vision (CV) and Artificial Intelligence (AI), with outstanding results at the application level. However, executing high-performance and safety-critical applications on embedded systems and in real-time is a challenge. There are not many commercially available solutions, since High-Performance Computing (HPC) platforms are typically seen as being beyond the business of safety-critical systems. This work proposes a novel safety-critical and high-performance computing platform for CV- and AI-enhanced technology execution used for automatic accurate stopping and safe passenger transfer railway functionalities. The resulting computing platform is compatible with the majority of widely-used AI inference methodologies, AI model architectures, and AI model formats thanks to its design, which enables process separation, redundant execution, and HW acceleration in a transparent manner. The proposed technology increases the portability of railway applications into embedded systems, isolates crucial operations, and effectively and securely maintains system resources.

Heat transfer and entropy optimization for unsteady MHD Casson fluid flow through a porous cylinder: Applications in nuclear reactors

Heat transfer and entropy generation are crucial considerations in the nuclear industry, where the safe and efficient transfer of heat is essential for the operation of nuclear reactors and other nuclear systems. Casson fluid is a useful tool in the nuclear industry for simulating the flow behavior of nuclear fuels and coolants, and for optimizing the design and operation of nuclear reactors. In view of this, the current investigation deals with the heat and fluid flow of unsteady Casson fluid in a circular pipe under the influence of magnetic field, internal heat generation, entropy generation and porous media. The governing equations have been simplified under suitable assumptions and nondimensional quantities. The simplified dimensionless governing equations have been solved using the method of separation of variables along with Bessel functions. It is concluded from the investigation that the temperature increases with time. The Casson fluid parameter raises the temperature and entropy generation. The temperature, entropy generation and Bejan number are the decreasing functions of the Prandtl number.

Pregnancy with heart disease: Fetomaternal outcome: A retrospective analysis from a tertiary care teaching hospital in Northern India

Background: Heart diseases are the most significant non-obstetrical causes of maternal deaths, accounting for up to 15% of all cases. The present retrospective analysis is an attempt to assess the spectrum and impact of cardiac diseases on pregnancy. Aims and Objectives: The aims of this study were to analyze the maternal and perinatal outcomes and spectrum of heart disease in pregnancy. Materials and Methods: The study was carried out in the Department of Obstetrics and Gynecology at PGIMS, Rohtak, where retrospective record of inpatient obstetrics registry of pregnant women with cardiac diseases was analyzed. Clinical information obtained from the patient’s medical records including clinical presentation, laboratory investigations, 2-D echocardiography, maternal, and neonatal outcomes were noted. All pregnant women as well as postpartum patient with cardiac disease were included in the study. Results: A total of 62 pregnant women with heart diseases were hospitalized during the study period. Spectrum of heart disease among these women analyzed and we found that the 22 had rheumatic heart disease (RHD), 14 had congenital heart disease (CHD), and 14 had cardiomyopathies (CMP). LSCS was done for 24 and out of these, nine were elective LSCS while 15 were emergency LSCS. Vaginal deliveries were performed in 31 women. Twenty-eight women got shifted to intensive care units during course of treatment. Three intrauterine deaths were noted in our study. Conclusion: We have concluded from the present study and after reviewing the literature about spectrum of heart diseases in pregnancy, that the most common cardiac lesions complicating the pregnancy are RHD followed by CHD and CMP. Successful management of heart disease with pregnancy can be achieved by timely diagnosis and safe transfer of patient to the cardiomaternal tertiary care, where multidisciplinary teams are available.

Improving Orthopedic Documentation Using Post-Operative Note Proformas: A Quality Improvement Study.

Accurate medical documentation is important in the perioperative period, ensuring the safe transfer of information between teams involved in the surgical patient's care. This has been highlighted by multiple standards of care guidelines within the United Kingdom. The use of standardized pre-templated documents has displayed significant success in minimizing errors during the admission and operative stages. The aim of this study is to evaluate whether a similar proforma for the post-operative stage is successful in orthopedic patients. A retrospective review of 25 consecutive orthopedic elective patients was conducted during the first cycle. Exclusion criteria included patients who were under 16, day case procedures, and admission due to trauma. The second cycle consisted of a prospective review of 25 patients a month following the implementation of the new proforma. Both cycles were scored against 10 inclusion parameters as outlined by national guidelines. Implementation of the proforma resulted in a significant improvement in post-operative note compliance. A total of six parameters showed a statistically significant improvement (p<0.05). This included wound assessment (58.3%-100%, p<0.001), post-operative imaging (37.5%-92%, p<0.001), neurovascular assessment (83.3%-100%, p=0.017), National Early Warning Score (25.0%-100%, p<0.001), venous thromboembolism prophylaxis (29.2%-96.0%, p<0.001), and antibiotic administration (4.2%-84.0%, p<0.001). Monitoring of important clinical parameters significantly improved following the implementation of the post-operative proforma. These results will hopefully cause the introduction of other proformas in other surgical specialties and other units.

Improving timely transfers from acute care to the local palliative care unit for patients at the end of life.

Despite evidence showing that nearly two thirds of the Canadian population prefer to die at home, the majority die in hospital. Honoring a patient's wish for their preferred location of death is an essential component in end-of-life care. Therefore, for those patients admitted to acute care whose choice is to transfer to a palliative care unit for end-of-life care, it is imperative that this occurs in a safe and timely manner. The General Internal Medicine ward at this local tertiary care academic center, did not have a standardized process for transferring patients at the end-of-life to the local palliative care unit. With bed calls made between Monday to Saturday at 8am, weekday and weekend transfer times ranged between 1 to 6 hours. The aim of this project was to establish a standardized, safe and efficient patient transfer from acute care to the palliative care unit for a daily standard arrival time. A multidisciplinary quality improvement team was formed to analyze the transfer process. Several Plan Do Study Act cycles were tested, targeting all steps of the transfer process and turnaround time. An outcome measure aiming for a turnaround time of two hours was set as the target. A total of fourteen patient transfers were included. Average transfer time during the weekday was reduced from a baseline average of 180.2 to 128.3 mins. This change was found to be statistically significant and sustained (P<0.003). The average transfer time on weekends remained stable at 234 mins. The outcome target of a 10:00 am arrival time to the palliative care unit was achieved 42% of the time. This project remains on-going and early data is encouraging as it met the targeted transfer time 42% of the time. Fidelity in the process measures helped to meet the targeted turnaround time of two hours for a safe and efficient transfer to the palliative care unit and ensured patients got to their preferred location for end of life care. The goal is to expand this project to other general internal medicine wards across the organization.

Efficiency Optimization of Wireless Power Transfer System for Electric Vehicle Based on Improved Marine Predators Algorithm

Electric vehicle (EV) is the core part of future automobile technology, and safe and reliable wireless power transfer (WPT) technology is the key link to improve the intelligent driving technology of EV. In this paper, the uncertainty quantification method is proposed to guide the optimization design of WPT structure, so as to improve the efficiency of WPT. First this paper establishes a surrogate model of WPT efficiency based on the adaptive sparse polynomial chaos expansion, and the uncertainty of EVs WPT transmission efficiency is quantified, the computational efficiency is improved by about 8.4 times. Then the surrogate model is combined with the global sensitivity analysis method to quantify the impact of different variables in WPT on efficiency and screen out the variables with greater impact. Finally, this paper uses the improved marine predators algorithm to optimize the selected WPT system structure parameters. Considering the uncertainty, the average efficiency of the optimized WPT system is increased from 73.43% to 94.64%. Compared with other optimization methods, it proves that the method in this paper can optimize WPT more efficiently, and significantly improve the transmission efficiency.

Veno-venous extracorporeal membrane oxygenation support of pulmonary insufficiency using Avalon Elite® cannula in pediatric patients.

The "Avalon Elite®" cannula is a double-lumen cannula used to establish veno-venous extracorporeal membrane oxygenation support. The reported advantages are that extracorporeal circulation can be established by cannulating through the right internal jugular vein only, and there is less re-circulation than with a two-cannula technique. It is available in a wide range of cannula sizes and can be used in a variety of patients, from children to adults. We herein report three pediatric cases in which an Avalon Elite® cannula was useful. The first was a case of acute mitral regurgitation due to idiopathic chordal rupture for postoperative severe lung injury and atelectasis due to cardiogenic pulmonary edema. The second was a case of end-stage radiation pneumonitis for safe transfer to facility of lung transplantation. The third was a convalescent case of fulminant myocarditis with severe atelectasis due to cardiogenic pulmonary edema. In each case, veno-venous extracorporeal membrane oxygenation using an Avalon Elite® cannula was established, the expected sufficient support was secured, and a good clinical course was obtained without major complications associated with an Avalon Elite® cannula.

BT26 Safe use of mobile photographic devices in dermatology: a multicentre quality-improvement project

Abstract Mobile devices are increasingly being used in dermatology to take clinical images, particularly in settings where medical photography services are not readily available. Healthcare professionals are expected to use mobile technology safely to improve patient care. Published UK guidance on the use of mobile photographic devices in dermatology details standards in three key areas: gaining patients’ informed consent, safe use of mobile devices to capture patient images, and safe transfer and storage of these images. A quality-improvement project was conducted across three UK centres. Baseline data were collected over a 2-week period in January 2023 using an anonymous staff survey and analysis of 50 outpatient encounters where mobile devices were used to take clinical images. Our survey achieved a response rate of 77% (n = 20) from consultants (60%), specialty doctors/fellows (30%) and nurses/advanced care practitioners (10%). All respondents sought patient consent prior to taking images on their personal devices, with only 10% using written consent forms (remainder using verbal consent). Thirty-five per cent reported always documenting consent in patient notes and only 20% discussed the risks and benefits of using mobile devices to take patient images. Eighty-five per cent used devices with strong passcodes (six or more characters), but only 50% confirmed that data encryption was enabled on the device. Thirty-five per cent disabled cloud-based back-up systems, 55% disabled Bluetooth and only 5% switched off global positioning system information before taking patient images. For image transfer, 80% used NHS.net email and 20% used a secure clinical image transfer application. Seventy per cent confirmed using a secure network server for image storage and that they always removed patient images from their device after transfer. Analysis of 50 patient encounters revealed that verbal consent was only documented in 8% of cases and a discussion around the risks and benefits of using mobile devices was not documented in any case. National guidance states that it is the healthcare professional’s responsibility to give patients clear information on the risks and benefits of using mobile devices to capture and transfer clinical images for storage, without which there is no informed consent. Our findings highlight a lack of awareness and adaptation of practice to these standards. We will ascertain reasons for this and implement interventions to meet guidance, including an educational meeting and introduction of a standardized written consent form to ensure patient safety and appropriate informed consent. We will present our findings on the impact of these interventions following subsequent rounds of data collection.

LEGAL ASPECTS OF PATIENTS SAFE DISCHARGE FROM THE ICU DEPARTMENT

Analysis of the world dynamics of the number of surgical interventions indicates an increase of doctor’s engagements from of anaesthesiology and intensive care units (AICU) in the process of patient treatment surgical or therapeutic profile. Using of approved normative documents allows to standardize and formalize the assessment of patient’s condition before the operation and to make decision on the selection of anaesthetic support, necessity to stay in AICU, and possibility of safely patient’s transfer to specialized department. The use of standardized system of assessment of patient’s condition is the effective tool for work planning of intensive care patients. The checklist «Criterion for the safe transfer of patients from AICU» allows to assess the patient’s condition in the absence of integrative system.

P-653 Natural proliferative phase frozen embryo transfers: a novel, safe and efficient transfer strategy

Abstract Study question How do natural proliferative phase for frozen embryo transfers (NPP-FET) compare to traditional artificial and natural cycle FETs in terms of pregnancy and neonatal outcomes? Summary answer NPP-FETs were associated with similar ongoing pregnancy rates after 22 weeks, but with less miscarriage rates comparing to artificial cycles. What is known already The best FET protocol for endometrial preparation is still controversial. A natural cycle (NC) FET may require more visits to the clinic and provides less flexibility. Conversely, artificial cycles (AC), although being more flexible in terms of scheduling, have been previously associated with higher rates of miscarriage and maternal morbidity. Here we describe an alternative FET strategy (NPP-FET) in which, during an unmediated ovulatory cycle, progesterone is initiated as soon as the endometrium proliferation reaches 7 mm of thickness, regardless of the size of the dominant follicle and without the administration of exogenous hCG or spontaneous LH peak. Study design, size, duration We performed a single center retrospective cohort study of FET cycles performed between January 2020 and June 2022 (n = 2158). Only single embryo blastocyst stage transfers were included. The main outcome was ongoing pregnancy rate after 22 weeks. Secondary outcomes included the number of visits to the clinic during monitoring, serum levels of progesterone on the day of FET, livebirth (LBR) and miscarriage rates, and maternal/perinatal outcomes. Participants/materials, setting, methods FETs cycles were divided in three subgroups: NC, NPP and AC. For the main outcome measures, a multivariable logistic regression was performed, to adjust for potential confounding (oocyte age/source, use of PGT-A and embryo quality), followed by pairwise comparisons whenever statistically significant. Main results and the role of chance In total, 2158 FET cycles were analysed (1219 NC, 277 NPP and 662 AC). The mean number of visits before FET planning were 2.14, 1.83 and 1.33 for NC, NPP and AC FETs, respectively (p &amp;lt; 001 for all pairwise comparisons). Mean progesterone levels on the day of transfer were significantly higher after NPP and NC (29.4 ng/mL and 40.2ng/mL, respectively), compared to AC (12.7 ng/mL). Progesterone rescue therapy (administered whenever serum progesterone &amp;lt;8.8 ng/mL) was also significantly more frequently needed following AC (24,9% for AC versus 0.6% and 2.6% in NC and NPP, respectively). The ongoing pregnancy rates after 22 weeks were 57.3% for NC, 55.6% for NPP and 54.5% for AC. LBRs following NPP were comparable with NC (38.9% and 42.7%, respectively), and significantly lower with AC (36.0%) compared to NC. The miscarriage rates were significantly lower after NPP and NC-FET when compared to AC (18.4%, 24.3% and 30.7% respectively). Considering maternal outcomes, NPP and NC were associated with a significantly lower risk of first trimester bleeding compared to AC (17.5%, 13.8% and 36.7%, respectively). The rate of gestational hypertensive disorders did not vary significantly (7.5% for NPP, 9.9% for NC and 12.6% for AC). Limitations, reasons for caution While serum progesterone and miscarriage rates comparable to NC-FET allude to the possibility that ovulation may still occur in NPP-FETs, this study cannot establish such causality due to its retrospective design. Moreover, the study may have been underpowered to detect clinically relevant subgroup differences such as for hypertensive disorders. Wider implications of the findings NPP-FETs seems to be an effective and safe alternative, potentially wielding both the advantages of the natural proliferative endometrium of the NC with the ease for scheduling of ACs. Nonetheless, further investigation is warranted attempting also to confirm whether ovulation does indeed still occur despite the progesterone administration. Trial registration number not applicable

An interprofessional peer learning event improves Doctor of Physical Therapy and Bachelor of Science in Nursing students' readiness and self-efficacy for interprofessional learning

Interprofessional learning and collaboration are essential for successful patient care. We describe an interprofessional education (IPE) event between Doctor of Physical Therapy (DPT) and Bachelor of Science in Nursing (BSN) students focused on increasing students' readiness and self-efficacy for interprofessional learning. First-year DPT and junior level BSN students in their first upper-level nursing semester participated in the IPE event. DPT students peer taught BSN students about safe patient transfers, assistive device management, and safe gait patterns for patient mobilization. A pre-post survey using the Readiness for Interprofessional Learning Scale (RIPLS) and Self-efficacy for Interprofessional Experiential Learning (SEIEL) outcome measures assessed changes in students' readiness and self-efficacy toward interprofessional learning. A statistically significant (p < 0.001) improvement in RIPLS score (pre: 81.8 ± 7.4, post: 85.2 ± 7.6), and SEIEL scores (pre: 123 ± 22.7, post: 141.8 ± 16.1) were found. This IPE event improved students' readiness and self-efficacy toward interprofessional learning.

Test and simulation of mechanical properties of a lightweight adaptation device

Based on carbon fiber, extruded polystyrene foam (XPS), ethylene vinyl acetate plastic foam (EVA), and other materials, a lightweight fitting device is designed. Its mechanical properties are tested and simulated. The experimental results and simulation are consistent. The adaptive device adopts a lightweight design, and the single piece weight is less than 30 kg. The final height of the adaptive device can be changed through manual stacking and combination to meet different application scenarios. The adaptive device also adopts a modular design, which separates the bearing function from the adaptive function. The bearing module meets the bearing demand, while the adaptive module has good deformation capacity. The device can be repeatedly used for the safe and fast transfer of heavy equipment.