Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework

IntroductionUnexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs.MethodsThe University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information.DiscussionThe cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions

NASA Thermal Control Technologies for Robotic Spacecraft

Technology development is inevitably a dynamic process in search of an elusive goal. It is never truly clear whether the need for a particular technology drives its development, or the existence of a new capability initiates new applications. Technology development for the thermal control of spacecraft presents an excellent example of this situation. Nevertheless, it is imperative to have a basic plan to help guide and focus such an effort. Although this plan will be a living document that changes with time to reflect technological developments, perceived needs, perceived opportunities, and the ever-changing funding environment, it is still a very useful tool. This presentation summarizes the current efforts at NASA/Goddard and NASA/JPL to develop new thermal control technology for future robotic NASA missions

“Cricket ball in the scrotum:” Calcification of old hematoma

The intrascrotal calculus was first described during surgery by Kickham in 1935 as a “fibrinoid loose body” or “scrotal pearl.” The etiology of scrotal calculi is unclear. They may develop as a sequela to hematomas or inflammatory changes within the scrotum or loose bodies from torsion and infarction of the appendix testis or epididymis. Hardly few cases were reported in the literature. We present a case of painless right scrotal swelling since 6 years’ duration which gradually increased in size after following trauma. Finally, it is diagnosed as calcified hematoma and excision of the scrotal swelling was carried out after the exclusion of other causes (testicular malignancy) of scrotal swelling

Comparison of Laser and Conventional Welding Processes for Joining of Ti-6Al-4V Alloy (Abstract

NRC publication: Ye

Spacecraft Thermal Control

Thermal control of the spacecraft is typically achieved by removing heat from the spacecraft parts that tend to overheat and adding heat to the parts that tend get too cold. The equipment on the spacecraft can get very hot if it is exposed to the sun or have internal heat generation. The pans also can get very cold if they are exposed to the cold of deep space. The spacecraft and instruments must be designed to achieve proper thermal balance. The combination of the spacecraft's external thermal environment, its internal heat generation (i.e., waste heat from the operation of electrical equipment), and radiative heat rejection will determine this thermal balance. It should also be noted that this is seldom a static situation, external environmental influences and internal heat generation are normally dynamic variables which change with time. Topics discussed include thermal control system components, spacecraft mission categories, spacecraft thermal requirements, space thermal environments, thermal control hardware, launch and flight operations, advanced technologies for future spacecraft