Inequities in quality and safety outcomes for hospitalized children with intellectual disability

Aim: To investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals. Method: A cross-sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children’s hospitals in Sydney, Australia (1st January–31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents. Results: In total, 12.3% (n=125) of children admitted during the study period had intellectual disability, which represented 13.9% (n=190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p=0.875; median age 3 years (0–18y) vs 4 years (0–18y), p=0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, p<0.001) and cost of admission (A$11 596.38 vs A$8497.96) than their peers (p=0.001). Children with intellectual disability had more admissions with at least one incident compared to children without intellectual disability (14.7% vs 9.7%); this was not statistically significant (p=0.06). Interpretation: Children with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital

Inequities in quality and safety outcomes for hospitalized children with intellectual disability.

AimTo investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals.MethodA cross-sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children's hospitals in Sydney, Australia (1st January-31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents.ResultsIn total, 12.3% (n=125) of children admitted during the study period had intellectual disability, which represented 13.9% (n=190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p=0.875; median age 3 years (0-18y) vs 4 years (0-18y), p=0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, pInterpretationChildren with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital

'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability.

AIM: To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. DESIGN: Interpretive qualitative study. METHODS: Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. RESULTS: Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. CONCLUSION: Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. IMPACT: The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital

Fault Diagnosis for Satellite Sensors and Actuators using Nonlinear Geometric Approach and Adaptive Observers

This paper presents a novel scheme for diagnosis of faults affecting sensors that measure the satellite attitude, body angular velocity, flywheel spin rates, and defects in control torques from reaction wheel motors. The proposed methodology uses adaptive observers to provide fault estimates that aid detection, isolation, and estimation of possible actuator and sensor faults. The adaptive observers do not need a priori information about fault internal models. A nonlinear geometric approach is used to avoid that aerodynamic disturbance torques have unwanted influence on the fault estimates. An augmented high-fidelity spacecraft model is exploited during design and validation to replicate faults. This simulation model includes disturbance torques as experienced in low Earth orbits. This paper includes an analysis to assess robustness properties of the method with respect to parameter uncertainties and disturbances. The results document the efficacy of the suggested methodology.This paper presents a novel scheme for diagnosis of faults affecting sensors that measure the satellite attitude, body angular velocity, flywheel spin rates, and defects in control torques from reaction wheel motors. The proposed methodology uses adaptive observers to provide fault estimates that aid detection, isolation, and estimation of possible actuator and sensor faults. The adaptive observers do not need a priori information about fault internal models. A nonlinear geometric approach is used to avoid that aerodynamic disturbance torques have unwanted influence on the fault estimates. An augmented high-fidelity spacecraft model is exploited during design and validation to replicate faults. This simulation model includes disturbance torques as experienced in low Earth orbits. This paper includes an analysis to assess robustness properties of the method with respect to parameter uncertainties and disturbances. The results document the efficacy of the suggested methodology

Combined Geometric and Neural Network Approach to Generic Fault Diagnosis in Satellite Reaction Wheels

This paper suggests a novel diagnosis scheme for detection, isolation and estimation of faults affecting satellite reaction wheels. Both spin rate measurements and actuation torque defects are dealt with. The proposed system consists of a fault detection and isolation module composed by a bank of residual filters organized in a generalised scheme, followed by a fault estimation module consisting of a bank of adaptive estimation filters. The residuals are decoupled from aerodynamic disturbances thanks to the Nonlinear Geometric Approach. The use of Radial Basis Function Neural Networks is shown to allow design of generalised fault estimation filters, which do not need a priori information about the faults internal model. Simulation results with a detailed nonlinear spacecraft model, which includes disturbances, show that the proposed diagnosis scheme can deal with faults affecting both reaction wheel torques and flywheel spin rate measurements, and obtain precise fault isolation as well as accurate fault estimates

Copper accumulation in vineyard soils: Rhizosphere processes and agronomic practices to limit its toxicity.

Viticulture represents an important agricultural practice in many countries worldwide. Yet, the continuous use of fungicides has caused copper (Cu) accumulation in soils, which represent a major environmental and toxicological concern. Despite being an important micronutrient, Cu can be a potential toxicant at high concentrations since it may cause morphological, anatomical and physiological changes in plants, decreasing both food productivity and quality. Rhizosphere processes can, however, actively control the uptake and translocation of Cu in plants. In particular, root exudates affecting the chemical, physical and biological characteristics of the rhizosphere, might reduce the availability of Cu in the soil and hence its absorption. In addition, this review will aim at discussing the advantages and disadvantages of agronomic practices, such as liming, the use of pesticides, the application of organic matter, biochar and coal fly ashes, the inoculation with bacteria and/or mycorrhizal fungi and the intercropping, in alleviating Cu toxicity symptoms

Efficient Symmetry Reduction and the Use of State Symmetries for Symbolic Model Checking

One technique to reduce the state-space explosion problem in temporal logic model checking is symmetry reduction. The combination of symmetry reduction and symbolic model checking by using BDDs suffered a long time from the prohibitively large BDD for the orbit relation. Dynamic symmetry reduction calculates representatives of equivalence classes of states dynamically and thus avoids the construction of the orbit relation. In this paper, we present a new efficient model checking algorithm based on dynamic symmetry reduction. Our experiments show that the algorithm is very fast and allows the verification of larger systems. We additionally implemented the use of state symmetries for symbolic symmetry reduction. To our knowledge we are the first who investigated state symmetries in combination with BDD based symbolic model checking

Exploiting the Temporal Logic Hierarchy and the Non-Confluence Property for Efficient LTL Synthesis

The classic approaches to synthesize a reactive system from a linear temporal logic (LTL) specification first translate the given LTL formula to an equivalent omega-automaton and then compute a winning strategy for the corresponding omega-regular game. To this end, the obtained omega-automata have to be (pseudo)-determinized where typically a variant of Safra's determinization procedure is used. In this paper, we show that this determinization step can be significantly improved for tool implementations by replacing Safra's determinization by simpler determinization procedures. In particular, we exploit (1) the temporal logic hierarchy that corresponds to the well-known automata hierarchy consisting of safety, liveness, Buechi, and co-Buechi automata as well as their boolean closures, (2) the non-confluence property of omega-automata that result from certain translations of LTL formulas, and (3) symbolic implementations of determinization procedures for the Rabin-Scott and the Miyano-Hayashi breakpoint construction. In particular, we present convincing experimental results that demonstrate the practical applicability of our new synthesis procedure

Laser-Induced, Green and Biocompatible Paper-Based Devices for Circular Electronics

The growing usage and consumption of electronics-integrated items into the daily routine has raised concerns on the disposal and proper recycling of these components. Here, a fully sustainable and green technology for the fabrication of different electronics on fruit-waste derived paper substrate, is reported. The process relies on the carbonization of the topmost surface of different cellulose-based substrates, derived from apple-, kiwi-, and grape-based processes, by a CO2 laser. By optimizing the lasing parameters, electronic devices, such as capacitors, biosensors, and electrodes for food monitoring as well as heart and respiration activity analysis, are realized. Biocompatibility tests on fruit-based cellulose reveal no shortcoming for on-skin applications. The employment of such natural and plastic-free substrate allows twofold strategies for electronics recycling. As a first approach, device dissolution is achieved at room temperature within 40&nbsp;days, revealing transient behavior in natural solution and leaving no harmful residuals. Alternatively, the cellulose-based electronics is reintroduced in nature, as possible support for plant seeding and growth or even soil amendment. These results demonstrate the realization of green, low-cost and circular electronics, with possible applications in smart agriculture and the Internet-of-Thing, with no waste creation and zero or even positive impact on the ecosystem