Identification of Operational Design Domain for Autonomous Truck Mounted Attenuator System on Multilane Highways

The Autonomous Truck Mounted Attenuator (ATMA) vehicle system is a technology that leverages connected and automated vehicle (CAV) capabilities for maintenance of transportation infrastructure. Promoted by FHWA and state departments of transportation (DOTs), it is a niche CAV application in leader–follower style, intended to remove DOT workers from the following maintenance truck, to reduce fatalities in work zones. Because practicable guidance for deployment of this technology is largely missing in MUTCD, state DOTs have been making their own deployment criteria. In this manuscript, we focus on the operational design domain (ODD) problem—under what traffic conditions should ATMA be deployed. Modeling efforts are first focused on the derivation of an effective discharge rate that can be associated with a moving bottleneck caused by slow-moving ATMA vehicles on a multilane highway. Then, based on the demand input and discharge rates, microscopic traffic flow models calculate vehicle delay and density, which the Highway Capacity Manual (HCM) suggests are key indicators of a multilane highway’s level of service (LOS). In this way, the linkage between AADT and LOS is analytically established. NGSIM data is used for the model validation and shows that the developed model correctly captures the effective discharge rate discount caused by moving bottlenecks. The modeling results demonstrate that roadway performance is sensitive to the K factor and D factor, as well as the operating speed of ATMA and, if LOS = C is a desirable design objective, a good AADT threshold to use would be around 40,000 vehicles per day.

Implementation of a patient progress diary for stoma patients living with dementia

With an ageing population and an increase in the prevalence of dementia, stoma care nurses (SCNs) are experiencing greater challenges in their role supporting this group of patients with their stoma care. Following concerns raised in our department by relatives about the care and teaching provided in this area, with patients occasionally denying having even seen an SCN, the need for a visual tool to enable timely interventions and increase knowledge for family, carers and ward staff became apparent. There is a comprehensive list of local and national guidelines underlining the need to provide more support and an increased comprehensive teaching plan specially tailored to dementia patients’ needs. The development of a patient progress diary, with a traffic light system showing each stage that the patient has reached, has provided a visual, up-to-date guide to the patient’s stoma management and highlights the need for further input to enable the patient to be discharged home safely and in a timely manner. The diary was formulated by the SCNs and printed by Coloplast, culminating in an easy-to-read booklet with a pictorial step-by-step guide to be inserted into patients’ washbags. The diary was reviewed by Great Western Hospitals Patient Advice and Liaison Service (PALS) and the Carers Committee, who provided positive feedback and subsequently supported the development of this patient-focused tool. Since introducing the diary, our team has decided to implement it with all patients, with positive feedback from patients, relatives, carers and ward staff. This has assisted in safe, timely and effective discharge planning.

BLANKETS: a toasty tool to improve social history documentation for our older patients

A thorough social history is an important component of all medical clerkings and is particularly crucial when admitting an older patient. Standards exist to guide the social history content but are rarely referenced in practice. This quality improvement project conceived and implemented the novel BLANKETS (Bladder and bowels, Legal arrangements, Activities of daily living, Neurology (cognition), Kit (dentures, hearing or visual aids), EtOH and smoking, Trips, walking aids and exercise tolerance, Setup at home) tool for social history documentation, derived from existing standards, at a specialist medical inpatient hospital setting. Over a 15-week period with two cycles of intervention involving 125 patients in total, there was good staff engagement and overall improvement in social history documentation with 194/403 (48.1%) vs 199/545 (36.5%) criteria met overall and on average 6.3/13 vs 4.7/13 criteria documented for each patient. The social history BLANKETS tool is a memorable acronym to prompt clerking doctors to take a thorough and focused social history which is intrinsic to determining appropriate rehabilitation goals for effective discharge planning and setting appropriate ceiling of care decisions.

Effect of the Sound Source Position Error on Distribution Characteristics of Underwater Shock Wave Bunching Sound Field

Curved reflection bunching technique of underwater plasma sound source (UPSS) uses the geometric characteristics of the curved reflector to reflect and bunching intense sound shock wave, so the center position error of the sound source is one of the important factors affecting the bunching performance of the shock wave. In this paper, the cause of the sound source position error is analyzed in detail, and nonlinear finite element software ANSYS/LS-DYNA (dynamic analysis software developed by LSTC) is used to establish the model of the shock wave bunching sound field. Through numerical simulations, the shock wave bunching sound field distribution characteristics under the influence of different position errors are comprehensively simulated, and the bunching performance of the shock wave and its influence law are deeply analyzed according to the simulation results. It provides guidance for reasonably controlling the machining error and installation error of the reflector and discharge electrode, estimating the effective discharge times of the discharge electrode, and formulating the design process.

Study on the effective discharge energy mechanism of vertical ultrasonic vibration assisted EDM processing

Compared to traditional EDM processing, UEDM (Ultrasonic Vibration Assisted EDM) have a great improvement in optimizing discharge environment. In this study, ultrasonic vibration is attached to the electrode. According to the relative positional relationship between the movement path of the electrode tip and the discharge gap, four working states of UEDM are defined. The four working states are the path within the discharge gap, the path in contact with the edge of the discharge gap, part of the electrode end path outside the discharge gap, and the path in contact with the workpiece, respectively. States are analyzed from the effective discharge energy and discharge frequency. A mathematical model for effective discharge energy and surface roughness is established for two conventional working states. The correctness of the theoretical research is verified by experiments. As the experiment results shown, the influence of ultrasonic amplitude on the energy of UEDM is primary, while frequency is secondary. A working state with better discharge stability and higher discharge energy when the electrode end path is in contact with the edge of the discharge gap. In the first three conventional machining states, the surface quality of the workpiece increases with the increase of ultrasonic amplitude and frequency. The study can provide scientific guidance for parameter matching of UEDM.

The Role Of The Pediatric Nurse In Discharge Planning; Identifying Gaps In Sri Lanka

Background: Pediatric discharge planning is a complex process, and that nurses need lengthy preparations. Role confusion among nurses will disrupt the smooth planning of the discharge. In Sri Lanka, although there is a possibility of reducing health costs through effective discharge planning led by pediatric nurses, it is questionable whether Sri Lankan nurses have clarified their role in this process.Method: This systematic review was conducted to map the different roles of nurses in the pediatric discharge planning process. Electronic databases of PubMed and CINAHL were searched for peer-reviewed journal articles among the pediatric population from 2005-2019, using the keywords such as discharge planning, pediatric nurse, care transitions, transitional care, and Sri Lankan nurse.Results: Articles that resulted in the word combination ‘Discharge planning and pediatric nursing (n=329) were used for screening. Two hundred and forty articles out of the nursing scope and sixty articles that do not describe an apparent nursing involvement in the discharge process were excluded, based on abstract review and full-text review, respectively. Sixteen studies were included in the final review. Few literature was found on the topic among Sri Lankan pediatric population. Four main categories of nurses’ roles were identified with the thematic analysis: discharge educator, discharge collaborator, post-discharge care coordinator, and family counselor. Conclusion: In Sri Lanka, no such defined roles of a nurse have been established yet in the discharge planning of pediatric patients. These roles may help nurses carry out discharge planning effectively, and future studies are needed on this topic in Sri Lanka.

North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people

AimsSpecialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.Our aims:To reduce length of inpatient stayTo enable admission of young people as close to home as possibleTo improve resource efficiency, capacity and capability of managing young people in crisis in the community.MethodA number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.ResultAfter four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.ConclusionThere have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.

The effect of the phytocomplex Renotineх® on postoperative period after external shock wave lithotripsy in patients with urolithiasis

INTRODUCTION: Phytopreparations are one of the leading medicines used as preoperative preparation and postoperative management in patients with urolithiasis. THE AIM of the study was to evaluate the nephroprotective effect of Renotinex in patients with urolithiasis after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: The study included 86 patients (43 in the main and the comparison group) with urolithiasis with localization of the stone in the renal pelvis without disturbing the outflow of urine. All patients underwent extracorporeal shock wave lithotripsy (ESWL). After ESWL patients in both groups received spasmodic, anti-inflammatory, antibacterial therapy. Patients of the main group additionally received Renotinex 2 capsules 3 times a day for 14 days before and 14 days after surgery. RESULTS: During the observation a more effective discharge of calculus fragments was noted in patients of the main group while taking the phytocomplex Renotinex, as well as less pronounced damage and faster recovery of the renal parenchyma after ESWL according to the level of enzimuria. CONCLUSION: The results of the study indicate the feasibility of prescribing the phytocomplex Renotinex for nephroprotective and lithokinetic therapy in patients after ESWL.