Abstract This paper describes the advantages of using data acquisition systems and software modelling tools to support the assessment and therefore redesign of the existing medium voltage switchgear. A 38kV/630A load break linear puffer (LP) will be used as an example for this study. In house testing was conducted to capture important design parameters of the switch such as displacement, velocity of mechanical parts and gas pressure using various sensors and three different measurement setups. The first setup, which is primarily intended for no-load measurements, consists of a DAQ system equipped with different types of sensors - two rotational encoders, three laser-based distance sensors, six pressure sensors, contact separation measurement, and a high-speed camera integrated and synchronized with the measurement system. The second and third setups, which are suitable both for no-load and on-load measurements, are based on state-of-the-art DAQ systems, which use three piezo-electric based pressure sensors, two fibre-optic based pressure sensors, three laser-based distance sensors and a high speed camera synchronized with the measurement system. The data acquired by the measurement systems is used in combination with an in-house developed simulation software HV CB Simulation, which enables simulating and predicting various variables of switching devices. Moreover, high speed camera videos analysed with both commercial and in-house developed image processing software, visualize and reveal many otherwise inaccessible occurrences. In addition to a comprehensive analysis of the proposed data acquisition and simulation setups, three design improvements in the linear puffer design - increase of the opening speed, removal of the flexible conductors and the length increase of the puffer cylinder - are presented and discussed in this paper.

ntroduction: Sleep is one of the most important components of overall health. Children with developmental disabilities are at a higher risk of having sleep problems. Purpose: The goal of the present study is to compare sleep patterns of children with developmental disabilities with those of typically developing children. In particular, we examined whether children with an intellectual disability (ID), children with an autism spectrum disorder (ASD) and typically developing children differ in sleep duration, number of night’s waking, screen time (time spent on smartphones, tablets, TV), and outdoor activities. Methods: The sample for this study consisted of 114 children (34 children with ASD, 40 children with ID and 40 typically developing children) aged 2 to 14 years (mean age= 6.4 years, SD = 3.0). Information on children’s sleep patterns was obtained through an online survey completed by the parents of the children. We also collected information regarding the strategies parents use to settle their children for sleep, as well as information regarding screen time and outdoor activities. Results: The results of this study indicate that sleep duration was shortest for children with ID and longest for children without developmental disabilities. Another finding in this study is that screen time and not the outdoor activities was associated with sleep duration. Children with ASD were more likely to use melatonin to fall asleep, while the children with ID were more likely to use medications. Conclusion: Children with ID have shorter sleep duration than children with ASD and typically developing children. Parents have several cognitive and behavioural strategies at their disposal to improve their children’s sleep.

The data on the relationship on gastroesophageal reflux (GER) and brief resolved unexplained events (BRUE) in infants are scarce. The aim of this study was to investigate the diagnostic usefulness of combined multichannel intraluminal impedance-pH (MII-pH) monitoring in children with suspected GER-related BRUE. Infants hospitalized due to BRUE and who were referred for 24-hour MII-pH monitoring from January 2012 to September 2017 were prospectively included in the study. All children underwent 24-hour MII-pH monitoring using a MIIpH ambulatory system (Ohmega, MMS, Enschede, Netherlands). The impedance recordings were analyzed using criteria described in a consensus statement on indications, methodology and interpretation of combined MII-pH monitoring in children. Twenty-one infants (mean age 4.7 months; range 0.9 to 8.9 months; male/female 10/11) participated in the study. Irregular breathing/apnea associated with GER was found in 10 (52.4%) of infants. Based on RI on pH-metry alone only 7 (33.3%) infants would be diagnosed with GERD. More than 100 GER episodes detected by MII were found in 10 (47.6%) infants. Nineteen percent of infants had GERD diagnosed based on both pH-metry and MII. Acid and non-acid reflux seems to have a significant role in the pathogenesis of GER-related BRUE.

Architectural design decisions, such as service deployment and composition, plant layout synthesis, or production planning, are an indispensable and overarching part of an industrial manufacturing system design. In the fourth industrial revolution (Industry 4.0), frequent production changes trigger their synthesis, and preferably optimization. Yet, knowledge on architecture synthesis and optimization has been scattered around other domains, such as generic software engineering. We take a step towards synthesizing current knowledge on architectural design decisions in Industry 4.0. We developed a taxonomy describing architectural models, design decisions, and optimization possibilities. The developed taxonomy serves as a guideline for comparing different possibilities (e.g., application of different optimization algorithms) and selecting appropriate ones for a given context. Furthermore, we reviewed and mapped 30 relevant research works to the taxonomy, identifying research trends and gaps. We discuss interesting, and yet uncovered topics that emerged from our review.

Aims: We studied the syntaxonomic position, biodiversity, ecological features, nature conservation value and current status of dry grasslands investigated by Josias Braun-Blanquet more than 60 years ago. Study area: Inner-alpine valleys of Austria. Methods: We sampled 67 plots of 10 m2, following the standardized EDGG methodology. We subjected our plots to an unsupervised classification with the modified TWINSPAN algorithm and interpreted the branches of the dendrogram syntaxonomically. Biodiversity, structural and ecological characteristics of the resulting vegetation units at association and order level were compared by ANOVAs. Results: All the examined grasslands belong to the class Festuco-Brometea. From ten distinguished clusters, we could assign four clusters to validly published associations, while the remaining six clusters were named tentatively. We classified them into three orders: Stipo-Festucetalia pallentis (Armerio elongatae-Potentilletum arenariae, Phleo phleoidis-Pulsatilletum nigricantis, Medicago minima-Melica ciliata community, Koelerio pyramidatae-Teucrietum montani), Festucetalia valesiacae (Sempervivum tectorum-Festuca valesiaca community); Brachypodietalia pinnati (Astragalo onobrychidis-Brometum erecti, Agrostis capillaris-Avenula adsurgens community, Anthericum ramosum-Brachypodium pinnatum community, Ranunculus bulbosus-Festuca rubra community, Carduus defloratus-Brachypodium pinnatum community). Conclusions: The ten distinguished dry grassland communities of the Austrian inner-alpine valleys differ in their ecological affinities as well as their vascular plant, bryophyte and lichen diversity. We point out their high nature conservation importance, as each of them presents a unique habitat of high value. Taxonomic reference: Names of vascular plants, bryophytes and lichens follow Fischer et al. (2008), Frahm and Frey (2004) and Nimis et al. (2018), respectively. Syntaxonomic reference: Names of orders and classes follow Mucina et al. (2016), references for associations and alliances are given in the text. Abbreviations: ANOVA = analysis of variance; DCA: detrended correspondence analyses; EDGG: Eurasian Dry Grassland Group; EIV: ecological indicator value; FL: Fließ; GR: Griffen; GU: Gulsen; KA: Kaunerberg; LA: Laudegg castle in Ladis; MA: Marin; NM: Neumarkt in der Steiermark; OM: Obermauern; PÖ: Pöls; PU: Puxer Loch; TWINSPAN = Two-way indicator species analysis; ZS: Zinizachspitze.

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The need for swift international collaboration alongside rapidly deployable remote medical knowledge transition and implementation programs has been highlighted during the ongoing COVID-19 pandemic. Virtual programs have emerged as cost-effective alternatives to in-person education to spread best practices to resource-limited locations and garner purposeful learner engagement. Understanding local practice needs is paramount to the development of an effective quality improvement initiative. This study aimed to gain insight into the interests, clinical challenges, and attitudes of a group of interprofessional critical care providers from Bosnia and Herzegovina in preparation for a longitudinal remote education and quality improvement program. METHODS: A novel learning needs assessment tool was implemented in a cohort of critical care professionals from four hospitals in Bosnia and Herzegovina. A sequential explanatory design was employed, and a mixed-method assessment was conducted in three phases. 1) Utilizing the Delphi method, twenty statements containing common critical care entrustable professional activities (EPAs) were developed by a board of intensivists and medical education specialists. 2) Local learners used Q Sort methodology to rank-order EPAs based on self-perceived learning priorities, with subsequent by-person factor analysis. 3) Learners were invited for focus-group interviews to gather details of the rationale behind their rankings. RESULTS: Forty nine out of 105 participants completed the rank-order survey (response rate 47%). Factor analysis categorized the participants into two main groups based on the typology of their opinions, 22 participants into factor 1 and 9 participants into factor 2. The highest-ranked EPAs amongst the two factors were “evaluation and management of the patients with shock, stabilization, and resuscitation of critically ill patients” and “evaluation and management of ARDS,” respectively. Statements regarding common ICU complications and procedures were regarded as neutral. The lowest rank amongst factor 1 was “patient-centered care, communication skills, and interprofessional collaboration.” Participants in factor 2 ranked “preoperative evaluation and management” and “common hematologic and oncologic complications” the lowest. The rationale behind rank orders focused on the current patient population and perceived EPA importance to critical care practice. Participants in factor 1 displayed pessimistic attitudes toward patient-centered care and interprofessional collaboration due to cultural and healthcare system constraints. Interviewees in both factors described local challenges and expressed a need for change. CONCLUSIONS: We conducted a remote needs assessment in an international, interprofessional group of critical care providers. In addition to building trust with learners, the acquired knowledge of cultural differences, needs, and barriers to implementation will guide an ongoing remote education and quality improvement initiative. CLINICAL IMPLICATIONS: This investigation will shape a critical care best practices quality improvement initiative and remote education program in a country with limited resources. DISCLOSURES: No relevant relationships by Marija Bogojevic, source=Web Response No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty no disclosure on file for Pedja Kovacevic;No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Aida Mujakovic, source=Web Response No relevant relationships by Alexander Niven, source=Web Response No relevant relationships by Manja Spahalic, source=Web Response no disclosure on file for Slavenka Straus;No relevant relationships by Simon Zec, source=Web Response

Introduction Current evaluation of patients suspected of a non-ST-elevation acute coronary syndrome (NSTE-ACS) involves the use of algorithms that incorporate clinical information, electrocardiogram (ECG) and high-sensitivity cardiac troponins (hs-troponins). While primarily designed to rule out NSTE-ACS safely, these algorithms can also be used for rule in of NSTE-ACS in some patients. Still, in a substantial number of patients, these algorithms do not provide a conclusive work-up. These patients often present with an atypical clinical profile and low-range positive hs-troponin values without a characteristic rise or fall pattern. They represent a heterogeneous group of patients with various underlying conditions; only a fraction (30%–40%) will eventually be diagnosed with a myocardial infarction. Uncertainty exists about the optimal diagnostic strategy and their management depends on the clinical perspective of the treating physician ranging from direct discharge to admission for invasive coronary angiography. Coronary CT angiography (CCTA) is a non-invasive test that has been shown to be safe, fast and reliable in the evaluation of coronary artery disease. In this study, we will determine the usefulness of CCTA in patients with acute chest pain and low-range positive hs-troponin values. Methods and analysis A prospective, double-blind, observational, multicentre study conducted in the Netherlands. Patients aged 30–80 years presenting to the emergency department with acute chest pain and a suspicion of NSTE-ACS, a normal or non-diagnostic ECG and low-range positive hs-troponins will be scheduled to undergo CCTA. The primary outcome is the diagnostic accuracy of CCTA for the diagnosis of NSTE-ACS at discharge, in terms of sensitivity and negative predictive value. Ethics and dissemination This study was approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam, the Netherlands (registration number MEC-2017-506). Written informed consent to participate will be obtained from all participants. This study’s findings will be published in a peer-reviewed journal. Trial registration number ClinicalTrials.gov (NCT03129659).