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Background: Physical restraint is applied in pediatric intensive care units to carry out certain painful procedures and to ensure the maintenance and continuity of life support devices. There is a need to analyse the factors that influence the behaviour or intention to use physical restraint. Aim: To create and test psychometrically a paediatric version of the Physical Restraint‐Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. Study Design: A psychometric study. Five medical‐surgical Paeditric Intensive care Units from five hospitals in Spain. The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. Results: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. Conclusions: The Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. Relevance for Clinical Practice: Having this instrument will help health centres move towards restraint‐free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs. [ABSTRACT FROM AUTHOR]

Introduction: ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey. Methods: We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021. Results: The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport. Conclusion: Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions. [ABSTRACT FROM AUTHOR]

Introduction: In performance-based approaches and quality assessment protocols used both in the technological design of architecture and the environmental design of the built habitat, the concept of psycho-physical wellbeing is usually defined in purely quantitative human-techno-centric or eco-techno-centric terms. However, in socio-technical-environmental realities in continuous transition, wellbeing extends to areas that cannot be confined within the notions of comfort or healthiness because it involves material and immaterial, cultural and technical, aesthetic and performative, real and virtual aspects. Method: The aim of this article emerges from studies being conducted as part of Ex-Mind research. The working hypothesis is to broaden performance-based approaches in a technological-environmental sense to avoid reducing the goal of psycho-physical wellbeing just to the compliance with technical-constructive aspects. It could be possible combining the material and quantifiable dimensions with other aspects that extend the project to sensorial, perceptive, and emotional interactions. Important theoretical-scientific evidence is already emerging on this dichotomy to be overcome from areas of project evaluation responsive to the new paradigms of sustainability such as resilience, inclusive placemaking, and wellbeing according to the flourish model. Characteristics such as dimensions, proportions, shapes, colors, scents and immaterial aspects of spaces, for example, should be evaluated with respect to the complex physical and mental comfort conditions that they can produce. Results: In the technological-environmental vision of the human habitat project, the objective of psycho-physical wellbeing should be a function of the dynamic balance between the constantly evolving users'/inhabitants' needs and the variability of context factors and agents. The concept of wellbeing therefore takes on a scalar and expanded declination. Considering the technological-environmental approach, a possible element of originality emerges in the integrated and balanced human-environmental centered vision aimed at broadening the framework of the qualitative-quantitative references of the project of the human habitat. This could be an alternative bio-psycho-socio-technological methodological vision starting from the determinants of wellbeing in a broad sense, including natural, cultural and socioeconomic environmental factors, social and collective networks of relationships and participation, individual behavioral, physical, and functional factors of people. Added to these determinants are the different technological-environmental interface systems with which the project is able to define, in a bio-psycho-socio-technological sense, multiple and variable regulatory conditions of wellbeing, at a building, urban, and territorial level. Discussion: The possible outcomes of this alternative and integrated hypothesis are related to the reconnection with the production and regeneration processes of the built material, to the reorganization and reinvention of spatial and perceptual relationships between individuals, communities, technologies, environment, and to the integration of non-directly quantifiable subjective variables into the design of the built environment. The proposed integrated bio-psycho-socio-technological vision may open for developments concerning the expansion of the determinants of psycho-physical wellbeing through new performative descriptors and the definition of agile tools, procedures, and metrics to integrate wellbeing assessments, including consensus-based approaches. [ABSTRACT FROM AUTHOR]

The quality of the indoor environment has evolved into a vital parameter for dwellings due to the increasing number of home-based jobs, with more people spending most of their time at home. Generally, the design and evaluation of indoor air quality in buildings depend on guidelines and recommendations from national and international standards. In a building stock in which mechanical ventilation is not mainstream, it is necessary to evaluate the natural ventilation habits and their impact on indoor air quality. This article describes a methodology to assess indoor air quality using four case studies in which habits and occupancy are representative samples of dwellings in Madrid, Spain. Temperature, relative humidity, formaldehyde, particle matter (PM), and carbon dioxide (CO2) concentrations have been measured over several months. The analysis of these values leads to conclusions that each pollutant has a different source. For example, Formaldehyde concentration depends mostly on indoor finishes and materials; indoor activities impact PM concentrations. The results showed high formaldehyde concentrations in the case study decorated with oil paintings, whereas bedrooms with insufficient ventilation showed consistently high CO2 concentrations. Finally, well-ventilated rooms showed high PM concentrations due to the smoking habits and pets that live with the family. [ABSTRACT FROM AUTHOR]

Introduction: The organization of primary Extracorporeal membrane oxygenation (ECMO) transport is highly variable. Methods: To present the experience of the first mobile pediatric ECMO program in Spain, we designed a prospective descriptive study of all primary neonatal and pediatric (0–16 years) ECMO transports carried out over 10 years. The main variables recorded include demographic information, patient background, clinical data, ECMO indications, adverse events, and main outcomes. Results: 39 primary ECMO transports were carried out with a 66.7% survival to hospital discharge. The median age was 1.24 months[IQR: 0.09–96]. Cannulation was mostly peripheral venoarterial (33/39). The mean response time from the call from the sending center to the departure of the ECMO team was 4 h[2.2–8]. The median inotropic score at the time of cannulation was 70[17.2–206.5], with a median oxygenation index of 40.5[29–65]. In 10% of the cases, ECMO-CPR was performed. Adverse events occurred in 56.4%, mostly related to the means of transport (40% overall). On arrival at the ECMO center, 44% of the patients underwent interventions. The median PICU stay was 20.5 days[11–32]. 5 patients developed neurological sequels. Statistically significant differences between survivors and deceased patients were not found. Conclusions: A good survival rate, with a low prevalence of serious adverse events, suggests a clear benefit of primary ECMO transport when conventional therapeutic measures are exhausted and the patient is too unstable to undergo conventional transport. A nationwide primary ECMO-transport program must therefore be offered to all patients regardless of their location. [ABSTRACT FROM AUTHOR]

This article discusses a design approach for ventilation and air conditioning systems based on the ASHRAE psychrometric chart and Mollier diagram. The authors emphasize the importance of making technically sound decisions in terms of energy consumption and assessing their impact on a building's energy performance. They propose conducting a comprehensive analysis of the processes occurring within a space to evaluate the performance of the air distribution system. The article provides a simplified case study to showcase this design methodology. The authors aim to improve energy efficiency in air conditioning systems and enhance communication among specialists in the field. The text also discusses the functioning of room air conditioning systems and the parameters involved in determining air comfort in a serviced room. It explains the relationship between the supply air, room air, and exhaust air, as well as the performance factor of the air distribution system. The text emphasizes the importance of indoor air quality and the role of HVAC professionals in advocating for healthy and sustainable buildings. It provides a case study of an air conditioning system in a historical theater hall and discusses the design considerations and strategies for achieving optimal air quality and comfort. The document discusses the use of displacement air distribution in theaters to ensure year-round comfort for attendees. It proposes modifications to the air handling unit to optimize the cooling and drying process of fresh air. The results show that employing displacement air distribution and only using fresh air reduces the cooling and heating requirements. The document emphasizes the importance of considering detailed design criteria, analyzing technological and human activities, and determining intake air quantities based on indoor and external [Extracted from the article]

The reactivation of coüuviai Landslides in reservoir banks poses a serious threat to the safety of hydropower projects and nearby towns. This study aims to research the morphological evolution of this type of landslides under the action of reservoir water and the impact of morphological evolution on landslide stability. The study focused on the Yulinerzu landslide, a large reactivated colluvial landslide in the Xiluodu Reservoir, China. Field surveys were conducted to analyze the geological structure of the landslide. In situ monitoring and surveys were used to obtain the deformation characteristics and morphological evolution of the landslide. A combined seepage-slope stability analysis was conducted to reveal the deformation mechanism. The results show that the reactivation of the Yulinerzu landslide is dominated by reservoir water fluctuations rather than rainfall. The underlying geological condition of the colluvial landslide is its hydrogeological structure, which causes the landslide to deform in a step-like manner during reservoir operation. With the accumulation of displacement and morphology evolution, the landslide displayed self-stabilizing characteristics. Therefore, in the stability analysis and risk assessment of large deformation landslides, it is essential to take into account not only the hydraulic effects of reservoir fluctuation but also the evolution of landslide morphology. [ABSTRACT FROM AUTHOR]

MELAS syndrome with chronic intestinal pseudo-obstruction and neurological symptoms in a patient with a fatal evolution despite medical and surgical treatment.