Occurrence Rate Of Events Research Articles

The CX-DZ-II intelligent electronic stimulator for neck pain caused by cervical spondylosis: A two-center, randomized, controlled, and non-inferiority trial.

BackgroundElectroacupuncture (EA) has been commonly used for the management of neck pain caused by cervical spondylosis (NPCS); however, current electrical instruments have limitations on intelligence, digitalization, and visualization. The intelligent electronic stimulator (CX-DZ-II) is a digital device with an evidence-based diagnosis and treatment system. This study aimed to investigate the efficacy and safety of the CX-DZ-II intelligent EA instrument for NPCS.Materials and MethodsA total of 164 patients with NPCS [mean age (SD), 49.48 (13.47) years] were randomly assigned to receive 8 sessions (over 2 weeks) EA of the intelligent electronic stimulator (CX-DZ-II) or the regular electronic stimulator (SDZ-II). The primary outcome was the change of the visual analog scale (VAS) from baseline to 2 weeks of treatment. Secondary outcomes included mean scores of the VAS after each treatment in 1 week, responder rate, drug-usage rate of non-steroidal antipyretic analgesics (NSAAs), the occurrence rate of adverse events (AEs), proportions of apparatus with defect during treatment, and excellent rate of apparatus.ResultsThe intelligent electronic stimulator (CX-DZ-II) was non-inferior to the regular electronic stimulator (SDZ-II) for changes from baseline in the VAS [3.36 vs. 3.23, with a difference of 0.17 (95% CI, −0.36 to 0.69), P < 0.025 for non-inferiority]. No between-group differences were found in outcomes of VAS in 1 week, overall responders, and drug-usage rate of NSAAs. The defect rate and excellent rate of the instrument were similar in the CX-DZ-II and SDZ-II groups. Adverse events occurred in 9 (10.84%) patients in the CX-DZ-II group and 4 (5.00%) patients in the SDZ-II group.ConclusionThe intelligent electronic stimulator (CX-DZ-II) was non-inferior to the regular electronic stimulator (SDZ-II) in relieving neck pain. The intelligent electronic stimulator (CX-DZ-II) is a promising non-inferior alternative instrument for NPCS.Clinical Trial Registration[https://clinicaltrials.gov/], identifier [NCT030 05301].

Neoadjuvant docetaxel, oxaliplatin and S-1 therapy for the patients with large type 3 or type 4 gastric cancer (OGSG1902): protocol of a multi-center, phase II study

BackgroundLarge type 3 and type 4 gastric cancers have extremely poor prognoses. To address this, neoadjuvant chemotherapy may be a promising approach. The phase III JCOG0501 study, conducted to confirm the superiority of neoadjuvant S-1 plus cisplatin followed by D2 gastrectomy over upfront surgery, showed no survival benefit for neoadjuvant S-1 plus cisplatin. In Korea, the PRODIGY study, which was a phase III study of neoadjuvant docetaxel plus oxaliplatin plus S-1 (DOS) followed by surgery and adjuvant S-1 versus surgery and adjuvant S-1 for gastric cancer of T2-3N+ or T4Nany, showed that progression-free survival (PFS) was significantly superior in the neoadjuvant DOS arm. Therefore, DOS therapy may be a promising candidate for preoperative chemotherapy for large type 3 or type 4 gastric cancer.MethodsPreoperative docetaxel 40 mg/m2 and oxaliplatin 100 mg/m2 will be intravenously administered on day1 every three weeks. S-1 will be orally administered 80 mg/m2 on days 1–14 of a 21-day cycle. Patients will receive three courses of treatment and gastrectomy with ≥D2 lymph node dissection. Postoperative S-1 plus docetaxel therapy (DS) will be administered according to the JACCRO GC-07 (START-2) study. The primary endpoint is the 3-year PFS rate. Secondary endpoints include PFS time, overall survival time, pathological response rate, response rate according to RECIST version1.1, proportion of completion of neoadjuvant chemotherapy, R0 resection rate, proportion of completion of surgery, proportion of completion of protocol treatment, proportion of negative conversion of CY, adverse event occurrence rate, and nutritional evaluation. The null hypothesis for the 3-year PFS rate is 45% and the expected value is 60%. The total sample size is 46 considering that the registration period and follow-up period are two and three years, respectively.DiscussionThis is a prospective, multicenter, single-arm, open-label, phase II trial assessing the efficacy and safety of preoperative DOS and postoperative DS for large type 3 or type 4 gastric cancer. The results will inform future phase III trials and are expected to lead to new treatment strategies for large type 3 or type 4 gastric cancer.Trial registrationRegistered with Japan Registry of Clinical Trials on October 11, 2019 (jRCTs051190060).

Clinical Benefits of Early Concurrent Use of Cryoprecipitate and Plasma Compared With Plasma Only in Bleeding Trauma Patients.

The effectiveness of cryoprecipitate (Cryo) in trauma has not been well established; the benefits of Cryo might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. We aimed to evaluate the benefits of the concurrent use of Cryo in combination with fresh frozen plasma (FFP) for bleeding trauma patients. Retrospective cohort study. The American College of Surgeons Trauma Quality Improvement Program database between 2015 and 2019. Patients who received greater than or equal to 5 units of packed RBCs and at least 1 unit of FFP within the first 4 hours after arrival to a hospital were included and dichotomized according to whether Cryo was used within the first 4 hours of hospital arrival. None. The outcomes of patients treated with Cryo and FFP were compared with those treated with FFP only using propensity score-matching analysis. The dose of administered clotting factors in each group was balanced. The primary outcome was inhospital mortality, and the secondary outcome was the occurrence rate of adverse events. A total of 24,002 patients (Cryo+FFP group: 6,018; FFP only group: 17,984) were eligible for analysis, of whom 4,852 propensity score-matched pairs were generated. Significantly lower inhospital mortality (1,959 patients [40.4%] in the Cryo+FFP group vs 2,142 patients [44.1%] in the FFP only group; odds ratio [OR], 0.86; 95% CI, 0.79-0.93) was observed in the Cryo+FFP group; no significant difference was observed in the occurrence rate of adverse events (1,857 [38.3%] vs 1,875 [38.6%]; OR, 1.02; 95% CI, 0.94-1.10). Several sensitivity analyses showed similar results. Cryo use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients. Future randomized controlled trials are warranted to confirm these results.

O-287 Prognostic value of perivitelline-thread-associated kinetic activity of the plasma membrane of the pronuclear human zygote: a retrospective, observational study

Abstract Study question Is perivitelline-thread-associated kinetic activity of the zygote membrane prior to pronuclear fading (tPNf) indicative of the developmental potential of human embryos in vitro? Summary answer Embryos displaying kinetic activity of the zygote membrane had a significantly decreased clinical utilization rate, compared to those without. What is known already Morphology (pronuclei, cytoplasm etc.) of the pronuclear human zygote has been shown to correlate with ongoing embryo development and implantation potential. Further morphokinetic observations have been noted during this dynamic period of preimplantation development with the use of time-lapse imaging. The hypothesized mechanical actions of perivitelline threads (PVT) have been associated with blastomere fragmentation during early cleavage divisions and subsequent poor embryo development. Their presence and activity prior to tPNf and prognostic value with regard to treatment outcome, have not been studied in detail. Study design, size, duration This retrospective study assessed the development of 1047 two pronuclear (2PN) zygotes post IVF/ICSI until culture day 5, from a total of 172 patients which underwent time-lapse imaging monitoring with the EmbryoScope + (Vitrolife) between 01/06/2019 and 20/03/2020. Participants/materials, setting, methods Time-lapse videos of embryo development were analyzed manually for the detection and characterization of the ‘event’ of interest: an evident wave of membrane displacement coordinated by PVT prior to tPNf and first cleavage division. Assessed embryos were then categorized into two groups: an event group and a non-event group. The primary outcome of embryo utilization rate was compared between the two groups. Live birth and miscarriage rates per blastocyst transferred were assessed as secondary outcomes. Main results and the role of chance Morphokinetic analysis of the event established a mean commencement time at 22.5 ± 9.6 hours, cessation at 27.3 ± 4.7 hours, followed by tPNf at 27.9 ± 5.1 hours post fertilization. A total of 157 embryos in the event group and 890 in the non-event group were assessed (event occurrence rate of 15.0%). The average age of oocyte utilized was not significantly different between the event and non-event group at 34.6 years versus 34.5 years, respectively. The embryo utilization rate in the non-event group was significantly higher than that observed in the event group; 50.6% versus 29.9%, respectively (p &amp;lt; 0.001). The odds of an embryo not being utilized were higher in embryos with an observed event, compared to those without (OR = 2.3; 95% CI = 1.66, 3.45). Live birth rates for fresh blastocyst transfers were 42.9% (6/14) and 29.8% (42/141) for the event and non-event groups, respectively (p &amp;gt; 0.05). Miscarriage rates for fresh blastocyst transfers were 33.3% (3/9) and 35.4% (23/65) for the event and non-event groups, respectively (p &amp;gt; 0.05). Overall, these results indicate that event observation is associated with a significantly decreased embryo utilization rate due to subsequent poor embryo development in extended culture conditions. Limitations, reasons for caution A number of events occurring outside the plane of focus prevented accurate assessment, resulting in data exclusion. High levels of variability between the degree of kinetic activity, and transient nature of the PVT were observed. Differences in treatment outcomes were not powered for statistical analysis. Wider implications of the findings Notably, embryos displaying kinetic activity of the zygote membrane prior to tPNf are less likely to develop into embryos which can be utilized for transfer or cryopreservation. Observation of the described event may aid with clinical decision-making and managing patient expectations during the period of in vitro monitoring and development. Trial registration number Not applicable

Inference of a time-varying coefficient regression model for multivariate panel count data

Panel count data consist of the numbers of event occurrences between two consecutive observation times and are prevalent in many areas. Correspondingly a bulk of literature has been developed for the analysis of panel count data with time-independent or time-dependent covariates but assuming time-invariant covariate effects. However, the time-invariant coefficient assumption is too restrictive in reality and fails to represent the time-dynamic association between the covariates and event occurrence rates. In this paper, we discuss regression analysis of multivariate panel count data where both the covariates and their effects may be time-varying. We propose a marginal estimating equation approach combined with the B-splines that approximate the functional forms of the regression coefficients. The asymptotic properties of the proposed estimators are rigorously established. A simulation study is conducted to assess the performance of the proposed estimation procedure and suggests that it works well for practical situations. The proposed methodology is applied to a real dataset that motivated this study.

Analysis of Hospital-Level Readmission Rates and Variation in Adverse Events Among Patients With Pneumonia in the United States

It is known that hospitalized patients who experience adverse events are at greater risk of readmission; however, it is unknown whether patients admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. To evaluate whether patients with pneumonia admitted to hospitals with higher risk-standardized readmission rates had a higher risk of adverse events. This cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS), a randomly selected medical record abstracted database, to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. Patients with pneumonia discharged from July 1, 2010, through December 31, 2019, in the MPSMS data were included. Hospital performance on readmissions was determined by the risk-standardized 30-day all-cause readmission rate. Mixed-effects models were used to examine the association between adverse events and hospital performance on readmissions, adjusted for patient and hospital characteristics. Analysis was completed from October 2019 through July 2020 for data from 2010 to 2017 and from March through April 2022 for data from 2018 to 2019. Patients hospitalized for pneumonia. Adverse events were measured by the rate of occurrence of hospital-acquired events and the number of events per 1000 discharges. The sample included 46 047 patients with pneumonia, with a median (IQR) age of 71 (58-82) years, with 23 943 (52.0%) women, 5305 (11.5%) Black individuals, 37 763 (82.0%) White individuals, and 2979 (6.5%) individuals identifying as another race, across 2590 hospitals. The median hospital-specific risk-standardized readmission rate was 17.0% (95% CI, 16.3%-17.7%), the occurrence rate of adverse events was 2.6% (95% CI, 2.54%-2.65%), and the number of adverse events per 1000 discharges was 157.3 (95% CI, 152.3-162.5). An increase by 1 IQR in the readmission rate was associated with a relative 13% higher patient risk of adverse events (adjusted odds ratio, 1.13; 95% CI, 1.08-1.17) and 5.0 (95% CI, 2.8-7.2) more adverse events per 1000 discharges at the patient and hospital levels, respectively. Patients with pneumonia admitted to hospitals with high all-cause readmission rates were more likely to develop adverse events during the index hospitalization. This finding strengthens the evidence that readmission rates reflect the quality of hospital care for pneumonia.

Formation of Dataset for Fuzzy Quantitative Risk Assessment of LNG Bunkering SIMOPs

New international regulations aimed at decarbonizing maritime transportation are positively contributing to attention being paid to the use of liquefied natural gas (LNG) as a ship fuel. Scaling up LNG-fueled ships is highly dependent on safe bunkering operations, particularly during simultaneous operations (SIMOPs); therefore, performing a quantitative risk assessment (QRA) is either mandated or highly recommended, and a dynamic quantitative risk assessment (DQRA) has been developed to make up for the deficiencies of the traditional QRA. The QRA and DQRA are both data-driven processes, and so far, the data of occurrence rates (ORs) of basic events (BEs) in LNG bunkering SIMOPs are unavailable. To fill this gap, this study identified a total of 41 BEs and employed the online questionnaire method, the fuzzy set theory, and the Onisawa function to the investigation of the fuzzy ORs for the identified BEs. Purposive sampling was applied when selecting experts in the process of online data collection. The closed-ended structured questionnaire garnered responses from 137 experts from the industry and academia. The questionnaire, the raw data and obtained ORs, and the process of data analysis are presented in this data descriptor. The obtained data can be used directly in QRAs and DQRAs. This dataset is first of its kind and could be expanded further for research in the field of risk assessment of LNG bunkering.

Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting.

Fluoroscopy forms an essential part of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and hepaticogastrostomy with antegrade stenting (EUS-HGAS). To date, no study has assessed and compared radiation exposure between EUS-HGS and EUS-HGAS. This study aimed to compare the radiation exposure parameters between EUS-HGS and EUS-HGAS. This retrospective single-center cohort study included consecutive patients who underwent EUS-HGS or EUS-HGAS from October 2017 to March 2019. The air kerma (AK: mGy), kerma–area product (KAP: Gycm2), fluoroscopy time (FT: min), and procedure time (PT: min) were assessed and compared between the two procedures. Altogether, 45 and 24 patients underwent EUS-HGS and EUS-HGAS, respectively. The median AK, KAP, FT, and PT were higher in the EUS-HGAS group than in the EUS-HGS group. A comparison revealed no difference in the technical success rate, complications rate, adverse event occurrence rate, and re-intervention rate between both procedures. This is the first report in which radiation exposure was used as a comparative parameter between EUS-HGS and EUS-HGAS. This study revealed that radiation exposure is significantly higher in EUS-HGAS than in EUS-HGS. Increased awareness on radiation exposure is warranted among gastroenterologists so that they choose the procedure with lower radiation exposure in cases where both procedures are indicated.

The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS.

Burning mouth syndrome (BMS) is defined by chronic oral burning sensations without any corresponding abnormalities. Besides amitriptyline, aripiprazole has been reported as a possible medication to manage BMS. However, especially for elderly patients, the adverse events of these medications would be a problem. The aim of the present study was to investigate the differences in the effectiveness and adverse events of amitriptyline and aripiprazole in very elderly patients with BMS. This is a retrospective comparative study of 80 years old and older patients with BMS who were initially treated with amitriptyline or aripiprazole and who were new outpatients of our department from April 2017 to March 2020. All clinical data, including sex, age, comorbid physical diseases, comorbid psychiatric disorders, the prescribed doses (initial, maximum, and effective dose), prognosis, and adverse events, were collected from their medical charts. Each medication was selected considering their medical history. Amitriptyline was prescribed in 13 patients (11 women, 82.3 ± 2.1 years old) and aripiprazole was prescribed in 27 patients (26 women, 84.2 ± 3.8 years old). There were no significant between-group differences in sex, age, duration of illness, pain intensity, salivation, and psychiatric comorbidity at the first examination. Amitriptyline clinically improved more patients (7 patients, 53.8%) with the effective dose of 10 (7.5, 15.0) mg than aripiprazole (11 patients, 40.7%) of which the effective dose was 1.0 (0.5, 1.5) mg, although there were no significant between-group differences. The adverse events of amitriptyline were found in 9 patients (69.2%) and most patients had constipation (46.2%). For aripiprazole, 7 patients (25.9%) showed adverse events, most of them reported sleep disorder (11.1%). Amitriptyline had significantly longer duration taking medication (p = 0.021) and lower discontinuation (p = 0.043) despite of higher occurrence rate of adverse events (p = 0.015) compared to aripiprazole. These results suggest that both psychopharmacotherapies with a low dose of amitriptyline and aripiprazole are effective for the very elderly patients with BMS. Furthermore, aripiprazole may have some advantages in the adverse events compared to amitriptyline; however, the low dose amitriptyline monotherapy may have more benefit in the effectiveness and tolerability over prudent collaboration with primary physicians.

Periodic/Aperiodic parameterization of transient oscillations (PAPTO)–Implications for healthy ageing

Two techniques for analyzing human extracranial neurophysiological signals, namely the periodic/aperiodic parameterization of neural power spectra and the transient events framework of oscillatory activity, have recently emerged in the scientific literature. In this work, we integrate these two analysis perspectives to analyze extracranial neurophysiological signals as a series of transient rhythmic events disambiguated from the background aperiodic activity. We call this novel technique the periodic/aperiodic parametrization of transient oscillations (PAPTO). We demonstrate PAPTO by investigating resting-state sensorimotor magnetoencephalography recordings from the Cambridge Center for Ageing and Neuroscience cross-sectional study on healthy ageing (n = 600, ages 18–88). We show that PAPTO is more sensitive to neocortical transient beta rhythms compared to more conventional transient event detection algorithms and captures more variance in the resting-state occurrence rate of beta events across participants. The improved sensitivity of PAPTO reveals that the beta occurrence rate almost doubles over the adult lifespan which we discuss in terms of thalamocortical beta generation in the somatosensory cortex and the age-related decline of sensory perception.

Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers.

Simple SummaryPatients with head and neck cancers may suffer from cancer-associated thromboembolism and direct oral anticoagulants (DOACs) are a potential new therapeutic option. We aimed to determine the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with head and neck cancers. In our study, DOAC users had significantly better disease-specific survival (DSS) and higher overall survival (OS) rates than warfarin users and those who did not use any anticoagulant. Further, there were no significant differences in the occurrence rate of bleeding or ischemic events between DOAC and warfarin users. Our study suggested that DOACs can be a treatment choice or prophylaxis for tumor emboli in head and neck cancer patients and that they might be a better choice than traditional anticoagulants.Increasing clinical evidence supports the use of direct oral anticoagulants (DOACs) as a potential new therapeutic option for patients suffering from cancer-associated thromboembolism. However, the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with head and neck cancer has not been well studied. A total of 1025 patients diagnosed as having head and neck cancer, including 92 DOAC users, 113 warfarin users, and 820 nonusers of anticoagulants, were selected from the Chang Gung Research Database between January 2001 and December 2019. The patients were matched using the propensity-score method. The survival rates were estimated among the three groups using the Kaplan–Meier method. The protective effects and side effects of the two anticoagulants were compared using the chi-square test. The death rate (18 patients, 19.57%) in patients using DOACs was significantly lower than that in patients using warfarin (68 patients, 60.18%) and those not using any anticoagulant (403 patients, 49.15%). DOAC users had significantly better disease-specific survival (DSS) than warfarin users (p = 0.019) and those who did not use any anticoagulant (p = 0.03). Further, DOAC users had significantly higher overall survival (OS) rates than warfarin users and those who did not use any anticoagulant (p = 0.003). Patients with oropharyngeal and laryngeal cancer and DOAC users had a significantly lower hazard ratio for survival, whereas patients with American Joint Committee on Cancer stage IV disease and those receiving multidisciplinary treatment (e.g., surgery with radiotherapy or concurrent radiochemotherapy) had a significantly higher hazard ratio for survival. Among them, patients with laryngeal cancer (HR = 0.47, 95% CI = 0.26–0.86, p = 0.0134) and DOAC users (HR = 0.53, 95% CI = 0.29–0.98, p = 0.042) had the lowest hazard ratio from DSS analysis. Similarly, patients with laryngeal cancer (HR = 0.48, 95% CI = 0.30–0.76, p = 0.0018) and DOAC users (HR = 0.58, 95% CI = 0.36–0.93, p = 0.0251) had the lowest hazard ratio from OS analysis. As for the protective effects or side effects of anticoagulants, there were no significant differences in the occurrence rate of bleeding or ischemic events between DOAC and warfarin users. In our study, DOACs were found to be better than warfarin in terms of survival in patients with head and neck cancer. As regards thromboembolism prevention and side effects, DOACs were comparable to warfarin in our patients. DOACs can be a treatment choice or prophylaxis for tumor emboli in head and neck cancer patients and they might be a better choice than traditional anticoagulants according to the results of our study.

The implementation of a standardized optimal procedure for peripheral venous catheters' management: Results from a multi-dimensional assessment.

Peripheral Venous Catheter (PVC) is a widely used device in the hospital setting and is often associated with significant adverse events that may impair treatment administration and patient health. The aim of the present study is to define the incremental benefits related to the implementation and the standardized and simultaneous use of three disposable devices for skin antisepsis, infusion, and cleaning, assuming the hospital's point of view, from an effectiveness, efficiency, and organizational perspective. For the achievement of the above objective, real-life data were collected by means of an observational prospective study, involving two hospitals in the Liguria Region (Northern Italy). Consecutive cases were enrolled and placed into two different scenarios: 1) use of all the three disposable devices, thus representing the scenario related to the implementation of a standardized optimal procedure (Scenario 1); 2) use of only one or two disposable devices, representing the scenario related to not being in a standardized optimal procedure (Scenario 2). For the definition of effectiveness indicators, the reason for PVC removal and the PVC-related adverse events occurrence were collected for each patient enrolled. In addition, an activity-based costing analysis grounded on a process-mapping technique was conducted to define the overall economic absorption sustained by hospitals when taking in charge patients requiring a PVC. Among the 380 patients enrolled in the study, 18% were treated with the standardized optimal procedure (Scenario 1). The two Scenarios differed in terms of number of patients for whom the PCV was removed due to the end of therapy (86.8% versus 39.40%, p-value = 0.000), with a consequent decrease in the adverse events occurrence rate. The economic evaluation demonstrated the sustainability and feasibility of implementing the standardized optimal procedure specifically related to the need for lower economic resources for the hospital management of adverse events occurred (€19.60 versus €21.71, p-value = 0.0019). An organizational advantage also emerged concerning an overall lower time to execute all the PVC-related activities (4.39 versus 5.72 minutes, p-value = 0.00). Results demonstrate the feasibility in the adoption of the standardized optimal procedure for PVC management, with significant advantages not only from a clinical point of view, but also from an organizational and economic perspective, thus being able to increase the overall operational efficiency of the hospitals.

Out-of-the-ICU Mobilization in Critically Ill Patients: The Safety of a New Model of Rehabilitation.

OBJECTIVES:Early mobilization of ICU patients has been reported to be safe and feasible. Recently, our ICU implemented out-of-the-ICU wheelchair excursions as a daily rehabilitation practice. The aim of this study is to investigate the safety of participation in the out-of-the-ICU program for early mobilization.DESIGN:Retrospective cohort study.SETTING:Single general ICU in a tertiary teaching hospital.PATIENTS:Adult patients who were admitted to the ICU and underwent the out-of-the-ICU program as an early mobilization intervention was investigated.INTERVENTIONS:The out-of-the-ICU activities include visiting indoor area, visiting our outdoor garden, and bathing.MEASUREMENTS AND MAIN RESULTS:Medical records of ICU patients who participated in the out-of-the-ICU program were reviewed. The primary outcome was the occurrence rate of physical safety events, defined as unintentional removal of medical devices, patient agitation, a fall, or an injury. The secondary outcome was the occurrence rate of adverse physiologic changes, defined as hypotension, hypertension, bradycardia, tachycardia, desaturation, bradypnea, tachypnea, an increase in Fio2, or an increase in doses of vasoactive drugs. In total, 99 adult patients participated in the program, comprising a total of 423 out-of-the-ICU sessions. Among them, one session resulted in a physical safety event, the dislodgement of a tracheostomy tube. In 23 sessions, one or two adverse physiologic changes occurred. None of these events required additional treatment nor resulted in serious sequelae.CONCLUSIONS:An out-of-the-ICU program can be provided safely to adult ICU patients, provided that it is supervised by a dedicated intensivist with an appropriately trained multiprofessional staff and equipment on-site. It appears to contribute to the promotion of humanizing intensive care.

Occurrence rate and duration of space weather impacts on high-frequency radio communication used by aviation

High frequency (HF) radio wave propagation is sensitive to space weather-induced ionospheric disturbances that result from enhanced photoionization and energetic particle precipitation. Recognizing the potential risk to HF radio communication systems used by the aviation industry, as well as potential impacts on GNSS navigation and the risk of elevated radiation levels, the International Civil Aviation Organization (ICAO) initiated the development of a space weather advisory service. For HF systems, this service specifically identifies shortwave fadeout, auroral absorption, polar cap absorption, and post-storm maximum useable frequency depression (PSD) as phenomena impacting HF radio communication and specifies moderate and severe event thresholds to describe event severity. This paper examines the occurrence rate and duration of events crossing the moderate and severe thresholds. Shortwave fadeout was evaluated based on thresholds in the solar X-ray flux. Analysis of 40-years of solar X-ray flux data showed that moderate and severe level solar X-ray flares were observed, on average, 123 and 5 times per 11-year solar cycle, respectively. The mean event duration was 68 min for moderate level events and 132 min for severe level events. Auroral absorption events crossed the moderate threshold for 40 events per solar cycle, with a mean event duration of 5.1 h. The severe threshold was crossed for 3 events per solar cycle with a mean event duration of 12 h. Polar cap absorption had the longest mean duration at ~8 h for moderate events and 1.6 days for severe events; on average, 24 moderate and 13 severe events were observed per solar cycle. Moderate and severe thresholds for shortwave fadeout, auroral absorption, and polar cap absorption were used to determine the expected impacts on HF radio communication. Results for polar cap absorption and shortwave fadeout were consistent with each other, but the expected impact for auroral absorption was shown to be 2–3 times higher. Analysis of 22 years of ionosonde data showed moderate, and severe PSD events occurred, on average, 200 and 56 times per 11-year solar cycle, respectively. The mean event duration was 5.5 h for moderate-level events and 8.5 h for severe-level events. During solar cycles 22 and 23, HF radio communication was expected to experience moderate or severe impacts due to the ionospheric disturbances caused by space weather, a maximum of 163 and 78 days per year, respectively, due to the combined effect of absorption and PSD. The distribution of events is highly non-uniform with respect to the solar cycle: 70% of moderate or severe events were observed during solar maximum compared to solar minimum.

Peri-abortion contraceptive counseling: A systematic review of randomized controlled trials.

To assess the effects of peri-abortion contraceptive counseling interventions. We performed a systematic review of randomized controlled trials (RCTs) that compared the effect of different types of peri-abortion contraceptive counseling interventions and were published as original papers in scientific journals. The literature search was performed in June 2021 in PubMed, Central Cochrane Library (CENTRAL), Scopus, and Google Scholar; without restrictions in language or publication date. Two independent authors identified studies that met the inclusion and exclusion criteria and extracted the data. The risk of bias was assessed using the Cochrane tool, and evidence certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Whenever possible, meta-analyses were performed. The protocol was registered at PROSPERO (CRD42020187354). Eleven RCTs were eligible for inclusion (published from 2004 to 2017), from which nine compared enhanced versus standard counseling. Pooled estimates showed that, compared to standard counseling, enhanced counseling was associated with a higher incidence of effective contraceptive use (>3 months) (relative risk [RR], 1.12; 95% confidence interval [CI], 1.09-1.16), although no significant difference was found in the incidence of long-acting reversible contraceptive use (RR, 1.25; 95% CI, 0.68-2.29), contraceptive uptake (RR, 1.06; 95% CI, 0.98-1.15), and obstetric event occurrence (RR, 0.91; 95% CI, 0.57-1.47). Certainty of evidence was very low for all outcomes. In addition, two studies compared contraceptive counseling provided by physicians versus that provided by non-physicians, which did not show significant differences. Enhanced contraceptive counseling may favor effective contraceptive use but may not affect the rate of obstetric event occurrence. Also, the studies did not find a difference in the effects of counseling interventions given by different providers. Since evidence certainty was very low, future well-designed RCTs are needed to make informed decisions. The study protocol was registered at PROSPERO (CRD42020187354).

Great Lakes Basin Heat Waves: An Analysis of Their Increasing Probability of Occurrence Under Global Warming

Extreme heat events in the Great Lakes Basin (GLB) region of eastern North America are expected to increase in concert with greenhouse gas (GHG) induced global warming. The extent of this regional increase is also influenced by the direct effects of the Great Lakes themselves. This paper describes results from an ensemble of dynamically downscaled global warming projection using the Weather Research and Forecast (WRF) regional climate model coupled to the Freshwater Lake (FLake) model over the Great Lakes region. In our downscaling pipeline, we explore two sets of WRF physics configurations, with the initial and boundary conditions provided by four different fully coupled Global Climate Models (GCMs). Three time periods are investigated, namely an instrumental period (1979–1989) that is employed for validation, and a mid-century (2050–2060) and an end-century (2085–2100) periods that are used to understand the future impacts of global warming. Results from the instrumental period are characterized by large variations in climate states between the ensemble members, which is attributed to differences in both GCM forcing and WRF physics configuration. Results for the future periods, however, are such that the regional model results have good agreement with GCM results insofar as the rise of average temperature with GHG is concerned. Analysis of extreme heat events suggests that the occurrence rate of such events increase steadily with rising temperature, and that the Great Lakes exert strong lake effect influence on extreme heat events in this region.

Statistical Study of Small-scale Magnetic Holes in the Upstream Regime of the Martian Bow Shock

Abstract Small-scale magnetic holes (SSMHs) are frequently observed in the solar wind at 1 au, as well as the terrestrial current sheet and magnetosheath. These kinetic-size structures play an important role in energy dissipation and particle transportation. Here, we report the existence of SSMHs in the upstream regime of the Martian bow shock and statistically investigate these SSMHs based on 5 yr observations of the Mars Atmosphere and Volatile EvolutioN spacecraft. A total of 549 SSMHs are found, and their durations and sizes obey the lognormal distribution. The median duration is ∼0.46 s, and the median size is ∼2 ion inertial lengths. We regard an isolated SSMH or a train of SSMHs as a SSMH event. The average occurrence rate of the SSMH events is ∼0.6 event per day. The occurrence rate is much larger in the region belonging to the ion foreshock on average, suggesting that the ion foreshock is an important source of SSMHs. The occurrence of the SSMH events tends to be larger when the ion number density and the interplanetary magnetic field (IMF) strength are larger, indicating that the generation of SSMHs might be associated with ions and the IMF strength. Although their generation mechanism is still unclear, the finding of the link between the occurrence rate of the SSMH events and ion number density, as well as the IMF strength, might provide a clue to further reveal the generation mechanism of SSMHs in the solar wind or planetary foreshock.

Optimal timing for removing a laryngeal mask airway in patients with special needs

ObjectiveWhether a laryngeal mask airway (LMA) should be removed under deep anesthesia or after awakening from general anesthesia remains controversial. Among patients with special needs, removing an LMA after awakening might be difficult because they may be unable to follow instructions during LMA removal. Thus, requirements of patients with special needs must be taken into consideration while deciding on LMA removal. This study aimed to determine optimal timing of LMA removal after dental treatment under general anesthesia in disabled patients by comparing adverse event occurrence rates. MethodsBetween February and December 2018, we randomly categorized 80 disabled patients administered general anesthesia into two groups, namely, the Deep group (40 patients, LMA removed under deep anesthesia) or the Preawake group (40 patients, LMA removed in the Preawake state). Anesthesia in both groups comprised propofol (PROP) and remifentanil (RMFT), and flexible LMAs were used. Dental anesthesiologists assessed the frequency of adverse events, both during and immediately after LMA removal. ResultsClenching, gross body movement, and difficult ventilation were more frequently seen in the Preawake group than in the Deep group (P < 0.05; χ2 test). The rate of coughing, although higher in the Preawake group, was not significantly different between the groups. Laryngospasm occurred in one case in the Preawake group, but the event was insignificant and was responsive to 40 mg PROP administration. ConclusionsAmong disabled patients requiring general anesthesia with PROP and RMFT for dental treatment, LMA should be removed under deep anesthesia to minimize adverse events.

Obstructive sleep apneas naturally occur in mice during REM sleep and are highly prevalent in a mouse model of Down syndrome

Study objectivesThe use of mouse models in sleep apnea study is limited by the belief that central (CSA) but not obstructive sleep apneas (OSA) occur in rodents. We aimed to develop a protocol to investigate the presence of OSAs in wild-type mice and, then, to apply it to a validated model of Down syndrome (Ts65Dn), a human pathology characterized by a high incidence of OSAs. MethodsIn a pilot study, nine C57BL/6J wild-type mice were implanted with electrodes for electroencephalography (EEG), neck electromyography (nEMG), and diaphragmatic activity (DIA), and then placed in a whole-body-plethysmographic (WBP) chamber for 8 h during the rest (light) phase to simultaneously record sleep and breathing activity. CSA and OSA were discriminated on the basis of WBP and DIA signals recorded simultaneously. The same protocol was then applied to 12 Ts65Dn mice and 14 euploid controls. ResultsOSAs represented about half of the apneic events recorded during rapid-eye-movement-sleep (REMS) in each experimental group, while the majority of CSAs were found during non-rapid eye movement sleep. Compared with euploid controls, Ts65Dn mice had a similar total occurrence rate of apneic events during sleep, but a significantly higher occurrence rate of OSAs during REMS, and a significantly lower occurrence rate of CSAs during NREMS. ConclusionsMice physiologically exhibit both CSAs and OSAs. The latter appear almost exclusively during REMS, and are highly prevalent in Ts65Dn. Mice may, thus, represent a useful model to accelerate the understanding of the pathophysiology and genetics of sleep-disordered breathing and to help the development of new therapies.

Chemical Response of the Upper Atmosphere Due to Lightning‐Induced Electron Precipitation

AbstractTerrestrial lightning frequently serves as a loss mechanism for energetic electrons in the Van Allen radiation belts, leading to lightning‐induced electron precipitation (LEP). Regardless of the specific causes, energetic electron precipitation from the radiation belts in general has a significant influence on the ozone concentration in the stratosphere and mesosphere. The atmospheric chemical effects induced by LEP have been previously investigated using subionospheric VLF measurements at Faraday station, Antarctica (65.25°S, 64.27°W, L = 2.45). However, there exist large variations in the precipitation flux, ionization production, and occurrence rate of LEP events depending on the peak current of the parent lightning discharge, as well as the season, location, and intensity of the thunderstorm activity. These uncertainties motivate us to revisit the calculation of atmospheric chemical changes produced by LEP. In this study, we combine a well‐validated LEP model and first‐principles atmospheric chemical simulation, and investigate three intense storms in the year of 2013, 2015, and 2017 at the magnetic latitude of 50., 32., and 35., respectively. Modeling results show that the LEP events in these storms can cumulatively drive significant changes in the , , and concentration in the mesosphere. These changes are as high as , , and at 75–85 km altitude, respectively, and comparable to the effects typically induced by other types of radiation belt electron precipitation events. Considering the high occurrence rate of thunderstorms around the globe, the long‐term global chemical effects produced by LEP events need to be properly quantified.