Letters Information Research Articles

Strategies to Limit Benzodiazepine Use in Anesthesia for Older Adults

Despite guidelines recommending avoidance of benzodiazepine administration to older patients, many of them now receive benzodiazepines as a part of anesthesia care. The effectiveness of clinician- and patient-facing interventions to discourage such use remains insufficiently characterized. To evaluate the effect of clinician peer comparison, patient informational mail, or a combination of these interventions compared with usual care on the rate of perioperative benzodiazepine administration to older patients. This 2 × 2 factorial, stepped-wedge, cluster randomized clinical trial of a corporate quality improvement initiative was conducted between August 8, 2022, and May 28, 2023, across 415 hospitals, surgery centers, and physician offices in 8 US states served by anesthesia clinicians from a national anesthesia practice. Participants were adults aged 65 years or older who underwent an elective surgical or endoscopic procedure with general anesthesia. Data analyses followed the intention-to-treat principle. Patients were randomly assigned to 1 of 4 groups-clinician peer comparison (wherein clinicians received feedback regarding their performance compared with other clinicians in the practice), patient informational mail (wherein patients received an informational letter encouraging them to have a discussion regarding medication selection with their clinician on the day of surgery), both interventions, or usual care (no intervention). Rate of benzodiazepine administration during anesthesia care and patient satisfaction with anesthesia care (measured by the Anesthesia Patient Satisfaction Questionnaire, version 2). Among the 509 269 enrolled participants (255 871 females [50.2%]; mean [SD] age, 74 [7] years), 81 363 (16.0%) were assigned to clinician peer comparison, 98 520 (19.3%) to patient informational mail, 169 712 (33.3%) to both interventions, and 159 674 (31.4%) to usual care. Among patients who received benzodiazepine during anesthesia care, 24.5% were in the usual care group compared with 19.7% in the clinician peer comparison group, 20.0% in the patient informational mail group, and 19.7% in the combination group. After adjustment for time, none of the study interventions were associated with lower odds of benzodiazepine administration compared with usual care (odds ratio [OR], 1.02 [95% CI, 0.98-1.07]; P = .35 for clinician peer comparison; OR, 1.01 [95% CI, 0.96-1.05]; P = .81 for patient informational mail; and OR, 1.11 [95% CI, 1.05-1.16]; P < .001 for combined interventions). Satisfaction scores were high in all groups and did not vary by treatment assignment. This randomized clinical trial found that clinician peer comparison, patient informational mail, or a combination of both interventions did not reduce benzodiazepine administration to older patients compared with usual care; patient satisfaction remained high throughout the study. Overall, the findings suggest a need to explore other patient-targeted interventions to improve anesthesia care. Clinicaltrials.gov Identifier: NCT05436392.

Effect of integrated medicines management on quality of discharge medication information - a secondary endpoint in a randomized controlled trial.

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 (mean difference 2.7, 95% CI 2.3-3.2, p < 0.001). In total 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), p < 0.001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, p < 0.001). Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

Multimodal, Ultrasensitive, and Biomimetic Electronic Skin Based on Gradient Micro‐Frustum Ionogel for Imaginary Keyboard and Haptic Cognition

AbstractElectronic skins (E‐skins) are poised to revolutionize human interaction not only with one another but also with machines, electronics, and surrounding environment. However, the wearable E‐skin that simultaneously offers multiple sensing capabilities, high sensitivity, and broad sensing ranges remains a great challenge. Here, drawing inspiration from human haptic perception, a multimodal, ultrasensitive, and biomimetic E‐skin (MES) founded on micro‐frustum ionogel is developed based on iontronic capacitive and triboelectric effects for imaginary keyboard and multifunctional haptic cognition. Leveraging simultaneously the ionogel as capacitive layer and triboelectric layer, the MES enables human‐dermis perception performances of high sensitivity (357.56 kPa−1), low limit of detection (0.47 Pa), and broad linear detection range (0–500 kPa). Moreover, human finger joint movements can be precisely monitored by the attached MES and be transferred into accurate typed letter information on an imaginary keyboard. More importantly, by harnessing signal acquisition/processing circuits and machine learning, the real‐time haptic cognition of different materials, surface roughness, and contact pressure can be achieved by the MES, which endows the advancement of interaction between next‐generation intelligent robot and physical environment. Consequently, the proposed MES demonstrates impressive potentials in the fields of wearable electronics, human–machine interaction (HMI), and Artificial Intelligence (AI).

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

Modulation of audiovisual integration in the left and right sides: effects of side and spatial coherency

BackgroundUsing event-related potentials (ERPs), we aimed to investigate audiovisual integration neural mechanisms during a letter identification task in the left and right sides. Unimodal (A,V) and bimodal (AV) stimuli were presented on either side, with ERPs from unimodal (A,V) stimuli on the same side being compared to those from simultaneous bimodal stimuli (AV). Non-zero results of the AV-(A + V) difference waveforms indicated audiovisual integration on the left/right side.ResultsWhen spatially coherent AV stimuli were presented on the right side, two significant ERP components in the integrated differential wave were noted. The N134 and N262, present in the first 300 ms of the AV-(A + V) integration difference wave, indicated significant audiovisual integration effects. However, when these stimuli were presented on the left side, there were no significant integration components. This audiovisual integration difference may stem from left/right asymmetry of cerebral hemisphere language processing.ConclusionsAudiovisual letter information presented on the right side was easier to integrate, process, and represent. Additionally, only one significant integrative component peaked at 140 ms in the parietal cortex for spatially non-coherent AV stimuli and provided audiovisual multisensory integration, which could be attributed to some integrative neural processes that depend on the spatial congruity of the auditory and visual stimuli.

Diagnostic information in GP referral letters to a memory clinic: a cohort study.

Dementia diagnostics can often be performed in primary care, yet older persons with memory complaints are frequently referred to memory clinics (MCs). To compare diagnostic information in general practitioner (GP) referral letters of patients with and without an eventual dementia diagnosis. Retrospective cohort study in a Dutch academic geriatric MC. We collected electronic health record (EHR) data of consecutive patients aged≥65 referred by their GP between 2016-2020. EHR data included patient characteristics, diagnostic information in referral letters, ancillary investigations performed at the MC, and established diagnoses. Chi-square tests were applied to compare groups. Of 651 patients included, the average age was 78.0 (SD: 6.8), and 348 (53.5%) were diagnosed with dementia. Most people with dementia were diagnosed without ancillary investigations (235/348, 67.5%). In GP referral letters of people with dementia compared with people without dementia, a collateral history, any physical examination, a differential diagnosis including dementia, an MMSE score, interference with daily functioning, and decline from previous levels of functioning were mentioned more often. Furthermore, the more diagnostic criteria mentioned in the referral letter, the more often dementia was diagnosed at the MC (no criteria: 35.4%, one criterion: 47.3%, two criteria: 53.4%, three criteria: 69.9%, four or five criteria: 83.3%). GPs often correctly mention diagnostic information and dementia criteria in referral letters of people with dementia, and they are often diagnosed without ancillary investigations. This suggests that referral is often unnecessary, and GPs can be empowered to diagnose dementia themselves.

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

Nudging for prompt tax penalty payment: Evidence from a field experiment in Indonesia

We conduct a randomised controlled trial in Indonesia to evaluate the effect of three intervention letters on tax penalty compliance behaviour. Over 10,000 individual taxpayers are randomly assigned to receive either a deterrence, information, or simplification letter, or no letter. Our results indicate that simplification, which makes paying a penalty less burdensome administratively by providing billing codes to pay the penalties, yields the highest probability of timely settlement, increasing compliance by 32% compared to the control group. Deterrence also positively impacts penalty compliance, increasing timely settlement rates by 27%. The least effective intervention is the information letter. Although associated with a 10% increase in timely settlement, this effect is statistically insignificant at the 10% confidence level. Our results suggest that strategic messaging by tax authorities in developing countries can be a cost-effective tool for improving tax penalty payment compliance.

Профилактика правонарушений и предупреждение преступности органами прокуратуры и другими правоохранительными органами

The article is devoted to the study of the issue of delinquency prophylaxis and crime prevention. The article analyzes the definitions of “prophylaxis” and “prevention” in relation to offenses and crimes. The content and essence of delinquency prophylaxis and crime prevention are revealed. The authors examines the norms of the current legislation in the field of crime prevention, orders and information letters of the General Prosecutor’s Office of the Russian Federation. The authors comes to the conclusion that between the Federal Law of June 23, 2016 No. 182-FZ “On the Basics of Crime Prevention in the Russian Federation” and the Federal Law of January 17, 1992 No. 2202-1 “On the Prosecutor’s Office of the Russian Federation” there are legal conflicts that require legislative permissions and settlements in law enforcement. The powers of the prosecutor’s office to coordinate the activities of law enforcement agencies to combat crime are analyzed. Several changes and additions to the current legislation of the Russian Federation, which regulates the issues of crime prevention, are proposed.

Assessment of a systematic approach for implementing novel medications in clinical practice: an observational study with dapagliflozin

ObjectiveTo assess a systematic implementation approach for introducing dapagliflozin to individuals with heart failure and reduced ejection fraction in an outpatient clinical setting.MethodsRetrospective medical record data were analysed. All individuals diagnosed with heart failure who resided within the hospital catchment area and had visited cardiology or internal medicine department between 2010 and 2019 were screened by using the main inclusion criteria from the DAPA-HF trial. The effectiveness of the previously described seven-step systematic implementation approach was assessed by the proportion receiving information letter, dapagliflozin treatment, follow-ups at 2–12 weeks and 12 months post-dapagliflozin initiation, persistence on dapagliflozin, adverse events, and reasons for discontinuation.ResultsOf the 2433 individuals, 352 met the main DAPA-HF trial criteria in step 2. After exclusions in steps 3 and 4, 191 individuals remained. Of these, 158 were invited for eligibility discussion in step 5, with 107 having received an information letter beforehand. In step 6, dapagliflozin was prescribed to 69 individuals, and in step 7, follow-ups were conducted with 56 individuals at 2–12 weeks and 62 individuals at 12 months. Sixty out of 69 persisted on dapagliflozin after 12 months. Adverse events were reported by nine individuals. Discontinuation was attributed to reasons such as urinary tract infections, genital or abdominal discomfort, and hypotension.ConclusionThe systematic introduction of dapagliflozin to heart failure patients was effective. Despite this, challenges in uniformly implementing procedures across patients were evident, emphasizing the necessity for a systematic implementation approach.

NRC’s methodology to estimate fuel dispersal during a large break loss of coolant accident

Recent experimental findings indicate that under certain transient conditions, high-burnup fuel operating at sufficiently high power can fragment and escape from burst fuel cladding, as discussed in the Nuclear Regulatory Commission’s Research Information Letter (RIL) 2021–13. The escaped fuel fragments could subsequently be distributed throughout a reactor coolant system (RCS), potentially challenging core coolability during a loss of coolant accident (LOCA). Consequently, the NRC has developed a methodology to estimate the mass of fuel that could be dispersed during a large-break LOCA. The methodology involves several NRC-sponsored computer codes, including SCALE/Polaris for lattice physics, PARCS/PATHS for full-core neutronics, TRACE for core and RCS thermal hydraulics, and FAST for steady-state and transient fuel performance calculations. Output from FAST is combined with the models in RIL 2021–13 to estimate fuel dispersal to the coolant.NRC staff have exercised this methodology using a prospective Westinghouse four loop core design with high burnup and extended enrichment that was obtained from the Department of Energy’s NEAMS program. Results demonstrate that the NRC methodology can be exercised to provide fuel dispersal estimates that can subsequently be used to study the potential consequences of FFRD. However, this exercise has also identified several areas for improvements to both the codes and to the modeling approaches used here, including the pin power reconstruction methods in PARCS, the modeling approach used to connect the Cartesian and cylindrical vessel components in TRACE, transient fission gas release and fuel rod upper plenum models in FAST, and tighter coupling between FAST and TRACE.

Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer: A Million Veteran Program study.

1541 Background: Germline pathogenic alterations are found in approximately 10% of men with metastatic prostate cancer (mPC) and can inform precision therapy, surveillance, and cancer prevention for family. National guidelines recommend germline genetic testing be offered to all men with mPC, yet uptake of testing in the community has been documented to be 10-12% with many barriers to testing. We conducted a study to determine uptake of testing using remote consenting and testing for veterans with mPC who had participated in the Department of Veteran’s Affairs (VA) Million Veteran Program (MVP). We wanted to know if remote testing could augment point-of-care counseling and ordering to increase uptake of germline testing. Methods: This prospective study enrolled veterans who participated in MVP study with a diagnosis of mPC. Veterans were contacted by mail with an option to opt-out of future contact. Those who did not opt-out were mailed information about the study and received a follow-up call to establish interest in germline testing with a CLIA-level germline test. Those expressing interest provided verbal informed consent and were mailed a saliva collection kit for a multigene cancer predisposition gene panel test. Results were disclosed by phone and mailed to the patient with genetic counseling support and were sent to the oncology provider by email, phone or both. Two research coordinators and two part-time genetic counselors provided consenting, counseling and return of results. A study evaluating facilitated communication of results to first degree relatives (FDR) and germline testing of FDR was a component of study. Results: As of 2/6/2024, 1952 veterans who were alive with an incident diagnosis of mPC were identified through MVP and did not opt out. Informational letters were sent to the home address of all eligible participants. 683 (35%) of veterans completed informed consent and 457 (23% of total original cohort) completed testing. Among the participants, 70% were White, 21% were Black, 0.5% Asian and 8% unknown, 13% had a germline pathogenic variant. Documentation of positive germline results from study in the chart reports was 58%. Of 30 results relevant for targeted therapy, 16 have received that therapy, 11 were not yet appropriate and 3 patients did not receive targeted therapy. Twenty-nine FDR were contacted and tested through the pilot study of facilitated contact and testing. Conclusions: We evaluated uptake of germline testing using a remote, VA system-wide approach to identify and offer genetic testing for veterans with mPC with access and cost issues removed. We completed germline testing at rates higher than those reported in the community with modest personnel requirements, in a diverse population of patients. Documentation of results in the electronic medical record can be improved. Remote genetic testing can augment uptake of testing in large integrated health care systems.

Legal regulation of the trade secret regime in corporate conflicts

The author examines the features of the legal regulation of the trade secret regime in corporate conflicts between participants of business entities (limited liability companies, joint-stock companies). A study of the legal regulation of the Russian Federation, in terms of the legal regulation of the trade secret regime, has been conducted, and the judicial practice of applying the trade secret regime has been analyzed. Scientific works in the field of legal regulation of the trade secret regime in the Russian Federation, the countries of the Commonwealth of Independent States and the United States of America are also analyzed. As a result of the research, the author highlights a gap in the legal regulation of the trade secret regime in corporate conflicts. The problem is that despite the existence of a system of legal regulation of the trade secret regime, the share of trade secret leaks continues to grow. Previously, no research has been conducted in the field of legal regulation of the trade secret regime in the presence of corporate conflicts. Public relations arising in connection with the application of the commercial secret regime are regulated by the Law on Commercial Secrets, certain issues are explained in the information letter of the Presidium of the Supreme Arbitration Court of the Russian Federation dated 01/18/2011 No. 144 "On some issues of the practice of arbitration courts considering disputes on the provision of information to participants in business companies", while the share of leaks of commercial secrets is constantly growing. In this regard, it is necessary to identify ways to improve legal regulation in the field of legal regulation of the trade secret regime in corporate conflicts. To investigate the legal regulation of the Russian Federation, judicial practice, scientific work and identify problems of legal regulation of the trade secret regime in corporate conflicts between participants of business entities (limited liability companies, joint-stock companies).

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

Visual Mental Imagery and Neural Dynamics of Sensory Substitution in the Blindfolded Subjects

Although one can recognize the environment by soundscape substituting vision to auditory signal, whether subjects could perceive the soundscape as visual or visual-like sensation has been questioned. In this study, we investigated hierarchical process to elucidate the recruitment mechanism of visual areas by soundscape stimuli in blindfolded subjects. Twenty-two healthy subjects were repeatedly trained to recognize soundscape stimuli converted by visual shape information of letters. An effective connectivity method called dynamic causal modeling (DCM) was employed to reveal how the brain was hierarchically organized to recognize soundscape stimuli. The visual mental imagery model generated cortical source signals of five regions of interest better than auditory bottom-up, cross-modal perception, and mixed models. Spectral couplings between brain areas in the visual mental imagery model were analyzed. While within-frequency coupling is apparent in bottom-up processing where sensory information is transmitted, cross-frequency coupling is prominent in top-down processing, corresponding to the expectation and interpretation of information. Sensory substitution in the brain of blindfolded subjects derived visual mental imagery by combining bottom-up and top-down processing.

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors

Can the text features of regulatory inquiry letters predict companies’ financial restatements? Evidence from China

PurposeSince the implementation of the regulatory inquiry system, research on its impact on information disclosure in the capital market has been increasing. This article focuses on a specific area of study using Chinese annual report inquiry letters as the basis. From a text mining perspective, we explore whether the textual information contained in these inquiry letters can help predict financial restatement behavior of the inquired companies.Design/methodology/approachPython was used to process the data, nonparametric tests were conducted for hypothesis testing and indicator selection, and six machine learning models were employed to predict financial restatements.FindingsSome text feature indicators in the models that exhibit significant differences are useful for predicting financial restatements, particularly the proportion of formal positive words and stopwords, readability, total word count and certain textual topics. Securities regulatory authorities are increasingly focusing on the accounting and financial aspects of companies' annual reports.Research limitations/implicationsThis study explores the textual information in annual report inquiry letters, which can provide insights for other scholars into research methods and content. Besides, it can assist with decision making for participants in the capital market.Originality/valueWe use information technology to study the textual information in annual report inquiry letters and apply it to forecast financial restatements, which enriches the research in the field of regulatory inquiries.

National Experiences from 30 Years of Provider-Mediated Cascade Testing in Lynch Syndrome Families-The Danish Model.

Cascade genetic testing and surveillance reduce morbidity and mortality in Lynch syndrome. However, barriers to conveying information about genetic disorders within families result in low uptake of genetic testing. Provider-mediated interventions may increase uptake but raise legal and ethical concerns. We describe 30 years of national experience with cascade genetic testing combining family- and provider-mediated contact in Lynch syndrome families in the Danish Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Register. We aimed to estimate the added value of information letters to family members in Lynch syndrome families (provider-mediated contact) compared to family members not receiving such letters and thus relying on family-mediated contact. National clinical practice for cascade genetic testing, encompassing infrastructure, legislation, acceptance, and management of the information letters, is also discussed. Cascade genetic testing resulted in 7.3 additional tests per family. Uptake of genetic testing was 54.4% after family-mediated and 64.9% after provider-mediated contact, corresponding to an odds ratio of 1.8 (p < 0.001). The uptake of genetic testing was highest in the first year after diagnosis of Lynch syndrome in the family, with 72.5% tested after provider-mediated contact. In conclusion, the Danish model combining family- and provider-mediated contact can increase the effect of cascade genetic testing.

IEEE Microwave and Wireless Technology Letters Information for Authors

IEEE Microwave and Wireless Technology Letters Information for Authors