Record Of Events Research Articles

Assessment of dispatch-assisted cardiopulmonary resuscitation performance during out-of- hospital cardiac arrest in a Tuscan emergency operation center: a retrospective study

Background: Time is the most crucial prognostic factor in out-of-hospital cardiac arrest (OHCA) owing to its clinical features. Dispatcher-assisted CPR (DA-CPR) by dispatch centers to a bystander calling for an ambulance, enabling even an inexperienced bystander to start CPR in 50% of cases and reducing the free therapy interval from chest compression to less than three minutes. Objectives: to assess the dispatch-assisted cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest. Methods: a retrospective study was conducted at the Firenze-Prato Emergency Operation Centre to analyse data collected from all dispatch audio recordings of OHCA events that occurred between 1 January 2019 and 31 December 2020. Emergency calls lasting less than 60 s were excluded from the analysis, as this duration does not provide dispatchers with adequate time to accurately identify OHCA and provide pre-arrival instructions to the bystander.Results: A total of 1,267 OHCAs cases were included in this study, with 832 (65.7%) occurring in 2019 and 435 (34.3%) in 2020. Emergency nurses offered pre-arrival instructions in 272 cases (21.5%), with 160 cases in 2019 (19.2%) and 112 cases (25.7%) in 2020 (c2=7.19, p=0.007). These instructions were accepted by the caller in 9% (n=75) and 14% (n=61) of the cases, respectively (c2=7.48, p=0.006). OHCA events that could not be identified by telephone (therefore, DA-CPR was not possible) were 365 cases (43.9%) in 2019 and 175 cases (40.2%) in 2020 (c2=1.55, p=0.213). Conclusions: The adoption of a standardised protocol for delivering pre-arrival instructions, along with training programs focusing on OHCA and interview techniques, is strongly recommended based on the findings of our study. This was reinforced by the analysis of nighttime calls during which DA-CPR was not provided, including cases without clear justification.

Imprints of the internal dynamics of galaxy clusters on the Sunyaev–Zeldovich effect

Context. Forthcoming measurements of the Sunyaev–Zeldovich (SZ) effect in galaxy clusters will dramatically improve our understanding of the main intra-cluster medium (ICM) properties and how they depend on the particular thermal and dynamical state of the associated clusters. Aims. Using a sample of simulated galaxy clusters, whose dynamical history can be well known and described, we assess the impact of the ICM internal dynamics on both the thermal and kinetic SZ effects (tSZ and kSZ, respectively). Methods. We produced synthetic maps of the SZ effect, both thermal and kinetic, for the simulated clusters obtained in a cosmological simulation produced by a cosmological adaptive mesh refinement code. For each galaxy cluster in the sample, its dynamical state is estimated by using a combination of well-established indicators. We used the correlations between SZ maps and cluster dynamical state to look for the imprints of the evolutionary events, mainly mergers, on the SZ signals. Results. While the tSZ effect only shows dependency on dynamical state in its radial distribution, the kinetic effect shows a remarkable correlation with this property: unrelaxed clusters present a higher radial profile and an overall stronger signal at all masses and radii. The reason for this correlation is the fuzziness of the ICM produced by recent merging episodes. Furthermore, the kSZ signal is correlated with rotation for relaxed clusters, while for the disturbed systems, the effect is dominated by other motions such as bulk flows, turbulence, and so on. The kSZ effect shows a dipolar pattern when averaging over cluster dynamical classes, especially for the relaxed population. This feature can be exploited to stack multiple kSZ maps in order to recover a stronger dipole signal that would be correlated with the global rotation properties of the sample. Conclusions. The SZ effect can be used as a tool to estimate the dynamical state of galaxy clusters, especially to segregate those clusters with a quiescent evolution from those with a rich record of recent merger events. Our results suggest that the forthcoming observational data measuring the SZ signal in clusters could be used as a complementary strategy for classifying the evolutionary history of galaxy clusters.

Healthcare resource utilization following ustekinumab initiation among bio-naïve Canadian patients with moderately-to-severely active Crohn's disease

Background/aimsReal-world healthcare resource utilization (HCRU) of bio-naïve patients with Crohn's disease (CD) receiving ustekinumab was assessed. MethodsA multicentre, retrospective chart review study of bio-naïve Canadian adult patients with moderately-to-severely active CD treated with ustekinumab was conducted. CD-related HCRU (i.e., surgery, hospitalization, or emergency room [ER] visits) was evaluated at Months 4, 6, and 12 post-ustekinumab initiation, and associated costs were sourced from a provincial database. Proportion of patients with HCRU events and ustekinumab persistence were summarized at each timepoint. Paired analysis compared HCRU events and associated costs incurred by the same patient whilst in remission vs. when not in remission. ResultsBy Month 12, 11.1 % (17/153) of patients had record(s) of any CD-related HCRU event, with ER visits being the most common (7.7 %; 12/155). Hospitalization had the highest average cost (CAD $436.10; SD $2,089.25) across all patients, accounting for 82.2 % of the mean total annual cost/patient (CAD $530.47; SD $2,229.92). While in remission, ≤5 % of patients experienced some healthcare encounter, compared with 7 % when not in remission (P = 0.289). Finally, 93.5 % of patients persisted on ustekinumab at Month 12. ConclusionsHCRU rates and associated total annual costs were lower for bio-naïve CD patients receiving ustekinumab, and when patients were in remission. Most patients continued with ustekinumab at Month 12.

Implantable Loop Recorder (ILR) – Reimbursement 2024

Implantable loop recorders (ILRs) were introduced into clinical practice more than two decades ago. Monitoring of a heart rhythm using implantable event recorders has found its high position in numerous recommendations of the European Society of Cardiology, especially those regarding syncope and atrial fibrillation. The search for atrial fibrillation in patients after cryptogenic stroke is of great importance for improving the long-term prognosis and optimizing pharmacotherapy. In half of the cases of syncope, long-term ECG monitoring based on ILR allows for a definite diagnosis and effective treatment. It was not until the Regulation of the Minister of Health of 1 December 2023 and the Regulation of the President of the National Health Fund of 29 December 2023 that the procedure could be fully reimbursed in selected groups of patients. The article discusses the requirements for the implementation of the service.

Vortex-induced vibration dynamic characteristics monitoring with AI-based target object detection for long-span bridges

This research proposes an innovative framework for monitoring bridge Vortex-induced Vibration (VIV) dynamic characteristics utilizing AI-based machine-learning target object detection and tracking techniques with keypoint detection. Two camera calibration methods are implemented for cases with and without intrinsic and extrinsic camera setup information based on homography matrix conversion and distance-based conversion. The framework is verified on a video recording of a real-bridge VIV event and a simulation animation of bridge VIV with a peak/trough-based statistical method for calculating VIV frequency and amplitude. Accurate detection is achieved in both cases with short video durations. The framework demonstrates great potential for real-time bridge VIV monitoring, requiring minimal camera calibration and a straightforward device setup. It offers reliable and accurate results while remaining cost-effective.

Telemedicine for patients with cardiac implants : Insights into everyday practice of remote monitoring in Germany in 2022

As telemedical structures continues to be developed in the German healthcare system, remote monitoring is becoming increasingly important to ensure comprehensive, outpatient, and tailored care. The national quality assurance measure "DOQUVIDE-Documentation of quality in the assessment of vital parameters by implanted devices" is used to provide insight into everyday care for patients with telemedicine-enabled devices in Germany. DOQUVIDE is ameasuring instrument for recording outpatient remote monitoring for patients with implanted pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy with a pacemaker (CRT-P), CRT defibrillator (CRT-D) devices and event recorder. DOQUVIDE records telemedically measured vital signs as well as cardiac events and the associated procedures initiated by cardiologists using standardized forms. In 74practices/clinics in 14federal states, 6687 patients received telemedical care in 2022; 937 were newly enrolled. These (60% male) were on average 77.8 years old, mainly with New York Heart Association (NYHA) classII (62.6%). A total of 5801 electronic records were generated as aresult of telecardiology events, of which 3590 were due to pathological atrial fibrillation and 1812 due to ventricular high-frequency episodes. 295 events were triggered by event recorders and 95 by device therapies. The main measures taken were telephone contacts or outpatient visits. Remote monitoring has become areality in German healthcare. Standardized processes and the establishment of quality assurance measures enable the definition of common quality standards and the identification of the potential for further development and simplify implementation in day-to-day care for practices.

Reduced heart failure hospitalizations and improved quality of life in cardiac amyloidosis patients undergoing atrial fibrillation ablation

Abstract Background Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias and development and worsening of heart failure due to infiltration of the amyloid protein in the atrial wall. Few data exist regarding prognosis, symptoms, and quality of life after catheter ablation of atrial fibrillation in this category of patients. Objective The study evaluates the outcome of hospitalization for heart failure and quality of life in cardiac amyloidosis patients with atrial fibrillation after catheter ablation. Methods This is a study including 102 consecutive patients from two different centers with an established diagnosis of amyloidosis ATTR that underwent their first AF catheter ablation for persistent AF. They underwent pulmonary vein (PV) isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers were identified and ablated. Post procedure, patients were followed up routinely with ECG during office visits, 7-day Holter monitor and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Quality of life (QoL) was measured using The Minnesota Living Heart Failure Questionnaire (MLHFQ) before Catheter ablation and after 18 months follow up; QoL was compared with T-test. Results 102 patients (mean age 72 ± 6) were included in the study. After 18 months follow up, 72 patients (70.6%) remained arrhythmia-free without antiarrhythmic drugs (Group 1), whereas 30 patients (29.4%) experienced recurrence (Group 2). In Group 1, 9 patients were hospitalized for heart failure, in contrast to 18 patients in Group 2, indicating a higher rate of heart failure hospitalizations associated with arrhythmia recurrence (p=0.02). The Quality of life in group 1 was 62 ±12 points before ablation and 63±16 points at 18 months follow up (p=0.17) while in group 2 was 68±16 points before ablation and 86±12 points at 18 months follow up (p<0.001). Conclusion Catheter ablation for AF in patients with cardiac amyloidosis is associated with reduced hospitalizations for heart failure, along with improvement in QoL.

Efficacy of catheter ablation in patients with persistent atrial fibrillation on chronic ibrutinib therapy

Abstract Background Ibrutinib represents a cornerstone in the management of B-Cells malignancies and chronic lymphatic leukaemia. This drug however was associated with a 5-fold increased risk of developing atrial fibrillation (AF). The consequences of AF in this category of frailty patients such as heart failure may lead to the need of Ibrutinib withdrawal, which is considered a disease modifying therapy. Purpose This study aims to evaluate the safety and efficacy of catheter ablation in managing AF in patients on chronic ibrutinib therapy. Methods this study evaluated 20 consecutive patients from two centres in Italy who developed persistent AF during chronic therapy with Ibrutinib for chronic lymphatic leukaemia or small lymphocytic lymphoma and underwent AF catheter ablation from 2016 to 2020. Antiarrhythmic drugs were withdrawn because of side effects and drug interaction. All receive pulmonary vein (PV) isolation + isolation of left atrial posterior wall (PW) and superior vena cava. A standardized protocol was performed to confirm persistent PVI and elicit any triggers originating from non-PV sites. Ablation of non-PV sites triggering runs of atrial tachyarrhythmias was left to operator's discretion. Exclusion criteria were age<18 years and history of AF before ibrutinib therapy. Patients were monitored for arrhythmia at quarterly office visits, ECGs, 7-day Holter monitoring and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Results 12 patients received PV+PW+SVC isolation plus ablation of non-PV trigger (Group 1) whereas 8 receive only PV+PW+SVC isolation (Group 2). 10 (83,3%) patients in group 1 remained arrhythmia-free without the need for additional antiarrhythmic drugs while only 3 (37,5%) in group 2 maintained sinus rhythms. Non pulmonary triggers were mostly found in left atrial appendage (5/12, 41,6%), coronary sinus (4/12, 33,3%) and crista terminalis (3/12 25%). More than one trigger was found in 4 (33.3) patients. After 22.3 ±3.6 months follow-up, patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (Chi – square p value: 0.035; Log rank p value: 0.014) (Fig.1). 5 patient that received left atrial appendage isolation underwent a left atrial appendage closure with Watchman device 3 months after atrial fibrillation ablation. Conclusion Catheter ablation in this category of patients seems to be a safe and effective tool for managing atrial fibrillation in patients with persistent AF on chronic ibrutinib therapy; an ablation strategy that includes as a first line therapy non pulmonary vein triggers appears to be an effective approach when compared to pulmonary vein plus posterior wall only. This approach will allow continuation of ibrutinib treatment, which markedly enhances the prognosis and diminishes the risk of adverse cardiovascular events in this patient population.Kaplan-Meier curve showing recurrence-fr

Prevalence of non pulmonary vein triggers and pulmonary pressure change in atrial fibrillation ablation for cardiac amyloidosis patients

Abstract Background Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias and high risk to develop pulmonary hypertension due to infiltration of the amyloid protein in the atrial wall. Though non-PV triggers are commonly seen in left atrium, they are also seen in the right side of the heart, so identifying them at the time of ablation is essential. Objective The study evaluates the prevalence of non-PV triggers during catheter ablation in atrial fibrillation (AF) patients affected by cardiac amyloidosis and how restoration of sinus rhythm affects pulmonary pressures. Methods This is a study including 74 consecutive patients with an established diagnosis of amyloidosis ATTR diagnosed with cardiac MRI or myocardial biopsy that underwent their first AF catheter ablation. All have a transthoracic echocardiogram before ablation. They underwent pulmonary vein (PV) isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers, which are defined as ectopic triggers originating from sites other than PVs including left atrial appendage (LAA), coronary sinus (CS), interatrial septum, crista terminalis, mitral valve anulus were identified. Post procedure, patients were followed up routinely with ECG during office visits, echocardiogram, 7-day Holter monitor and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Student’s t-test was used to compare pulmonary pressure between the groups. Results Isoproterenol-challenge revealed non-PV triggers in 51 (68.9%) patients. These triggers were mostly mapped to LAA (39, 52.7%), CS (30, 40,5%), and crista terminalis (35, 47.3%). Besides, ectopic beats were seen originating from inter-atrial septum (19, 25.6%), mitral valve annulus (10, 13.5%). More than one trigger was found in (68%) patients. At 1-year after the ablation, 65 (87.8%) were arrhythmia-free off antiarrhythmic drugs. Moreover, in patients who maintained sinus rhythm post-ablation, there was either a non progression or a reduction in pulmonary pressures (PAPm before ablation: 44.8 ± 8.9 mmHg vs PAPm after ablation 45.1 ± 11.1 mmHg, P value =0.87). Conversely, those experiencing arrhythmic recurrences demonstrated an increase in pulmonary pressures (PAPm before ablation: 41.9 ± 7.7 mmHg vs PAPm after ablation 47.8 ± 10.2 mmHg, P value =0.019). Fig.1 Conclusion Our findings suggest that non-PV triggers are highly prevalent in cardiac amyloidosis AF patients including a high rate crista terminalis firing. Notably, restoration of sinus rhythm post-ablation was linked to stable or reduced pulmonary arterial pressures, whereas patients with arrhythmic recurrences experienced a significant increase.

Impact of catheter ablation on erectile dysfunction in atrial fibrillation patients

Abstract Background Previous studies suggested a consequential link between impaired diastolic function, which could be related to atrial fibrillation (AF), and a heightened susceptibility to erectile dysfunction (ED). No data exists regarding the correlation between restoration of sinus rhythm and ED. Objective This study investigates the influence of cardiac ablation on the need for phosphodiesterase-5 inhibitors (PDEF5i) medications in patients with atrial fibrillation. Methods We retrospectively investigated by chart review 220 consecutive male patients with erectile dysfunction who underwent AF catheter ablation and performed at least one follow-up visit afterward between 2019 and 2022. Exclusion criteria were considered patients older than 85 years old and those assuming non-selective beta-blockers or antidepressant medications. Patients were monitored for arrhythmia at quarterly office visits, ECGs, 7-day Holter monitoring, and event recorders during the first year. The Chi-Square test was utilized to statistically analyze the correlation between the achievement of sinus rhythm post-ablation and the discontinuation of ED medications. Results During follow-up 182 (82.7%) pts remained in sinus rhythm after one year (Group 1). Among these, 141 (77.4%) reported withdrawal of ED medication and a marked improvement in their overall sexual health and satisfaction. Whereas among the 38 (17.3%) who did not maintain stable sinus rhythm during follow-up (Group 2), only 2 (5.2%) reported a reduction in ED medication. A statistically significant difference was observed when comparing the two groups (p<0.001, OR 0,016, 95%, 0,003 - 0,061). Moreover, patients maintaining sinus rhythm for more than six months exhibited a higher tendency to stop ED medications compared to those with shorter periods of sinus rhythm or with recurrent AF episodes. Conclusion Our findings suggest a strong association between the achievement of sinus rhythm through cardiac ablation and a reduction PDEF5i in patients affected by ED medications in AF patients. This highlights the potential dual benefits of cardiac ablation in improving quality of life and in improving sexual health.

Comparison ofTheater Medical Data Store andReportableMedical Event Records to Theater Animal Bite Reports Submissions, 2018-2019.

This analysis evaluates potential reporting discrepancies of the DD2341 Form (Report of Animal Bite-Potential Rabies Exposure) submitted to a forward-deployed Rabies Advisory Board to the Theater Medical Data Store (TMDS) and ReportableMedical Event (RME) systems to identify reporting gaps that can lead to improved best practices that ensure documentation of Post Exposure Prophylaxis (PEP) of potential rabies exposures into service members (SMs) electronic medical records. The project compares the number of Service Member animal exposure DD2341 reports submitted to the Camp Arifjan, Kuwait Rabies Advisory Board to in-theater treatment electronic records at the same forward deployed locations from January 1, 2018 to December 31, 2019 recorded in the TMDS and RME databases. Records included active duty and reserve SM deployed to six countries in the United States Central Command (USCENTCOM) area of responsibility. The analysis compared some demographic information, type of potential rabies exposure (e.g., whether a bite or scratch), and PEP to rabies with Human Rabies Immune Globulin (HRIG), Human Rabies Vaccine (HRV), or both between the reporting systems. There were 44 fewer records of PEP from the TMDS data records than reported from in theater written reports. Electronic record data showed 85 coded rabies exposure diagnoses. Twenty-two received HRV and no HRIG, while four received HRIG and HRV for PEP. Only seven of the 26 SM receiving rabies PEP had a confirmed RME associated with the electronic record. There were 116 SM animal exposure written reports, with 70 reporting PEP. There were 41 records indicating the SM received HRIG and HRV as part of PEP, while 29 reports indicated that the patient received only HRV PEP. Of the 41 SM receiving HRIG, 32 of the exposures were from cat scratches or bites. Seven records specified HRIG was indicated for treatment but not available at the location; therefore, HRV was the only treatment available. The most common reason indicated on the written report for not receiving rabies PEP was that treatment was not indicated based on the risk category of animal exposure. This study is the first to compare the electronic medical record data to in theater reports for potential rabies exposure in a theater of operations. The analysis suggests that some written forms generated in the USCENTCOM theater are not entered into SM Military Health System electronic medical records, indicating that electronic medical records may be a less sensitive method than in-theatre reports for rabies program surveillance in a deployed setting. There is under-reporting in electronic medical records of rabies PEP in both TMDS and RME databases. Rabies PEP is an RME according to the Armed Forces Health Surveillance Division guidelines and case definitions. There needs to be better integration of the DD2341 into the electronic medical records system.

Landscape evolution in the southern Transantarctic Mountains during the early Miocene (c. 20–17 Ma) and evidence for a highly dynamic East Antarctic Ice Sheet margin from the southernmost volcanoes in the world (87°S)

Observations of ice sheet stability in Antarctica in the past, during significantly warmer climatic periods than today, are hampered by a paucity of continental outcrops but they are essential if we are to test and more fully understand established concepts of ice sheet growth and decay and robustly predict Earth's future during rapid global warming. In this paper we use the unique terrestrial record preserved in the three most southerly volcanoes on Earth to reconstruct Antarctica's environmental landscape in the Transantarctic Mountains for three time slices (at 20.1, 19.31 and c. 17 Ma). We demonstrate that the East Antarctic Ice Sheet margin was highly dynamic and fluctuated greatly during the Early Miocene. The period included a much-reduced ice cover that left the southern Transantarctic Mountains virtually ice-free, although a few tidewater glaciers reached the shores of the Early Miocene Ross Sea (Sheridan Bluff; 20.1 Ma); and a substantially thicker, much more voluminous ice mass (represented by volcanism at Mount Early; 19.31 Ma). An intermediate stage of ice retreat is also indicated (at c. 17 Ma), when the East Antarctic Ice Sheet had again withdrawn to behind the Transantarctic Mountains. It is represented by a subglacial volcanic centre identified remotely by aerogeophysics and sampled only as glacial erratics. The associated ice cover at c. 17 Ma had a relatively low surface elevation but it was confluent with thin ice domes that covered the adjacent mountains. Although the ice margin probably did not extend down to the Ross Sea coast, several glaciers fed icebergs into the Ross Sea. The large ice sheet indicated by the Mount Early volcanic centre is the only known physical record of a significant glacial event that took place at 19.31 ± 0.32 Ma (‘Mount Early glacial’). The records examined at the other two volcanic sites correspond to eruptions during periods of substantially reduced ice in Antarctica, of which that at 20.1 ± 0.4 Ma is the most remarkable (‘Sheridan Bluff interglacial’). The causes of the extreme variations in ice sheet thickness and extent indicated are uncertain but they occurred during a period of rapidly fluctuating atmospheric CO2 compositions. Although Milankovitch astronomical forcing probably also played a significant part, the results suggest that the East Antarctic Ice Sheet was highly susceptible to comparatively slight changes in CO2 during the warm Early Miocene.

Accuracy of the recording of pneumonia events in English electronic healthcare record data in patients with chronic obstructive pulmonary disease

BackgroundIn primary care, identifying pneumonia events in people with chronic obstructive pulmonary disease (COPD) may be challenging due to similarities in symptoms with COPD exacerbations and lack of diagnostic testing. This study explored the accuracy of pneumonia diagnosis coded in primary care by comparing diagnosis in primary care with diagnosis in hospital.MethodsA study population of people with COPD in England was created using the Clinical Practice Research Datalink Aurum database linked with Hospital Episode Statistics inpatient data. Pneumonia codes only, and pneumonia code with associated clinical and/or treatment codes (chest x-ray, symptoms, antibiotics, sputum and blood culture) were used to determine pneumonia events in primary care. Events that were followed by hospitalisation within 7 days were used to estimate the positive predictive value (PPV) of pneumonia coding in primary care, using primary diagnosis of pneumonia in secondary care as the gold standard. The PPV of primary care recording of hospitalised pneumonia was also calculated.ResultsTwo hundred seventy-four thousand one hundred fifty-six COPD patients were eligible for inclusion, of whom 7,560 had an eligible pneumonia event in primary care diagnosed between 2015–2019 which was not ‘hospital-acquired’ and was diagnosed and entered on the same day. Of the 2,094 events which were followed by hospitalisation within 7 days, 1,208 had a primary diagnosis of pneumonia in hospital, representing a PPV of pneumonia coding in primary care of 57.7% (95% CI 55.6%-59.8%). Another 284 (13.6%) were diagnosed as a COPD exacerbation and 114 (5.4%) were diagnosed as another respiratory disease. Use of additional pneumonia clinical and treatment codes had a modest effect on the PPV but substantially lowered the number of events. Of the 33,603 eligible pneumonia events identified in secondary care, only 11,445 were recorded in primary care within 42 days, representing a sensitivity of 34.1% (95% CI 33.6%-34.6%).ConclusionsUse of primary care pneumonia codes and associated clinical and treatment codes to determine pneumonia is not recommended due to significant levels of misdiagnosis and many hospitalised events failing to be recorded in primary care.

Operating room black box: GIMMICK or a patient safety tool?

The Operating Room Black Box (ORBB) is a relatively recent technology that provides a comprehensive solution for assessing technical and non-technical skills of the operating team. Originating from aviation, the ORBB enables real-time observation and continuous recording of intraoperative events allowing for an in-depth analysis of efficiency, safety, and adverse events. Its dual role as a teaching tool enhances transparency and patient safety in surgical training. In comparison to traditional methods, like checklists that have limitations, the ORBB offers a holistic understanding of clinical and non-clinical performances that are responsible for intraoperative patient outcomes. It facilitates systematic observation without additional personnel, allowing for review of numerous surgical cases. This review highlights the potential benefits of the ORBB in enhancing patient safety, its role as a surgical training tool, and addresses barriers especially in resource-constrained settings. It signifies a transformative step towards global surgical practices, emphasizing transparency and improved surgical outcomes.

A rigid microfluidic chip for high-throughput fluorescence-activated cell sorting

Fluorescence-activated cell sorting (FACS) holds great promise for the separation of single cells or cell populations according to specific light scattering and fluorescent characteristics. Here, we present a new perspective on microfluidic FACS (μFACS) with predictable geometry, which meets the requirements of high-throughput analysis and sorting. Instead of the widely applied elastic polydimethylsiloxane (PDMS), a rigid epoxy resin chip was rapidly fabricated and irreversibly encapsulated to eliminate channel deformation (tenfold reduction) and enhance performance while meeting high pressure (>600 kPa) and high flow rate application scenarios. Fluorescence discrimination and particle differentiation were additionally validated in a self-contained μFACS system using calibration microspheres and mammalian cells. The μFACS chip and system were integrally optimized to achieve a minimum interval (0.58 ms) with a mean flow rate of 1.5 m/s. Ultimately, event recording and automated sorting were accomplished in real time while achieving a sorting efficiency of 87% at cell throughput of 8,000 events/s. This rigid chip for high-throughput μFACS, which is independent of the physical properties of cells could pave the way for cell screening in plasma samples for personalized medicine.

TGIN: Document-level event extraction with two-phase graph inference network

Document-level event extraction aims to extract event records from a whole document that contain numerous entities scattered across multiple sentences. Efficiently modeling the interactions among these entities is crucial. However, previous methods suffer from two main shortcomings. Firstly, they tend to implicitly model key information, which can result in representations with higher levels of noise. Secondly, they excessively consider irrelevant entities, thereby reducing extraction efficiency and precision. To address these issues, we propose a novel Two-phase Graph Inference Network (TGIN) approach for extracting document-level events. In the first phase, TGIN constructs a heterogeneous document-level graph to capture complex interactions among nodes of different granularity, enabling the acquisition of document-aware features. Subsequently, a dedicated module is developed to extract relevant entity pairs within the same event record. This module utilizes a key information aggregator with an attention mechanism to explicitly aggregate key sentences for entity pairs. In the second phase, the entity links predicted in the first phase serve as prior information to construct the entity-level graph, which focuses on modeling interactions between entity pairs that potentially share the same event link, effectively reducing error propagation. Experimental results on the publicly available document-level event extraction dataset ChFinAnn demonstrate the superiority of our framework over most existing models.

A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data.

Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of AEs, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of AEs in administrative data through chart review. This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Fifty-six studies were included. Most sources reported on surgical AEs; however, other medical specialties were also explored. Chart reviews were used in all studies; however, few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage, or unclear approaches. The sources used samples of flagged charts (n = 24), flagged and random charts (n = 11), and random charts (n = 21). Most studies reported poor or moderate accuracy of AE rates. Some studies reported good accuracy of AE recording which highlights the potential of using administrative data for research purposes. This review highlights the potential for administrative data to provide information on AE rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice; therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.

Learning-induced bidirectional enhancement of inhibitory synaptic metaplasticity.

Training rodents in a particularly difficult olfactory-discrimination (OD) task results in the acquisition of the ability to perform the task well, termed 'rule learning'. In addition to enhanced intrinsic excitability and synaptic excitation in piriform cortex pyramidal neurons, rule learning results in increased synaptic inhibition across the whole cortical network to the point where it precisely maintains the balance between inhibition and excitation. The mechanism underlying such precise inhibitory enhancement remains to be explored. Here, we use brain slices from transgenic mice (VGAT-ChR2-EYFP), enabling optogenetic stimulation of single GABAergic neurons and recordings of unitary synaptic events in pyramidal neurons. Quantal analysis revealed that learning-induced enhanced inhibition is mediated by increased quantal size of the evoked inhibitory events. Next, we examined the plasticity of synaptic inhibition induced by long-lasting, intrinsically evoked spike firing in post-synaptic neurons. Repetitive depolarizing current pulses from depolarized (-70mV) or hyperpolarized (-90mV) membrane potentials induced long-term depression (LTD) and long-term potentiation (LTP) of synaptic inhibition, respectively. We found a profound bidirectional increase in the ability to induce both LTD, mediated by L-type calcium channels, and LTP, mediated by R-type calcium channels after rule learning. Blocking the GABAB receptor reversed the effect of intrinsic stimulation at -90mV from LTP to LTD. We suggest that learning greatly enhances the ability to modify the strength of synaptic inhibition of principal neurons in both directions. Such plasticity of synaptic plasticity allows fine-tuning of inhibition on each particular neuron, thereby stabilizing the network while maintaining the memory of the rule. KEY POINTS: Olfactory discrimination rule learning results in long-lasting enhancement of synaptic inhibition on piriform cortex pyramidal neurons. Quantal analysis of unitary inhibitory synaptic events, evoked by optogenetic minimal stimulation, revealed that enhanced synaptic inhibition is mediated by increased quantal size. Surprisingly, metaplasticity of synaptic inhibition, induced by intrinsically evoked repetitive spike firing, is increased bidirectionally. The susceptibility to both long-term depression (LTD) and long-term potentiation (LTP) of inhibition is enhanced after learning. LTD of synaptic inhibition is mediated by L-type calcium channels and LTP by R-type calcium channels. LTP is also dependent on activation of GABAB receptors. We suggest that learning-induced changes in the metaplasticity of synaptic inhibition enable the fine-tuning of inhibition on each particular neuron, thereby stabilizing the network while maintaining the memory of the rule.

Utilization of Frequency Ratio and Logistic Regression Model for Landslide Susceptibility Mapping in Bogor Area

Java Island holds the highest record of landslide events in Indonesia. In 2021, the Bogor area, consisting of the city and regency of Bogor, recorded the highest number of landslides. These events further impact the fatalities, damage, and loss to society. Landslide mitigation should be considered to reduce the risk caused by landslide hazards. In this regard, a landslide susceptibility analysis is one of the fundamental steps in mitigation measures that can support policymakers in response to landslide disaster risk reduction. The location of landslide possibilities can be identified by mapping landslide susceptibility. Therefore, this study aims to produce a landslide susceptibility map (LSM) using a statistical frequency ratio method and logistic regression. The number of landslide inventories used in the model is about 822 events. To apply the model, the present study evaluates 13 influencing factors consisting of elevation, slope angle, slope aspect, slope curvature, Topographic Wetness Index (TWI), distance to river, lithological, distance to fault, soil type, annual rainfall, Normalized Difference Vegetation Index (NDVI), land use land cover (LULC), and road distance. The model performance is further evaluated using Area Under the ROC Curve (AUC). The frequency ratio (FR) and logistic regression (LR) models produce satisfactory results and have high predictions of future landslide occurrences with a score of 0.8317 and 0.8817, respectively.

A continuous 18.6–10 ka record of seismic events revealed by Xinmocun lacustrine sediments at Diexi, eastern Tibetan Plateau

Five Ms 7.0 earthquakes (Wenchuan, Yushu, Lushan, Jiuzhaigou and Maudo) have occurred on the eastern Tibetan Plateau since 2008, and > 20 historical earthquakes (Ms ≥ 5.0) have also been recorded, demonstrating the strong seismic activity prevalent in this region. Owing to the geomorphology of the region, consisting of alpine valleys with a lack of Quaternary deposits, it is difficult to conduct paleo-earthquake research through the excavation of trenches. Lacustrine sediments are regarded as the most suitable archives for paleo-earthquake studies because they often comprise a detailed, long-term, and continuous environmental record. To assess the seismic activity of the Diexi, we studied a well-exposed outcrop of Xinmocun lacustrine sediments that included three sections (XMCⅠ (11.5 m), XMCⅡ (5.6 m), and XMCⅢ (11 m)) near Diexi Lake, moving from a lake shore to lake center environment, at the intersection between the Minjiang fault and Songpinggou fault. Taking into account the geodynamic setting of the area and its known tectonic activity, soft-sediment deformation structures, including load and flame structures, injection structures, ball structures, pseudo-nodules, boudinage structures, plunged sediment mixture, liquefied breccia and micro-faults, discovered within the sections are interpreted as seismites. High-resolution grain-size and magnetic susceptibility indicators were used to obtain a continuous record of the changes in physical properties within the three sections enabling the recognition of additional seismic events that did not result in soft-sediment deformation structures. Rapidly deposited layers with underlying soft-sediment deformation structures in the sections record five (XMCI, XMCII and XMCIII) seismic events; these comprise siliciclastic-enriched sandy sediment fluxes from earthquake-triggered landslides or dust of siliciclastic-enriched clastic materials. Isolated rapidly deposited layers (without underlying soft-sediment deformation structures) record 18 (XMCII), 12 (XMCI), and 21 (XMCIII) additional earthquake-induced inputs of detrital material into the lake. Optically stimulated luminescence and 14C dating of the XMCⅠ, XMCⅡ, and XMCⅢ sections indicate continuous sediment deposition from 19.4–9.9 ka, 15.5–10.1 ka, and 18.7–10.6 ka, respectively, and the seismic events recorded in these sections can be cross-correlated within the age error range. Hence, there are a total of 30 seismic events recorded within the Xinmocun sediments during the period 18.6–10 ka, suggests a weakly periodic pattern with an apparent recurrence time of ∼ 280 years. The Minjiang fault and Songpinggou fault are Holocene active faults with a risk of causing strong earthquakes. Due to the Diexi area is located at the intersection of the Minjiang fault and Songpinggou fault, and has frequent seismic activity, suggest a high seismic risk in the future.