Response Team Research Articles

To persist or not to persist: understanding student team responses to effectuation in the higher education classroom

Purpose Entrepreneurship education is transforming from traditional teacher-led classrooms to student-centred learning environments, where effectuation principles are increasingly adopted as a pedagogical framework. Yet despite its promise for developing real-world entrepreneurial capabilities, the implementation of effectuation principles in classrooms reveals a striking pattern: while some student teams excel, others struggle or even revert to passive learning approaches. Such variation in team responses raises an important question about the underlying mechanisms influencing team responses. This article aims to fill that gap by understanding why some student teams excel and others struggle in the higher education (HE) effectuation classroom.Design/methodology/approach A multiple case study involving 29 student teams enrolled in an undergraduate entrepreneurship class that is based on effectuation principles at a HE institution was conducted.Findings The study identifies three distinct responses among student teams. The first group displays apathy, and the second group rejects the process after a few classroom sessions. Both groups encounter student-centred learning identity threats. In contrast, the third group, despite facing similar identity threats, manages to persist.Originality/value This study argues that teaching and learning effectuation is more complex than generally depicted in the literature. It uncovers necessary and sufficient conditions related to students overcoming student-centred learning identity threats. By doing so, the study contributes to the understanding of why the connection between teaching effectuation and learning effectual behaviour is more intricate than previously understood. Additionally, it offers important practical implications for entrepreneurship educators and programme designers at HE institutions.

The Heart of the Matter: Exploring a Veteran's Wish for Pacemaker Deactivation.

Individuals living with serious illness might request deactivation of a cardiac implantable electronic device for a variety of reasons. Discontinuation of implantable cardiac defibrillators and pacemakers are considered to be ethically sound procedures. However, healthcare professional comfort with discontinuation of different types of devices might vary. In this case we describe a veteran's request for pacemaker deactivation and our interdisciplinary team's response to this request, including evaluation of total suffering, ethical considerations, and mood symptoms at end-of-life.

Beyond Crisis: Enhancing Behavioral Response Through a Conceptual Framework.

The objective of the study is to present a conceptual model informed by existing literature surrounding behavioral health crises and response teams. The Behavioral Crisis Response Model (BCRM) was developed through a comprehensive literature review, synthesizing existing knowledge to clarify the structure, relationships, and processes between patients and Behavioral Response Teams (BRTs), focusing on published literature from 2018 to 2023. Themes to inform the BCRM were developed through iterative review and discussion with an expert panel. The BCRM framework comprises five key domains: Patient-Centered Care, Preparation, Planning, Execution, and Evaluation. Each domain encompasses specific actions and strategies to ensure comprehensive and effective crisis intervention. The Patient-Centered Care domain ensures the patient remains the focus during a crisis. The Preparation domain focuses on readiness through training and resource verification. The Planning domain involves initial and risk assessments, followed by devising a tailored response plan. The Execution domain emphasizes the implementation of the response plan with adaptable leadership styles. The Evaluation domain involves debriefing, root cause analysis, and performance reviews to promote continuous improvement. The BCRM offers a patient-centered, structured approach to managing behavioral health crises and enhancing team cohesion and effectiveness. Further evaluation of adopting the BCRM is needed within health care institutions to improve patient outcomes, reduce harm, and advance better care quality.

Reducing Employee Injuries from Aggressive Patient Behavior at Children's Hospital by Implementing a Behavioral Response Team.

Among hospitalized children, episodes of aggressive patient behavior place healthcare staff at risk for serious injuries. By implementing a behavioral response team at a children's hospital, we aimed to reduce monthly employee injuries related to aggressive patient behavior from 3.4 to 2.4 per 1,000 acute care visits during 12 months. At a children's hospital, a multidisciplinary team used quality improvement methodology to implement a behavioral response team that provided proactive and reactive support to staff caring for children at risk for aggressive behavior. Full-scale implementation occurred in July 2022. We measured days between Occupational Health and Safety Administration (OSHA)-recordable employee injuries related to aggressive patient behavior and total monthly employee injuries related to aggressive patient behavior per 1,000 acute care visits (emergency department visits and/or hospitalizations) by patients 3 years of age or older. In the year after full-scale implementation, an average of 101 BRT rounds and 17 reactive responses occurred per month. The maximum number of days between OHSA-recordable employee injuries related to aggressive patient behavior increased from 163 days in the year before full-scale implementation to 271 days in the following year. Monthly employee injuries related to aggressive patient behavior decreased from 3.4 to 1.7 injuries per 1,000 acute care visits by patients 3 years of age or older. The BRT model, which provides proactive and reactive support to hospital staff caring for children at risk for aggressive behavior, should be considered a strategy to reduce employee injuries and promote workplace safety.

Characteristics and Outcomes of Pulmonary Embolism Patients Transferred After Activation of Pulmonary Embolism Response Team and Admitted from Local Emergency Department

Background: The primary role of a pulmonary embolism response team (PERT) is to support decision-making processes regarding acute pulmonary embolism (PE) patients and provide advanced rescue therapies when needed. Despite a great need for its availability among physicians, PERT’s usefulness is yet to be proven. Objectives: Our goal was to establish whether patients benefit from qualification by PERT for admission to a tertiary cardiology ward. Methods: Data of all patients hospitalized due to PE for 12 months (July 2023–June 2024) were retrospectively analyzed. We aimed to compare patients admitted primarily via the emergency department with those consulted by PERT and eventually transferred from other hospitals. The primary outcome was the use of advanced therapies. Results: We identified 167 patients (50.3% women) hospitalized with PE. Out of them, 102 (61.1%) came from the emergency department, while 65 (38.9%) patients were transferred after PERT consultation. The transferred patients generally had more severe conditions, as indicated by the ESC death risk group classification (intermediate-high and high risk, OR 19.2, 95% CI 8.3–44.2). They were more often qualified for at least one of the advanced therapies than the emergency department patients (OR 23.2, 95% CI 9.3–58.1). We found no significant differences in in-hospital mortality (6.9% versus 1.5%, OR 4.7, 95% CI 0.6–39.3). Conclusions: Establishing PERT as a reference unit providing advanced treatment resulted in successfully delivering more complex treatment to severely ill PE patients. Despite their unfavorable basic characteristics, neither length of hospitalization nor in-hospital mortality seem to differ when compared to unselected, less compromised cases.

Starting a Prehospital Medication for Opioid Use Disorder Program.

Over 2.7 million people have an opioid use disorder (OUD). Opioid-related deaths have steadily increased over the last decade. Although emergency department (ED)-based medication for OUD (MOUD) has been successful in initiating treatment for patients, there still is a need for improved access. This study describes the development of a prehospital MOUD program. An interdisciplinary team expanded a MOUD program into the prehospital setting through the local city fire department Quick Response Team (QRT) to identify patients appropriate for MOUD treatment. The QRT consisted of a paramedic, social worker, and police officer. This team visited eligible patients (i.e., history of an opioid overdose and received prehospital care the previous week). The implementation team developed a prehospital MOUD protocol and a two-hour training course for QRT personnel. Implementation also required a signed contract between local hospitals and the fire department. A drug license was necessary for the QRT vehicle to carry buprenorphine/naloxone, and a process to restock the vehicle was created. Pamphlets were created to provide to patients. A clinical algorithm was created for substance use disorder (SUD) care coordinators to provide a transition of care for patients. Metrics to evaluate the program included the number of patients seen, the number enrolled in an MOUD program, and the number of naloxone kits dispensed. Data were entered into iPads designated for the QRT and uploaded into the Research Electronic Data Capture (REDCap) program. Over the six-month pilot, the QRT made 348 visits. Of these, the QRT successfully contacted 83 individuals, and no individuals elected to be evaluated for new MOUD treatment. Nine fatal opioid overdoses occurred during the study period. A total of 55 naloxone kits were distributed, and all patients received MOUD information pamphlets. A prehospital MOUD program can be established to expand access to early treatment and continuity of care for patients with OUD. The program was well-received by the local city fire department and QRT. There is a plan to expand the prehospital MOUD program to other local fire departments with QRTs.

Managing medical care for victims with thermal burn injuries caused by emergency accidents in megacity settings

Relevance. In emergency settings, medical care for thermal burn injuries remains a crucial problem of disaster medicine. In industrially advanced countries with ongoing urbanization, burns represent a most frequent and severe type of injuries requiring emergency medical care. The study objective is to analyze the efficiency of emergency medical care provided in Moscow over the 6 year’s timespan (2018 to 2023) to victims of emergency accidents presented with thermal burns.Methodology and methods. The study relies on the data obtained from the Disaster Medicine of Moscow automated analytical information system with a focus on the victims of emergency accidents presented with burns throughout the past 6 years (2018 to 2023). The platform is managed by the Moscow Territorial Scientific and Practical Center for Disaster Medicine (CEMP) and the N.V. Sklifosovsky Research Institute of Emergency Medicine.Results and discussion. Over the past 6 years (2018 to 2023), the emergency accidends affected 1989 victims presented with thermal burns, including 438 (22.0 %) declared dead at the scene prior to the arrival of CEMP medical and specialized emergency response teams. 1,216 patients (61.1 %) were evacuated to referral centers at multidisciplinary hospitals, 315 patients (15.9 %) travelled to medical hospitals by passing-by vehicles to apply for medical help independently, and 20patients (1 %) were referred for outpatient follow-up. Overall, 597 patients were admitted to burn injury department at the N.V.Sklifosovsky Research Institute. Those included 33.1 % in extremely severe and severe condition, with 1.7 % requiring tracheal intubation and respiratory ventilation support.Conclusion. At pre-hospital stage, deployment of the medivac ICU teams is the most promising strategy to ensure high quality medical care. Given the high incidence of multiple injuries (up to 49.6 %) in emergency accidents, sophisticated medical care shall be provided by a multidisciplinary team of reconstructive burn surgeons, ICU staff specializing in inhalation injuries, and medical professionals.

Neurocritical Care Rapid Response Team Providing Critical Care Support During Mechanical Thrombectomy of Emergent Large Vessel Occlusion Stroke.

Acute ischemic stroke with medium and large vessel occlusion is a leading cause of morbidity and mortality, in which timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. Effective analgosedation and hemodynamic management during MT are critical to patient outcomes and typically managed by anesthesia. Because of inconsistent anesthesia support at our institution, we implemented a dedicated neurocritical care rapid response team (NCC-RRT) to manage these aspects of care. The primary outcome of our study was door-to-groin puncture time, before and after the implementation of the NCC-RRT. Secondary outcomes included door-to-recanalization time, patient disposition status, and the need for emergent anesthesia support. We conducted a prospective analysis of patients with acute ischemic stroke undergoing MT at a comprehensive stroke center between January 2021 and December 2023. The study compared two periods: era 1 (pre-NCC-RRT, January to October 2021) and era 2 (post-NCC-RRT, December 2021 to December 2023). We excluded inpatient stroke alerts and patients intubated at outside hospitals. The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. A total of 373 patients were included in the study, with 86 patients in era 1 and 287 in era 2. The implementation of the NCC-RRT was associated with a statistically significant reduction in median DGP and door-to-recanalization times by 11.7% and 12.6%, respectively. NCC-RRT was also associated with a 21.4% increase in general anesthesia utilization, and no patients required emergent anesthesia support. The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.

Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated with Clinical Deterioration

Introduction: Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratification. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions. Methods: This was a retrospective study of a PE registry used by eight affiliated emergency departments. We used an artificial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018–2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration defined as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use. We used bivariable and multivariable analyses. For the latter, we used least absolute shrinkage and selection operator (LASSO) and random forest (RF) to determine associations of all candidate variables with the primary outcome (clinical deterioration), and the Youden index to determine RV:LV optimal cut-offs for primary outcome. Results: Artificial intelligence analyzed 1,467 CTPAs, with 88% agreement on RV:LV categorization with radiologist reports (kappa 0.36, 95% confidence interval [CI] 0.28–0.43). Of 1,639 patients, 190 (11.6%) had PE-related clinical deterioration, and 314 (19.2%) had advanced interventions. Mean RV:LV were 1.50 (0.39) vs 1.30 (0.32) for those with and without clinical deterioration and 1.62 (0.33) vs 1.35 (0.32) for those with and without advanced intervention use. The RV:LV cut-off of 1.0 by AI and radiologists had 0.02 and 0.53 P-values for clinical deterioration, respectively. With adjusted LASSO, top clinical deterioration predictors were cardiac arrest at presentation, lowest systolic blood pressure, and intensive care unit admission. The RV:LV measurement was a top 10 predictor of clinical deterioration by RF. Optimal cut-off for RV:LV was 1.54 with odds ratio of 2.50 (1.85, 3.45) and area under the curve 0.6 (0.66, 0.70). Conclusion: Artifical intelligence-derived RV:LV measurements ≥1.5 on initial CTPA had strong associations with in-hospital clinical deterioration and advanced interventions in a large PERT database. This study points to the potential of capitalizing on immediately available CTPA RV:LV measurements for gauging PE severity and risk stratification.

Nurse worry as a trigger for rapid response team activation improving outcomes: a retrospective cohort study in non-critical units.

Patients hospitalized outside of monitored environments may experience sudden clinical worsening requiring transfer to the Intensive Care Unit. Early detection based on the clinical nurse's identification of the risk of clinical deterioration represents an opportunity to prevent serious adverse events. Nurse worry is defined as the use of clinical reasoning combined with intuition that precedes the patient's clinical deterioration. The objective of this study was to evaluate nurse worry as a trigger for rapid response team activation in patients hospitalized in non-critical units and its association with the need in ICU admission. This retrospective cohort study utilized data retrieved from an anonymized institutional database used to monitor the actions of the rapid response team. Data collected from January 2021 to December 2022 were analyzed, encompassing patients over 18 years old admitted to non-critical units and evaluated by the rapid response team. Analyzed variables included demographic characteristics, MEWS score, and causes for activating the rapid response team, such as changes in vital signs and nurse worry. Main outcomes assessed were transfer to the ICU, medical procedures, and drug administration. Patients were divided into three groups for analysis: those triggered for RRT assessment exclusively by changes in vital signs, those triggered exclusively by nurse worry and those triggered by the nurse worry combined with changes in vital signs. A total of 4634 rapid response team consultations were included, with 1574 triggered by changes in vital signs, 1263 triggered by nurse worry and 1797 triggered by the nurse worry associated with changes in vital signs. The group with nurse concern showed a lower need for transfers to the ICU (40%) compared to the group with changes in vital signs (50%) p < 0.001 although there was no difference in relation to the need for medical procedures,17% in both groups. The NW emerges as a relevant factor in triggering RRT and may be associated with improved outcomes, such as reduced need for ICU transfers. However, the observational design of the study does not allow for establishing causal relationships.

Implementation of a Checklist Tool to Improve Understanding of Rapid Response Team Protocols.

Background and Objectives: Rapid response teams (RRT) are multidisciplinary teams activated to assess patients outside of the Intensive Care Unit (ICU) and require a shared framework for approaching a deteriorating patient. In this project, we aimed to improve the understanding of RRT protocols through the development and implementation of the RRT Huddle Checklist. Methods: This quality improvement project took place from 2019 to 2022. A multidisciplinary workgroup conducted a current state analysis and defined the ideal RRT process. To improve the RRT process, we developed and implemented an RRT Huddle Checklist based on the SBAR framework, standardized education, and created a process for regular feedback. The primary aim was to improve understanding of RRT protocols among participants. RRT duration was used as a balancing measure. Results: A total of 301 stakeholders completed surveys, including 127 nurses, 101 residents, 45 RRT nurses, 10 Hospital Medicine faculty and fellows, and 18 PICU fellows. After implementation of the RRT Huddle Checklist, the proportion of respondents who agreed with knowing RRT protocols increased from 69% in 2020 to 75% in 2022, with no increase in RRT duration. Conclusions: The implementation of the RRT Huddle Checklist resulted in an increased proportion of key stakeholders that understood RRT protocols without increasing the duration of RRTs. The RRT Huddle Checklist tool utilizes a widely known, validated framework that can be adapted at other institutions to standardize the RRT process and promote ongoing just-in-time education.

Psychosocial wellbeing and risk perception of older adults during COVID-19 pandemic in Nigeria: perspectives on the role of social workers.

The COVID-19 pandemic presented a 'double-edged sword' for older adults: not only were they more susceptible to the virus, but its broader consequences also exacerbated other challenges, particularly those related to psychosocial well-being. Limited evidence exists on how older adults perceive the pandemic and its impact on their well-being and the role of social workers in addressing these challenges, particularly in resource-limited settings like Nigeria. This study explored older adults' perceived risks regarding COVID-19, its impact on their psychosocial well-being, and the role of social workers in addressing these challenges in Nigeria. A phenomenological and exploratory research design was used. In-depth interviews (IDIs) were conducted with 16 older adults and 4 social workers in Onitsha metropolis, Anambra State, Southeast Nigeria. Data were analyzed through reflexive thematic analysis. The findings revealed that the COVID-19 restrictive measures negatively impacted the psychosocial well-being of older adults, where social isolation, lack of support, the inability to engage in wellbeing activities, and emotional trauma collectively contributed to a significant decline in their mental and emotional health. Additionally, widespread misconceptions about the origin of COVID-19 led to reluctance in adopting preventive measures. While social workers provided some awareness and counselling sessions, their involvement was limited. Social workers were not recognized as part of the frontline response team, and their efforts were primarily constrained by governmental and institutional neglect. The findings highlight the need for policy initiatives to enhance social workers involvement in strengthening the psychosocial resilience of older adults and addressing misconceptions during public health emergencies. Comprehensive strategies are essential for safeguarding the psychosocial well-being of older adults in future pandemics or similar crises.

Identification of Anthrax as the Cause of a Cluster of Unexplained Deaths, Uganda, 2023: The Role of Metagenomic Next-Generation Sequencing and Postmortem Specimens.

Between April and November 2023, 27 unexplained human deaths that presented with swelling of the arms, skin sores with black centers, difficulty in breathing, obstructed swallowing, headaches, and other body aches were reported in Kyotera District, Uganda by the Public Health Emergency Operations Center. Subsequently, the death of cattle on farms and the consumption of carcass meat by some residents were also reported. Field response teams collected clinical/epidemiological data and autopsy samples to determine the cause of deaths. Metagenomic next-generation sequencing (mNGS) and target enrichment sequencing conducted on postmortem samples confirmed Bacillus anthracis, the etiological agent of anthrax disease, as the cause of the deaths. Applying mNGS to autopsy specimens is useful as a retrospective tool for identifying high-consequence pathogens during suspected outbreaks of unknown etiology.

Long-Term Trajectories of Older Adults Served by an Emergency Department/Hospital-Based Elder Mistreatment Response Program.

An emergency department (ED) visit or hospitalization provides an opportunity to identify elder mistreatment and initiate intervention, but this seldom occurs. To address this, we developed the Vulnerable Elder Protection Team (VEPT), a novel interdisciplinary consultation service. We explored the long-term trajectories of patients receiving VEPT evaluation and intervention. We followed up at multiple intervals for 12 months older adults seen by VEPT from 9/1/2020-3/27/2023 with high or moderate concern for mistreatment who were discharged to the community, an elder abuse shelter, or rehabilitation facilities. We collected information through telephone calls to the older adult and others involved. We also analyzed separately cases in which the patient re-presented to the ED/hospital with VEPT consultation during the follow-up period. A total of 157 older adults met criteria for follow-up, and 30 of these (16.4%) died within 12 months. At 1 month, elder mistreatment was no longer occurring in 47.5% and still occurring but reduced in 20.3%, with 29.7% having no contact with the perpetrator and 17.8% having reduced contact. At 12 months, elder mistreatment was no longer occurring in 60.9% and still occurring but reduced in 14.5%, with 34.8% having no contact with the perpetrator and 17.4% having reduced contact. During the 12-month follow-up period, 16 (10.2%) patients re-presented to the ED with VEPT consultation, with 12 having persistent concern for ongoing elder mistreatment. Reasons included older adults/caregivers not accepting intervention or being willing to separate as well as VEPT reliance on community-based agencies and programs after discharge. We observed improved post-discharge safety for elder mistreatment victims who engaged with the VEPT program, with this increased safety durable over 1 year. Re-presentations highlighted the complexity of elder mistreatment intervention. Overall, these findings demonstrate the potential value of an ED/hospital-based elder mistreatment response team, a promising new geriatric care model.

Exploring the impact of age on the predictive power of the National Early Warning score (NEWS) 2, and long-term prognosis among patients reviewed by a Rapid Response Team: A prospective, multi-centre study.

To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients. Prospective, multi-centre study based on 830 complete cases. Data was collected by RRTs in 24 hospitals between October 2019, and January 2020. All NEWS 2 scores were uniformly calculated by the study team. Age was analysed as a continuous variable, in a spline regression model, and categorized into five different models, subsequently explored as additive variables to NEWS 2. The discriminative ability of NEWS 2 was evaluated using the Area under the receiver operating characteristics (AUROC). The discriminative ability of NEWS 2 alone in predicting 30-day mortality was weak. Adding age as a covariate improved the predictive performance (AUROC 0.66, 0.62-0.70 to 0.70, 0.65-0.73, p = 0.01, 95 % Confidence Interval). There were differences across age groups, with the best discriminative ability identified among patients aged 45-54 years. The 30- and 90-day mortality was 31% and 33% respectively. Adding age as a covariate improved the discriminative ability of NEWS 2 in the prediction of 30-day mortality among RRT-reviewed patients, with variations observed across age categories. The long- term prognosis of RRT-reviewed patients was poor.

Original Research: Is Your Outpatient Office Prepared to Manage an Opioid Overdose?

Outpatient facilities, such as family and adult practice offices, psychiatric offices, and substance use treatment centers, should be equipped to manage medical emergencies and facilitate hospital transfers. Clinics that treat patients with opioid use disorder must be especially prepared to address respiratory arrest due to opioid overdose. The objective of this integrative review was to identify emergency response initiatives already investigated or developed that could be adapted to address opioid-related medical emergencies in the outpatient adult treatment setting. Initial and updated literature searches were conducted using MEDLINE and PubMed. These searches yielded 207 and 60 articles of interest, respectively, and a total of 6 and 18 were selected for retrieval. Of these, 5 and 8, for a total of 13, met the inclusion criteria. We found few publications in the mental health literature to inform or guide outpatient practitioners in preparing their offices for emergencies. This integrative review draws from all areas of the medical literature to identify emergency response strategies that have been developed for outpatient settings. We identified 4 major themes in office emergency preparedness: simulation training, response team organization, equipment readiness, and emergency action protocols. These 4 themes can provide guidance for improving readiness in medical offices, and in ambulatory mental health and substance use clinics. Researchers will need to develop emergency response algorithms that address these themes and assess patient outcomes.

Home treatment team response for people with complex emotional difficulties: evidence informing service development

Home treatment team response for people with complex emotional difficulties: evidence informing service development

Analysis of cyber incidents in Senegal from 2005 to 2023

This article presents findings from a review of cyber incidents that occurred in Senegal between 2005 and 2023. Twenty-six incidents were identified, and they were analysed in terms of their frequency, incident type, perpetrator type, and victim type. The study found that cyber incidents are increasing in frequency in the country; that the most common incident types are cybercrimes and compromised websites; that the most frequent perpetrators are cybercriminals and hackers; that state/political organisations are slightly more likely than non-state/political entities to be attacked; that the most common incident type experienced by state/political entities is a compromised website; that the most frequent incident type for non-state/political organisations is cybercrime; and that insider attacks are much less common than external attacks, but still occur at a level that is a cause for concern. Based on the findings, the author recommends, inter alia, improved Senegalese government monitoring and reporting of cyber threats, with an emphasis on cooperation between the state’s Computer Security Incident Response Team (CSIRT-Senegal, or SNCSIRT) and the CSIRT-Universitaire established by tertiary institutions in the country.

Trustworthiness of a machine learning early warning model in medical and surgical inpatients.

In the general hospital wards, machine learning (ML)-based early warning systems (EWSs) can identify patients at risk of deterioration to facilitate rescue interventions. We assess subpopulation performance of a ML-based EWS on medical and surgical adult patients admitted to general hospital wards. We assessed the scores of an EWS integrated into the electronic health record and calculated every 15 minutes to predict a composite adverse event (AE): all-cause mortality, transfer to intensive care, cardiac arrest, or rapid response team evaluation. The distributions of the First Score 3 hours after admission, the Highest Score at any time during the hospitalization, and the Last Score just before an AE or dismissal without an AE were calculated. The Last Score was used to calculate the area under the receiver operating characteristic curve (ROC-AUC) and the precision-recall curve (PRC-AUC). From August 23, 2021 to March 31, 2022, 35937 medical admissions had 2173 (6.05%) AE compared to 25214 surgical admissions with 4984 (19.77%) AE. Medical and surgical admissions had significant different (P <.001) distributions of the First Score, Highest Score, and Last Score among those with an AE and without an AE. The model performed better in the medical group when compared to the surgical group, ROC-AUC 0.869 versus 0.677, and RPC-AUC 0.988 versus 0.878, respectively. Heterogeneity of medical and surgical patients can significantly impact the performance of a ML-based EWS, changing the model validity and clinical discernment. Characterization of the target patient subpopulations has clinical implications and should be considered when developing models to be used in general hospital wards.

КРАЖИ С БАНКОВСКОГО СЧЕТА, А РАВНО В ОТНОШЕНИИ ЭЛЕКТРОННЫХ ДЕНЕЖНЫХ СРЕДСТВ: ПРОБЛЕМЫ РАСКРЫТИЯ

Introduction: the authors consider features of bank accounts fraud, as well as online banking fraud; crime detection methods taken by internal affairs bodies; recommendations to improve police action in this field. Materials and Methods: sociological method and interviewing law enforcement officers, as well as criminal cases study and regulatory acts regulating law enforcement activity of the Russian Federation were used when investigating bank accounts fraud, as well as online banking fraud. The authors used content-analysis of scientific articles and Results: the authors suggest proposals to improve the work of law enforcement in the area of combating bank accounts fraud and online banking fraud. Discussion and Conclusions: the authors suggest authorize the local internal affairs bodies at district level (they are the ones who face the challenge of solving of crime at the initial stage) to direct appeal to financial institutions and network operators in investigations and obtain information about the users in real-time. Nowadays it is important to create a single interdepartmental platform to obtain information about all transactions in “a single chart”. Such a platform can be implemented in the Financial Sector Computer Emergency Response Team of the Bank of Russia.