Adequate preoperative evaluation of the post-intubation hemodynamic instability (PIHI) is crucial for accurate risk assessment and efficient anesthesia management. However, the incorporation of this ...evaluation within a predictive framework have been insufficiently addressed and executed. This study aims to developed a machine learning approach for preoperatively and precisely predicting the PIHI index values.
In this retrospective study, the valid features were collected from 23,305 adult surgical patients at Peking Union Medical College Hospital between 2012 and 2020. Three hemodynamic response sequences including systolic pressure, diastolic pressure and heart rate, were utilized to design the post-intubation hemodynamic instability (PIHI) index by computing the integrated coefficient of variation (ICV) values. Different types of machine learning models were constructed to predict the ICV values, leveraging preoperative patient information and initiatory drug infusion. The models were trained and cross-validated based on balanced data using the SMOTETomek technique, and their performance was evaluated according to the mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE) and R-squared index (R
).
The ICV values were proved to be consistent with the anesthetists' ratings with Spearman correlation coefficient of 0.877 (P < 0.001), affirming its capability to effectively capture the PIHI variations. The extra tree regression model outperformed the other models in predicting the ICV values with the smallest MAE (0.0512, 95% CI: 0.0511-0.0513), RMSE (0.0792, 95% CI: 0.0790-0.0794), and MAPE (0.2086, 95% CI: 0.2077-0.2095) and the largest R
(0.9047, 95% CI: 0.9043-0.9052). It was found that the features of age and preoperative hemodynamic status were the most important features for accurately predicting the ICV values.
Our results demonstrate the potential of the machine learning approach in predicting PIHI index values, thereby preoperatively informing anesthetists the possible anesthetic risk and enabling the implementation of individualized and precise anesthesia interventions.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Background
The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with ...in-hospital mortality.
Methods
A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included.
Results
A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy.
Conclusions
Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Due to the high‐speed switching, the switching process of a silicon carbide (SiC) metal oxide field effect transistor (MOSFET) in a practical circuit is susceptible to parasitics and exhibits ...significant current and voltage overshoots. This may subsequently lower the efficiency of the device, degrade the reliability of the system, increase the level of electromagnetic interference and prohibit the full utilization of SiC MOSFETs’ potential. Conventional qualitative analysis is difficult to support enough guidance to deal with the switching overshoots in practice. In order to implement quantitative analysis of the switching overshoots of SiC power electronic circuits, an analytical model of SiC MOSFET switching behaviour in the half‐bridge configuration was derived considering all important parasitic parameters, the non‐linear characteristics of the parasitic capacitances and the transconductance coefficient of the device. Based on the derived analytical model, the switching voltage and current overshoots under the specific circuit parameter conditions can be quantitatively evaluated without complex system‐level modelling. Sensitivity analysis for the voltage and current overshoots during the switching transient was quantified. Moreover, the effect rule of the gate resistance on the voltage overshoot was revealed. In the article, simulation and experimental results validate the analytical model and analysis results.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of ...various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression.
This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute.
A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047, the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants.
The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings.
Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
With increasing age older patients are at higher risk for cognitive decline after surgery. Even tailored anesthesia procedures in older patients remain a high risk for postoperative cognitive ...disorder. Additional stress derived from anxiety and anesthesia itself can negatively impact postoperative cognitive outcomes. The objective of this study was to evaluate the impact of general versus regional anesthesia on postoperative cognitive disorder and indicators of perioperative stress in elderly undergoing surgery.
In this single center prospective study between December 2014 and November 2015, 46 patients aged 50 to 85 years undergoing dermatology surgery were enrolled. Patients were stratified by receiving general versus regional nerve anesthesia. On three consecutive days, saliva cortisol levels were analyzed three times per day. Cognitive function was assessed on the day before and the day after surgery using comprehensive neuropsychological testing of multiple cognitive functions including memory, executive function, attention and processing speed.
Comparing the regional anesthesia group (RAG, n = 28) with the general anesthesia group (GAG, n = 18) no significant difference in the postoperative cognitive function was observed. However, patients in the GAG had significantly higher postoperative cortisol levels when compared to patients in the RAG. In both groups, a peak of cortisol value was detected on the day of surgery, which was higher in the GAG in comparison to the RAG.
We did not observe a difference in postoperative cognitive function between patients undergoing regional or general anesthesia for dermatology surgery. However, we found lower cortisol level in the RAG. Based on these findings, future studies should investigate alternatives to reduce stress in a general anesthesia setting.
ClinicalTrials.gov ID: NCT02505815.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Recycling of waste electrical and electronic equipment has become an urgent global issue in recent years from the prospectives of resources recycling and environmental protection. In the present ...work, the recycling of waste memory modules (WMMs) through low-temperature alkali melts was investigated, based on the thermodynamic analysis of the nonmetallic reactions of brominated epoxy resin, glass fiber and memory chip with the molten mixed alkali. The effects of the reaction temperature and the ratio of alkali mixture on the removal rate of nonmetallic parts in WMMs were discussed under the condition of air atmosphere. The optimum process parameters were further confirmed by
in-situ
monitoring of the temperature during the whole reaction process. The mixtures with Cu, Fe and Ni as the main components were obtained after the treatment of WMMs in the molten alkali. These mixed metals were further separated into copper-rich and ferronickel-rich metals by physical magnetic separation. Moreover, the precious metals Au and Ag were enriched in Cu-rich alloys. This work provided an efficient and environment-friendly method for metal recycling from WMMs.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The adoption of artificial intelligence (AI) algorithms is rapidly increasing in healthcare. Such algorithms may be shaped by various factors such as social determinants of health that can influence ...health outcomes. While AI algorithms have been proposed as a tool to expand the reach of quality healthcare to underserved communities and improve health equity, recent literature has raised concerns about the propagation of biases and healthcare disparities through implementation of these algorithms. Thus, it is critical to understand the sources of bias inherent in AI-based algorithms. This review aims to highlight the potential sources of bias within each step of developing AI algorithms in healthcare, starting from framing the problem, data collection, preprocessing, development, and validation, as well as their full implementation. For each of these steps, we also discuss strategies to mitigate the bias and disparities. A checklist was developed with recommendations for reducing bias during the development and implementation stages. It is important for developers and users of AI-based algorithms to keep these important considerations in mind to advance health equity for all populations.
Biomass-derived carbon is regarded as a potential replacement for commercial graphite carbon for the anode of powerful lithium-ion batteries (LIBs), because of its abundance and ecological advantage. ...In this research, biomass-derived carbon is prepared from natural Carex meyeriana Kunth, and the biomass-derived carbon electrode with coordinatively unsaturated Znx+(0 < x < 2) sites is synthesized by solar irradiation. The Znx+(0 < x < 2) electrode is used as the LIBs anode. It provides a highly specific capacity of 638.6 mAh g−1 at 200 mA g−1 after 900 cycles and an outstanding cycling capacity of 614.9 mAh g−1 at 1000 mA g−1 after 1000 cycles. The capacity of the electrode exceeds the majority of reported carbonaceous anodes. This study presents a practical strategy to prepare novel and low-cost carbonaceous anode. The resulting anode has promising potential for use in advanced LIBs and other energy storage devices due to its excellent Li+ storage capability.
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•Biomass-derived carbon with coordinatively unsaturated Znx + anode was prepared by solar irradiation.•The Li + diffusion coefficients and electrical conductivity of the biomass-derived carbon anode are enhanced by Znx+.•The biomass-derived carbon with Znx+ has a significant discharge capacity of 614.9 mAh g−1 over 1000 cycles at 1000 mA g−1.•Outstanding charge transfer kinetics and cyclic stability are demonstrated for the biomass-derived carbon with Znx + anode.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Introduction
The analysis of malpractice claims can provide risk managers with a detailed view of patient mortality and morbidity. The data comes from many institutions, encompasses a diverse group ...of practitioners and practice settings, and contains detailed clinical information. Analysis can help identify patterns of injury, risk factors, and rare and sentinel events.
Methods
We examined most recent anesthesia closed claims data collected by The Doctors Company, a large national malpractice insurer. We analyzed data from claims closed between 2007 and 2012. Each claim underwent a review by physician and nurse experts, and was then coded using the Comprehensive Risk Intelligence Tool. Injury distribution and association between the injury and patient comorbidity were also examined.
Results
A total of 607 claims were analyzed. Most frequent injuries were teeth damage (20.8%), death (18.3%), nerve damage (13.5%), organ damage (12.7%), pain (10.9%), and arrest (10.7%). Obesity was most frequently identified as a contributing factor leading to a claim. Injury‐to‐claim rates were highest in hospitals with fewer than 100 beds, while ambulatory surgery centers had the lowest death‐to‐claim rate (12%). Average indemnity for an anesthesia claim was $309 066, compared to $291 000 for all physician specialties.
Conclusions
The most frequent claims were death and nerve damage when teeth damage was excluded. Obesity impacted anesthesia outcomes more frequently than did other comorbidities. Although there were fewer claims from the smaller hospitals, those claims had higher rates of mortality and nerve damage compared to larger‐size hospitals. Further analysis is needed to evaluate these trends as well as impact of specific patient comorbidities on anesthesia outcomes.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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