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Studying near-miss errors is essential to preventing errors from reaching patients. When an error is committed, it may be intercepted (near-miss) or it will reach the patient; estimates of the proportion that reach the patient vary widely. To better understand this relationship, we conducted a retrospective cohort study using two objective measures to identify wrong-patient imaging order errors involving radiation, estimating the proportion of errors that are intercepted and those that reach the patient. This study was conducted at a large integrated healthcare system using data from 1 January to 31 December 2019. The study used two outcome measures of wrong-patient orders: (1) wrong-patient orders that led to misadministration of radiation reported to the New York Patient Occurrence Reporting and Tracking System (NYPORTS) (misadministration events); and (2) wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder (RAR) measure, a measure identifying orders placed for a patient, retracted and rapidly reordered by the same clinician on a different patient (near-miss events). All imaging orders that involved radiation were extracted retrospectively from the healthcare system data warehouse. Among 293 039 total eligible orders, 151 were wrong-patient orders (3 misadministration events, 148 near-miss events), for an overall rate of 51.5 per 100 000 imaging orders involving radiation placed on the wrong patient. Of all wrong-patient imaging order errors, 2% reached the patient, translating to 50 near-miss events for every 1 error that reached the patient. This proportion provides a more accurate and reliable estimate and reinforces the utility of systematic measure of near-miss errors as an outcome for preventative interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Neurons in the cerebral cortex fire coincident action potentials during ongoing activity and in response to sensory inputs. These synchronized cell assemblies are fundamental to cortex function, yet basic dynamical aspects of their size and duration are largely unknown. Using 2-photon imaging of neurons in the superficial cortex of awake mice, we show that synchronized cell assemblies organize as scale-invariant avalanches that quadratically grow with duration. The quadratic avalanche scaling was only found for correlated neurons, required temporal coarse-graining to compensate for spatial subsampling of the imaged cortex, and suggested cortical dynamics to be critical as demonstrated in simulations of balanced E/I-networks. The corresponding time course of an inverted parabola with exponent of χ = 2 described cortical avalanches of coincident firing for up to 5 s duration over an area of 1 mm 2 . These parabolic avalanches maximized temporal complexity in the ongoing activity of prefrontal and somatosensory cortex and in visual responses of primary visual cortex. Our results identify a scale-invariant temporal order in the synchronization of highly diverse cortical cell assemblies in the form of parabolic avalanches., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Patient’s regret (PatR) concerning the choice of therapy represents a crucial endpoint for treatment evaluation after radical prostatectomy (RP) for prostate cancer (PCA). This study aims to compare PatR following robot-assisted (RARP) and open surgical approach (ORP). A survey comprising perioperative-functional criteria was sent to 1000 patients in 20 German centers at a median of 15 months after RP. Surgery-related items were collected from participating centers. To calculate PatR differences between approaches, a multivariate regressive base model (MVBM) was established incorporating surgical approach and demographic, center-specific, and tumor-specific criteria not primarily affected by surgical approach. An extended model (MVEM) was further adjusted by variables potentially affected by surgical approach. PatR was based on five validated questions ranging 0−100 (cutoff >15 defined as critical PatR). The response rate was 75.0%. After exclusion of patients with laparoscopic RP or stage M1b/c, the study cohort comprised 277/365 ORP/RARP patients. ORP/RARP patients had a median PatR of 15/10 (p < 0.001) and 46.2%/28.1% had a PatR >15, respectively (p < 0.001). Based on the MVBM, RARP patients showed PatR >15 relative 46.8% less frequently (p < 0.001). Consensual decision making regarding surgical approach independently reduced PatR. With the MVEM, the independent impact of both surgical approach and of consensual decision making was confirmed. This study involving centers of different care levels showed significantly lower PatR following RARP.

The work describes three principal Diels-Alder cycloaddition approaches toward chromanes that are designed for the de novo construction of the benzene ring. This study specifically focuses on the potential exploitation in the total synthesis of chromane-bearing natural products such as cebulactam A.

Some interesting recent advances in the theoretical understanding of neural networks have been informed by results from the physics of disordered many-body systems. Motivated by these findings, this work uses the replica technique to study the mathematically tractable bipartite Sherrington-Kirkpatrick (SK) spin-glass model, which is formally similar to a restricted Boltzmann machine (RBM) neural network. The bipartite SK model has been previously studied assuming replica symmetry; here this assumption is relaxed and a replica symmetry breaking analysis is performed. The bipartite SK model is found to have many features in common with Parisi's solution of the original, unipartite SK model, including the existence of a multitude of pure states which are related in a hierarchical, ultrametric fashion. As an application of this analysis, the optimal cost for a graph partitioning problem is shown to be simply related to the ground state energy of the bipartite SK model. As a second application, empirical investigations reveal that the Gibbs sampled outputs of an RBM trained on the MNIST data set are more ultrametrically distributed than the input data themselves.

This Highlight covers the current status of relatively unexplored sp(3)-sp(3) cross-coupling reactions with particular focus on natural product and related syntheses.

With the increasing popularity of ice cream in the nineteenth century, the incidence of foodborne illness attributed to this dessert exploded. Struggling to understand the causes of the mysterious and sometimes lethal ailment called "ice cream poisoning," Victorian doctors and scientists advanced theories including toxic vanilla, galvanism in ice cream freezers, and extreme indigestion. In the late 1880s Victor C. Vaughan's argument that ice cream poisoning could be attributed to the ptomaine "tyrotoxicon" received widespread acceptance. To date historians have neglected the role played by the ptomaine theory of food poisoning in shaping the evolution of both scientific thinking and public health in the late nineteenth century. The case of ice cream poisoning illustrates the emergence, impact, and decline of the ptomaine idea.

Both one of the most iconic cookbooks of all time and one of the strangest, the "Kniga o vkusnoi i zdorovoi pishche" became the culinary bible of the Soviet household during the mid-twentieth century. The logical culmination of a decade of Soviet culinary evolution under the leadership of Anastas Mikoian, the original "Book about Delicious and Healthy Food" is a microcosm of Stalinist civilization that exemplifies the contradictory trends making up Soviet politics and culture in the late 1930s. Drawing on previously unexamined documents from the State Archive of the Russian Federation, Anastas Mikoian's personal papers retained in the Russian State Archive of Socio-Political History, as well as published primary sources, this article seeks to contextualize the complex tale of the cookbook's origins in a broader narrative of the construction of the Soviet Union's official food culture under Mikoian's leadership during the 1930s.

Purpose: Position tracking is an important aspect of many computer-aided surgical techniques. Given the obstacles of current optical, electromagnetic, and mechanical systems for medical applications, this work investigates error reduction in a new mechanical tracking system developed for arthroscopic hip surgery. This new tracking linkage addresses the current contradictory requirements of a thin, small linkage for ease of surgical use and a large, bulky linkage for increased accuracy by using (1) kinematic redundancy and (2) data averaging and curve fitting., Method: To reduce the position error in the proposed mechanical tracking linkage, four numerical techniques were applied to data from the linkage. Two averaging techniques and two curve fitting techniques were investigated. After implementing each numerical technique, error testing was performed to quantify improvement in performance., Results: While the simple average and moving average techniques lowered the error by over 30%, these two methods were undesirable for the overall system performance. The lowest error was measured by the linear curve prediction method. This technique measured 0.552 mm of error, roughly half of the error measured by the control case. The quadratic prediction method reduced the error by 35% and had the lowest standard deviation in the measurements., Conclusion: The linear prediction technique was able to significantly lower the error measured by a kinematically redundant mechanical tracking linkage. While further testing is still necessary, this data suggests that a thin, small mechanical tracking linkage could achieve a high level of accuracy to be an appropriate choice for a surgical tracking application.

A simple algorithm for blind extraction of phase shifts is proposed for generalized phase-shifting interferometry from only three interferograms. Based on the statistical property of the object wave, the algorithm calculates approximately the involved phase shifts as initial values. The extraction is further improved by an iterative method, considering the fact that the closer the phase shifts approach their real values, the more uniform the reconstructed reference wave will become. The feasibility of this algorithm is demonstrated by both simulation and experiment.

Increasing accuracy requirements in aspheric metrology make the development of absolute testing procedures for aspheric surfaces important. One strategy is transferring the standard practice three-position test for spheres to aspherics. The three-position test, however, involves a cat's eye position and therefore has certain drawbacks. We propose an absolute testing method for rotationally symmetric aspherics where the cat's eye position is replaced with a radially sheared position. Together with rotational movements of the specimen, the surface deviations can be obtained in an absolute manner. To demonstrate the validity of the procedure, we present a measurement result for a sphere and compare it with a result obtained by the standard three-position test.

Purpose: In up to 50% of patients with vesico-enteric fistula conventional diagnostic methods fail. We report a simple and low cost diagnostic method that involves the oral intake of poppy seed., Materials and Methods: From 1994 to 1999, 17 patients in whom vesico-enteric fistula was suspected underwent the poppy seed test. We administered 250 gm. poppy seed orally in the evening and the urinary excretion of poppy seed was evaluated during the next 2 days., Results: Of the 17 patients 11 excreted the black seeds in the urine for 2 days after oral intake of the seeds. The diagnosis was supported by conventional diagnostic methods in 9 of the 11 cases, while in the remaining 2 the poppy seed test was the only preoperative diagnostic procedure that proved the existence of a fistula. The diagnosis was confirmed by surgical exploration in all 11 patients. In the remaining 6 patients with a nonspecific complaint vesico-enteric fistula was excluded by conventional diagnostic techniques and by the success of nonoperative therapy., Conclusions: The oral intake of poppy seed is a simple and ready available method for diagnosing vesico-enteric fistula. It may support the surgeon decision when conventional diagnostic tools fail.

Objective: It can be claimed that ESWL is an optimal alternative for ablation of calculi by external shock waves. The new developments in ESWL have focussed more on the economic aspects of treatment rather than enhancing its efficacy or reducing the side effects. Since August 1993, the prototype of the Dornier Lithotripter U-30 was used at the Department of Urology of the Katharinen hospital in Stuttgart., Methods/results: In 16 months, 1092 stones were treated requiring 1533 sessions. Complete disintegration was achieved in 84%; after 3 months' follow-up, 85.5% of the patients were stone free., Conclusion: The Dornier Lithotripter U-30 provides easy handling and a short learning curve and a sufficient disintegration of the stones. The device is suitable for safe and effective treatment of all urinary calculi, with special respect to in situ treatment of ureteral stones.

It can be claimed that ESWL is an optimal alternative for ablation of calculi by external shock waves. The new developments in ESWL focus more on the economic aspects of treatment rather than enhancing its efficacy or reducing the side effects. The routine indications of ESWL are well known and widely accepted. Similarly, its limitations are well defined: silent caliceal calculi, diverticular caliceal calculi, nephrolithiasis in horseshoe kidney, medullary sponge kidney and residual fragments after ESWL. Although endourology offers new, less invasive and less traumatic ways for stone ablation, such as lasertripsy, mini flexible ureteroscopes and ureteropyeloscopes, the indication for a more aggressive approach in the cases mentioned above is limited to the symptomatic cases. For calculi in the distal ureter, only the ureteroscope and intraureteral laser open new and interesting possibilities in the near future.

This report described two cases of postoperative adynamic ileus after iliac bone autografts. The etiology, treatment, and differentiation of this problem from mechanical obstruction are discussed.