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Peri-intubation cardiac arrest is an uncommon, serious complication following endotracheal intubation in the emergency department. Although several risk factors have been previously identified, this study aimed to comprehensively identify risk factors associated with peri-intubation cardiac arrest.This retrospective, nested case-control study conducted from January 1, 2016 to December 31, 2020 analyzed variables including demographic characteristics, triage, and pre-intubation vital signs, medications, and laboratory data. Univariate analysis and multivariable logistic regression models were used to compare clinical factors between the patients with peri-intubation cardiac arrest and patients without cardiac arrest.Of the 6983 patients intubated during the study period, 5130 patients met the inclusion criteria; 92 (1.8%) patients met the criteria for peri-intubation cardiac arrest and 276 were age- and sex-matched to the control group. Before intubation, systolic blood pressure and diastolic blood pressure were lower (104 vs. 136.5 mmHg, p0.01; 59.5 vs. 78 mmHg, p0.01 respectively) and the shock index was higher in the patients with peri-intubation cardiac arrest than the control group (0.97 vs. 0.83, p0.0001). Cardiogenic pulmonary edema as an indication for intubation (adjusted odds ratio [aOR]: 5.921, 95% confidence interval [CI]: 1.044-33.57, p = 0.04), systolic blood pressure90 mmHg before intubation (aOR: 5.217, 95% CI: 1.484-18.34, p = 0.01), and elevated lactate levels (aOR: 1.012, 95% CI: 1.002-1.022, p = 0.01) were independent risk factors of peri-intubation cardiac arrest.Patients with hypotension before intubation have a higher risk of peri-intubation cardiac arrest in the emergency department. Future studies are needed to evaluate the influence of resuscitation before intubation and establish airway management strategies to avoid serious complications.

BackgroundEsophageal cancer is a highly malignant neoplasm with poor prognosis. Of its patients, upper gastrointestinal bleeding (UGIB) is one of the most challenging and threatening conditions in the emergency department (ED). However, no previous studies have analyzed the etiologies and clinical outcomes in this specific population. This study aimed to identify the clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with UGIB.MethodsThis retrospective cohort study enrolled 249 adult patients with esophageal cancer presenting with UGIB in the ED. Patients was divided into the survivor and non-survivor groups, and their demographic information, medical history, comorbidities, laboratory parameters, and clinical findings were recorded. The factors associated with 30-day mortality were identified using Cox’s proportional hazard model.ResultsAmong the 249 patients in this study, 30-day mortality occurred in 47 patients (18.9%). The most common causes of UGIB were tumor ulcer (53.8%), followed by gastric/duodenal ulcer (14.5%), and arterial-esophageal fistula (AEF) (12.0%). Multivariate analyses indicated that underweight (HR = 2.02, p = 0.044), history of chronic kidney disease (HR = 6.39, p < 0.001), active bleeding (HR = 2.24, p = 0.039), AEF (HR = 2.23, p = 0.046), and metastatic lymph nodes (HR = 2.99, p = 0.021) were independent risk factors for 30-day mortality.ConclusionsThe most common cause of UGIB in esophageal cancer patients was tumor ulcer. AEF, accounting for 12% of UGIB in our study, is not an uncommon cause. Underweight, underlying chronic kidney disease, active bleeding, AEF, and tumor N stage > 0 were independent risk factors for 30-day mortality.

Search for simple and economical electrocatalyst for the hydrogen gas evolution reaction (HER), which can resemble to the performance of Pt and other precious metals, is a challenging research interest. In this work, a systematic effect of pre-treatment potential of screen-printed carbon (SPCE) surface on the HER performance in 0.5 M H2SO4 was carried out. A new observation of a low potential HER (onset potential, Eonset = −0.02 V vs. RHE) at a cathodic potential, −0.5 V vs. Ag/AgCl on 1 hr pre-treated screen-printed carbon electrode (SPCE*, * = pre-treated) was observed. Physicochemical and electrochemical characterizations of the SPCE* by field emission scanning electron-microscope, Raman, IR and X-Ray photoelectron spectroscopes reveals specific generation of carboxylic acid functionalized carbon surface and in turn for the enhanced HER on the modified electrode surface. Electrochemical characterization of SPCE* with Fe(CN)63− support the observation. A marked decrement in the peak current and significant increase in the peak-to-peak separation potential response due electrostatic repulsion between the anion sites of Fe(CN)63− and –COO– were noticed. This observation is in parallel with the reduced electrical double layer capacitance value of the SPCE* system. The Eonset and Tafel value (54.7 mV dec−1) obtained here are comparable to those at Pt, MoS2, MoSe2 and superior over the N- and P-doped graphene/carbon electrocatalysts for HER. A prototype HER system was developed and demonstrated for H2 gas production at a rate of 0.0053 μM s−1 (Operating potential = −0.5 V vs Ag/AgCl), which is comparable to that of precious metal and metal compound electrocatalysts based HER performance.

Tracheal intubation is an important clinical skill for medical students and junior residents (novice intubators). They are usually trained to use a direct laryngoscope (DL) with straight-to-cuff styletted tracheal tubes first. Only later are they exposed to the bougie as an airway adjunct and videolaryngoscope (VL) with either a standard blade or a hyperangulated blade. The purpose of this study was to investigate the performance of novice intubators in using DL with 3 common stylets.We conducted a prospective study to compare the performance of DL with 3 common stylets, namely the straight-to-cuff stylet (S), hyperangulated VL stylet (G), and bougie (B), on a manikin model.Among 72 participants, no significant difference was observed between the success rates of S, G, and B at the first attempt (84.72%, 81.94%, and 86.11%, respectively [P = .78]) or within 2 minutes (91.67%, 93.06%, and 91.67%, respectively [P = .94]). For participants with successful intubation within 2 minutes, the average total intubation times for S, G, and B were 25.05, 24.39, and 37.45 seconds, respectively. Among the 3 stylets, B had the longest intubation time, which differed significantly from S and G (P .01).The performances of novice intubators with 3 different stylets were similar. The success rates for DL with either hyperangulated VL stylet or bougie were not inferior compared with the straight-to-cuff stylet on manikin airway training model. If we properly trained novice intubators to use corresponding maneuvers, they can learn to use the 3 stylets early in their airway learning course.

In this study, we report the application of an inexpensive and easily prepared lead oxide–manganese oxide catalyst combined with Nafion (designated as Nf/PbMnO x ) as a highly efficient air-cathode for a zinc–air battery. We verify the mechanistic study of the reduction of O 2 for Nf/PbMnO x in alkaline aqueous solution using rotating ring/disk electrode voltammetry, and also an electrochemical approach using a wall-jet screen-printed ring disk electrode. The presence of Nf/PbMnO x shows great catalytic activity for the disproportionation reaction of HO 2 − to O 2 and OH − with an overall 4e − reduction of O 2 in the first reduction reaction. The 4e − reduction of O 2 was eventually achieved at the Nf/PbMnO x through evidence from the slope of Koutecky–Levich plots. With these inherent features, we then fabricated the zinc–air battery with the Nf/PbMnO x catalyst and examine the performance for a practical application with air cathodes.

A simple electrochemical approach to evaluate oxygen reduction catalysts using an inexpensive screen-printed ring disk carbon electrode system, consisting of a ring electrode deposited with MnO2 and a disk electrode modified with the catalysts for study, is developed in this study. The as-prepared MnO2 is selective and sensitive for H2O2 oxidation in the presence of O2 and is crucial to the proposed approach. By coupling with a wall-jet electrochemical cell, the product generated from the reduction reaction at the disk electrode can effectively be monitored at the MnO2-deposited ring electrode. Model catalysts of nano-Au and nano-Pd representing 2e− reduction of O2 to H2O2 and 4e− reduction to H2O, respectively, were evaluated as electrode materials in oxygen reduction reaction to demonstrate the applicability of the proposed method.

Aluminum chlorohydrate (Al2(OH)5Cl · 2H2O, ACH) is an active ingredient in many antiperspirants and deodorants formulation to reduce the body odors (mainly sweat) through interaction with apocrine sweat glands to produce insoluble aluminum hydroxide and free chloride, which then plugs the sweat gland that stops the flow of sweat to the skins surface. We demonstrated here an one drop (50 mL) electrochemical sensing of the ACH using an in-built three screen-printed electrodes assembly containing Ag as working and pseudo reference and carbon as counter electrode system (AgSPE). The free Cl � ion librated from ACH/H2O reaction was detected at AgSPE surface at 0.072 V vs. pseudo Ag reference electrode system in pH 2 phosphate solution by Cyclic voltammetric Technique. Under optimal working condition the AgSPE shows a linear calibration plot in the window of 30 - 2000 ppm of ACH with sensitivity and regression values of 0.104 mA/ppm and 0.998 respectively. Calculated detection limit is 3.03 ppm. RSD values of intra- and interassays were 0.19% and 2.79% respectively. Finally, real sample (antiperspirant deodorant lotions) assays were successfully demonstrated with results comparable to the predicted values.

Here we report the unique property of a preanodized screen-printed carbon electrode (SPCE∗) that can allow direct electron transfer (DET) reaction of glucose oxidase (GOx). The GOx can be immobilized in the composite of oxygen functionalities and edge plane sites generated during preanodization without additional cross-linking agents. The electron transfer rate of GOx is greatly enhanced to 4.38 s−1 as a result of the conformational change of GOx in the microenvironment enabling the accessibility of active site for GOx to the electrode. The analytical versatility is further improved with the aid of Nafion film. As a consequence, the as-prepared electrode can be used as a glucose biosensor and the number of potential foreign species is then restricted by molecular size, permeation and/or (bio)chemical reaction. Most importantly, the disposable nature of the proposed electrode is expected to promote the DET-related researches. Keywords: Glucose oxidase, Direct electron transfer, Preanodization, Disposable, Screen-printed carbon electrode

In this paper, we propose a novel frame-based approach (FBA) and use reference metadata extraction as a case study to demonstrate its advantages. The main contributions of this research are three-fold. First, the new frame matching algorithm, based on sequence alignment, can compensate for the shortcomings of traditional rule-based approach, in which rule matching lacks flexibility and generality. Second, an approximate matching is adopted for capturing reasonable abbreviations or errors in the input reference string to further increase the coverage of the frames. Third, experiments conducted on extensive datasets show that the same knowledge framework performed equally well on various untrained domains. Comparing to a widely-used machine learning method, Conditional Random Fields (CRFs), the FBA can drastically reduce the average field error rate across all four independent test sets by 70% (2.24% vs. 7.54%).

Evaluation have been an important subject since the early days of recommender systems. In online test, the click-through rate (CTR) is often adopted as the metric. However, recommended items with higher CTR does not imply higher relevance of two items since factors like item popularity or item serendipity may influence user's click behavior. We argue that the relevance of recommendation system is also desirable in many real applications. Here relevant means relevance in a human perceptible way. Relevant recommendations not only increase the users' trust to the system but are extremely useful for the vast number of anonymous user as their recommendations may only be made based on the current item. In this paper, we empirically examine the relation between the relevance of recommendations and the corresponding CTR with a few representative ItemCF algorithms through online data from a TV show/movie website, Hulu. Experiments show that algorithms with higher overall CTR may not correspond to higher relevance. Thus CTR may not be the optimal metric for online evaluation of recommender systems if producing relevant recommendations is of importance.

This paper presents an overview of the emerging field of emotion detection from text and describes the current generation of detection methods that are usually divided into the following three main categories: keyword-based, learning-based, and hybrid recommendation approaches. Limitations of current detection methods are examined, and possible solutions are suggested to improve emotion detection capabilities in practical systems, which emphasize on human-computer interactions. These solutions include extracting keywords with semantic analysis, and ontology design with emotion theory of appraisal. Furthermore, a case-based reasoning architecture is proposed to combine these solutions.