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The purpose of this paper is to improve the fault early warning effect of smart grid equipment through multi-sensor information fusion technology. Therefore, based on the analytical model of power grid fault diagnosis, this paper considers the influence of distributed generation in distribution network on fault diagnosis, as well as the misoperation or refusal of protection and switch, and the false alarm or leakage of alarm signal. At the same time, in order to display the results of fault diagnosis accurately and intuitively, an analytical model of fault diagnosis of distribution network based on multi-source information fusion is proposed. Finally, this paper verifies the effectiveness of this method through an example application. This article uses the PEDL dataset for experimental research, Through the comparison of fault data, it can be seen that compared with existing methods, the method proposed in this paper achieves the highest goodness of fit for warning, indicating the best fault warning effect.When there is enough training set, the prediction accuracy of the fault set can reach over 99%, Based on experimental analysis, it can be concluded that the proposed power grid equipment model has higher accuracy and reliability compared to traditional models. And the model in this article integrates the real-time monitoring function of power grid equipment and the equipment fault warning function, which improves the practicality of the power grid equipment monitoring system. [ABSTRACT FROM AUTHOR]

Background/Aim. The most important moment in modern endodontics is the inclusion of rotating instruments made of nickel-titanium alloy in daily clinical work, which have supplanted stainless steel instruments due to their superior properties. The aim of this study was to investigate the influence of autoclave sterilization on cyclic fatigue (CF) in two types of rotating instruments produced by M-wire technology with different types of rotation. Methods. This research included two types of M-wire rotary instruments -- 48 ProTaper Next® instruments with full rotation and 48 WaveOne® Gold instruments with reciprocating rotation. Each of the two groups of instruments was divided into four additional groups of 12 instruments depending on the number of cycles of sterilization in the autoclave. The instruments were tested in an artificial canal with a 2 and 5 mm radius of curvature. Results. Statistically significantly higher resistance to CF was observed with WaveOne® Gold compared to ProTaper Next® (p < 0.001) instruments, both in the non-sterilized group and after their exposure to the first, third, and fifth cycle of sterilization. The third and fifth cycle of sterilization significantly reduced resistance to CF in the WaveOne® Gold (p < 0.001) group. There was no statistically significant difference in CF resistance between sterilized and non-sterilized instruments of the ProTaper Next® group. Conclusion. Sterilization in an autoclave for instruments based on M-wire technology did not increase resistance to CF. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this paper is to improve the fault early warning effect of smart grid equipment through multi-sensor information fusion technology. Therefore, based on the analytical model of power grid fault diagnosis, this paper considers the influence of distributed generation in distribution network on fault diagnosis, as well as the misoperation or refusal of protection and switch, and the false alarm or leakage of alarm signal. At the same time, in order to display the results of fault diagnosis accurately and intuitively, an analytical model of fault diagnosis of distribution network based on multi-source information fusion is proposed. Finally, this paper verifies the effectiveness of this method through an example application. This article uses the PEDL dataset for experimental research, Through the comparison of fault data, it can be seen that compared with existing methods, the method proposed in this paper achieves the highest goodness of fit for warning, indicating the best fault warning effect.When there is enough training set, the prediction accuracy of the fault set can reach over 99%, Based on experimental analysis, it can be concluded that the proposed power grid equipment model has higher accuracy and reliability compared to traditional models. And the model in this article integrates the real-time monitoring function of power grid equipment and the equipment fault warning function, which improves the practicality of the power grid equipment monitoring system.

With the progress of electrical equipment, various faults often occur during its operation, which adversely affect the efficiency and quality of power supply. In this paper, the neural network algorithm is used to detect the system parameters. This paper first discusses the shortcomings and defects of traditional diagnosis methods, and then proposes a new method combining with existing technologies to build fault state identification criteria and classifiers based on neural network model, and also uses a variety of intelligent algorithms such as fuzzy reasoning and support vector machine to solve the common short-circuit problem of electrical equipment on the power line, so as to provide reliable security for actual operation and help the power sector. The performance of the diagnostic system is tested in this paper. The test results show that in the process of real-time monitoring, analysis and feedback processing of the fault identification system, the fault detection time is 5.2, 5.1, 4.9, 4.7, 4.6, 4.5, 4.4, 4.3, 4.2, 4.1 seconds by applying the neural network algorithm. This data represents a significant improvement in fault detection speed, from 5.2 seconds to 4.1 seconds. [ABSTRACT FROM AUTHOR]

BackgroundRotating and laser sheaths are both routinely used in transvenous lead extraction (TLE) which can lead to catastrophic complications including death. The efficacy and risk of each approach are uncertain. To perform a meta-analysis to compare success and mortality rates associated with rotating and laser sheaths.MethodsWe searched electronic academic databases for case series of consecutive patients and randomized controlled trials published 1998-2017 describing the use of rotating and laser sheaths for TLE. Among 48 studies identified, rotating sheaths included 1,094 patients with 1,955 leads in 14 studies, and laser sheaths included 7,775 patients with 12,339 leads in 34 studies. Patients receiving rotating sheaths were older (63 versus 60 years old) and were more often male (74% versus 72%); CRT-P/Ds were more commonly extracted using rotating sheaths (12% versus 7%), whereas ICDs were less common (37% versus 42%), p > 0.05 for all. Infection as an indication for lead extraction was higher in the rotating sheath group (59.8% versus 52.9%, p = 0.002). The mean time from initial lead implantation was 7.2 years for rotating sheaths and 6.3 years for laser sheaths (p > 0.05).ResultsSuccess rates for complete removal of transvenous leads were 95.1% in rotating sheaths and 93.4% in laser sheaths (p

Study Design Observational study. Purpose Investigation of factors related to proximal junctional kyphosis (PJK) and device failure in patients with early-onset scoliosis. Overview of Literature The use of growth-friendly devices, such as traditional dual growing rod (TDGR) for the treatment of early-onset scoliosis (EOS), may be associated with important complications, including PJK and device failure. Methods Thirty-five patients with EOS and treated with TDGR from 2014 to 2021 with a minimum follow-up of 2 years were retrospectively evaluated. Potential risk factors, including demographic factors, disease etiology, radiological measurements, and surgical characteristics, were assessed. Results PJK was observed in 19 patients (54.3%), and seven patients (20%) had device failure. PJK was significantly associated with global final kyphosis change (p=0.012). No significant correlation was found between the rod angle contour, type of implant, connector design, and the risk of PJK or device failure. Conclusions Treatment of EOS with TDGR is associated with high rates of complications, particularly PJK and device failure. The device type may not correlate with the risk of PJK and device failure. The progression of thoracic kyphosis during multiple distractions is an important risk factor for PJK.

Introduction Emergent clinical care and patient movements through the military evacuation system improves survival. Patient management differs when transporting from the point-of-injury (POI) to the first medical treatment facility (MTF) versus transporting from the Role 2 to the Role 3 MTF secondary to care rendered within the MTF, including surgery and advanced resuscitation. The objective of this study was to describe care provided to patients during theater inter-facility transports and compare with pre-hospital transports (POI to first MTF). Materials and Methods We performed a retrospective chart review of patients with the Role 2 to the Role 3 transports in Afghanistan and Iraq from 2007 to 2016. Data collected included procedures and events at the MTF and during transport. We compared the intra-theater transport data (Role 2 to Role 3) to data from a previous study evaluating pre-hospiital transports (POI to first MTF). Results We reviewed the records of 869 Role 2 to Role 3 transport patients. Role 2 to Role 3 transports were longer in duration compared to POI transports (39 minutes vs. 23 minutes) and were more likely to be staffed by advanced personnel (nurses, physician assistants, and physicians) (57% vs. 3%). The sample primarily consisted of military-aged males (mean age 27 years) who suffered from explosive or blunt force injuries. Procedures performed during each phase of care reflected the capabilities of the teams and locations. Pain and cardiac events were more common in POI evacuations compared to the Role 2 to Role 3 transports, but documentation of respiratory events, hemodynamic events, neurologic events, and equipment failure was more common during the Role 2 to Role 3 transports. Survival rates were slightly higher among the Role 2 to Role 3 cohort (98% vs. 95%, difference 3% [95% confidence interval of the difference 1-5%]). Conclusions Inter-facility transports (Role 2 to Role 3) are longer in duration, transport more complex patients, and are staffed by more advanced level provider types compared to transports from POI. [ABSTRACT FROM AUTHOR]

Study Design: Observational study. Purpose: Investigation of factors related to proximal junctional kyphosis (PJK) and device failure in patients with early-onset scoliosis. Overview of Literature: The use of growth-friendly devices, such as traditional dual growing rod (TDGR) for the treatment of early-onset scoliosis (EOS), may be associated with important complications, including PJK and device failure. Methods: Thirty-five patients with EOS and treated with TDGR from 2014 to 2021 with a minimum follow-up of 2 years were retrospectively evaluated. Potential risk factors, including demographic factors, disease etiology, radiological measurements, and surgical characteristics, were assessed. Results: PJK was observed in 19 patients (54.3%), and seven patients (20%) had device failure. PJK was significantly associated with global final kyphosis change (p=0.012). No significant correlation was found between the rod angle contour, type of implant, connector design, and the risk of PJK or device failure. Conclusions: Treatment of EOS with TDGR is associated with high rates of complications, particularly PJK and device failure. The device type may not correlate with the risk of PJK and device failure. The progression of thoracic kyphosis during multiple distractions is an important risk factor for PJK. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to reduce instrument packaging defects in the Central Sterile Supply Department (CSSD) using action research. Data of the instrument packs packaged by the packaging personnel at the CSSD of the authors’ institution during March to May 2023 were collected and analyzed. After identifying the problems, 2 rounds of cyclic process of “plan-action-observe-reflect” were implemented to standardize the packaging procedures and develop and improve the applicable check of standard operating procedures for the CSSD. After strictly implementing the packaging operation standards and checklists, the number of packaging defect cases dropped from 274 to 41. A significant difference was identified between the number of packaging personnel who achieved a “pass” in the assessment of 3 items for maintenance. Also, 1 item for assembly had significant differences compared with the baseline number after the first cycle (P ≤ 0.001). A significant difference was identified between the number of packaging personnel who achieved a “pass” in the assessment of 20 items for 6 components after the second cycle compared with that after the first cycle (P ≤ 0.05). Through action research methodology, strict implementation of standardized packaging procedures in the CSSD can reduce packaging defects, thereby decreasing clinical complaints and ensuring patient safety.

This study aimed to reduce instrument packaging defects in the Central Sterile Supply Department (CSSD) using action research. Data of the instrument packs packaged by the packaging personnel at the CSSD of the authors' institution during March to May 2023 were collected and analyzed. After identifying the problems, 2 rounds of cyclic process of "plan-action-observe-reflect" were implemented to standardize the packaging procedures and develop and improve the applicable check of standard operating procedures for the CSSD. After strictly implementing the packaging operation standards and checklists, the number of packaging defect cases dropped from 274 to 41. A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 3 items for maintenance. Also, 1 item for assembly had significant differences compared with the baseline number after the first cycle (P ≤ 0.001). A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 20 items for 6 components after the second cycle compared with that after the first cycle (P ≤ 0.05). Through action research methodology, strict implementation of standardized packaging procedures in the CSSD can reduce packaging defects, thereby decreasing clinical complaints and ensuring patient safety. [ABSTRACT FROM AUTHOR]

Copyright of RSBO: Revista Sul-Brasileira de Odontologia is the property of UNIVILLE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Railway Standard Design is the property of Railway Standard Design Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research paper employs a comprehensive risk matrix approach to analyze the potential risks associated with the Orange Line Metro Rail Transit System (OLMRTS). The major focus of this study revolves around two critical safety variables: human error and equipment failure, with a particular emphasis on human error as the most significant contributing factor. The research methodology involves the development of risk assessment models based on various incident scenarios. To identify potential hazards and assess their severity, historical incident data from a range of sources was collected and analyzed. This data made it possible to identify a number of potentially hazardous circumstances that could have an adverse impact on OLMRTS depot operations. The frequency and severity of each hazardous event were carefully evaluated based on the historical incident data, providing valuable insights into the potential risks faced by the system. The key findings of this investigation highlight that human-related activities emerge as the most significant potential cause of risk within the context of OLMRTS. The data analysis indicates a high level of risk associated with human error, underscoring the importance of addressing and mitigating these risks to enhance the overall safety and reliability of the OLMRTS system. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. Materials and Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality. [ABSTRACT FROM AUTHOR]

Intermediate charging and sudden failure of automatic guided vehicles (AGVs) interrupt and severely affect the stability and efficiency of scheduling. Therefore, an AGV scheduling approach considering equipment failure and power management is proposed for outfitting warehouses. First, a power consumption model is established for AGVs performing transportation tasks. The powers for departure and task consumption are used to calculate the AGV charging and return times. Second, an optimization model for AGV scheduling is established to minimize the total transportation time. Different conditions are defined for the overhaul and minor repair of AGVs, and a scheduling strategy for responding to sudden failure is proposed. Finally, an algorithm is developed to solve the optimization model for a case study. The method can be used to plan the charging time and perform rescheduling under sudden failure to improve the robustness and dynamic response capability of AGVs. [ABSTRACT FROM AUTHOR]

Wearing surgical masks or other similar face coverings can reduce the emission of expiratory particles produced via breathing, talking, coughing, or sneezing. Although it is well established that some fraction of the expiratory airflow leaks around the edges of the mask, it is unclear how these leakage airflows affect the overall efficiency with which masks block emission of expiratory aerosol particles. Here, we show experimentally that the aerosol particle concentrations in the leakage airflows around a surgical mask are reduced compared to no mask wearing, with the magnitude of reduction dependent on the direction of escape (out the top, the sides, or the bottom). Because the actual leakage flowrate in each direction is difficult to measure, we use a Monte Carlo approach to estimate flow-corrected particle emission rates for particles having diameters in the range 0.5-20 μm. in all orientations. From these, we derive a flow-weighted overall number-based particle removal efficiency for the mask. The overall mask efficiency, accounting both for air that passes through the mask and for leakage flows, is reduced compared to the through-mask filtration efficiency, from 93 to 70% for talking, but from only 94-90% for coughing. These results demonstrate that leakage flows due to imperfect sealing do decrease mask efficiencies for reducing emission of expiratory particles, but even with such leakage surgical masks provide substantial control.

Impella devices are increasingly utilized for hemodynamic support in high-risk percutaneous coronary intervention or cardiogenic shock despite a lack of randomized clinical trial data showing clinical benefit and newer observational data suggesting harm. In this retrospective analysis, our aim was to determine the most common adverse events associated with Impella usage reported annually to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and to estimate via the National Inpatient Sample (NIS) database the number of percutaneous ventricular assist devices utilized and associated with inpatient mortality since introduction of the Impella. Among the 885 complete reports submitted to the MAUDE database from 2008 to 2019 related to Impella usage, there were 1,206 complications coded; 88.2% of reports occurred from 2016 to 2019. Among patients with adverse events reported, bleeding (32.8%), device deployment or retrieval issues (18.2%), vascular complications (15.8%), and death (12.4%) were the most common, and 7.9% of all complications were attributable to operator decision-making or technique. From 2007 to 2017 there was a >100-fold increase in percutaneous ventricular assist devices use with an increase and plateau in in-hospital mortality to 31% from 2012 to 2016 based on NIS data. In conclusion, Impella use has increased substantially over the last decade but remains associated with high inpatient mortality and serious complications based on data from the NIS and MAUDE databases. These findings emphasize the need for high quality randomized controlled trials to determine the clinical utility of Impella in high-risk percutaneous coronary intervention and cardiogenic shock.

Introduction: Sometimes, laboratory diagnosis accompany by errors. Detection of these errors could be effective in preventing their occurrence. This study aimed to evaluate random errors and their causes in a Hamadan teaching hospital laboratory during the years of 2020 to 2021. Methods and Materials: In this cross-sectional and retrospective study, recorded random errors in a Hamadan teaching hospital laboratory was gathered during 2020 to 2021. The data were analyzed by SPSS software version 24. Frequency and percentage of desired variables were presented. Results: According to the results, 312 random errors had been recorded. 98 (31.42%) of them had been only detected by Westgard method and 214 (68.58%) had been detected by both of Westgard and WHO methods. 98 (31.42%) of the random errors had been detected by R4S Westgard rule and 214 (68.58%) of them had been detected by 13S Westgard and WHO rule. The most common causes of random errors were equipment failure (109, 34.93%), reagent failure (82, 26.30%), environmental factors (68, 21.79%) and human error or procedure change (54, 17.07%) respectively. The most errors were related to biochemistry 200 (64.10%), hematology 70 (22.43%) and coagulation department 42 (13.47%) respectively. Discussion and Conclusion: The main causes of random errors were equipment and reagent failure. Equipment update, reagent quality control and staff training could be effective in the reduction of these errors. [ABSTRACT FROM AUTHOR]

Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/ cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability. [ABSTRACT FROM AUTHOR]

Background The entanglement of multiple central venous catheters is a rare and serious complication. The Swan-Ganz catheter is a responsible for various cases. Case A 66-year-old male patient was under general anesthesia for a coronary artery bypass graft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a Swan-Ganz catheter was inserted into the left internal jugular vein. Chest radiograph after catheter placement revealed that the Perm catheter had migrated to the left brachiocephalic vein. The surgeon attempted to reposition it manually, but postoperative radiograph showed that it had rolled into a loop. On postoperative day 1, radiological intervention was performed to untangle the loop, which was successful. Conclusions After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate the condition.

This paper proposes a rule base construction method of section out of limit disposal strategy for thermal power unit equipment fault, which can solve the problems of abnormal power transmission and grid real-time scheduling caused by section out of limit. Through the improved Apriori algorithm, the section out of limit disposal strategy of thermal power unit equipment fault is designed. In the mining result of thermal power unit equipment fault section out of limit, the association rules between section state and unit and load disposal strategy are established. By using the improved Apriori algorithm, the policy data and section state data are set as the preceding and following constraints of the association rules, The strong association rules are obtained, and the rule base of cross section out of limit disposal strategy is constructed according to the association rules. The experimental results show that: the number of association rules obtained by the improved Apriori algorithm mining each database is less than 1000, and the rule effectiveness and analysis efficiency are significantly improved; The rule base built by this method can effectively deal with the out of limit problems of different sections and units, and the sensitivity of each generator node increases greatly after the treatment.

Power generation from wind farms is growing rapidly around the world. In the past decade, wind energy has played an important role in contributing to sustainable development. However, wind turbines are extremely susceptible to component damage under complex environments and over long-term operational cycles, which directly affects their maintenance, reliability, and operating costs. It is crucial to realize efficient early warning of wind turbine failure to avoid equipment breakdown, to prolong the service life of wind turbines, and to maximize the revenue and efficiency of wind power projects. For this purpose, wind turbines are used as the research object. Firstly, this paper outlines the main components and failure mechanisms of wind turbines and analyzes the causes of equipment failure. Secondly, a brief analysis of the cost of wind power projects based on equipment failure is presented. Thirdly, the current key technologies for intelligent operation and maintenance (O&M) in the wind power industry are discussed, and the key research on decision support systems, fault diagnosis models, and life-cycle costs is presented. Finally, current challenges and future development directions are summarized. [ABSTRACT FROM AUTHOR]

Equipment failure is a common problem in mining operations, resulting in significant delays and reductions in production efficiency. To address this problem, this paper proposes a dynamic scheduling model for underground metal mines under equipment failure conditions. The model aims to minimize the impact of equipment failures on production operations while avoiding extensive equipment changes. A case study of the southeastern mining area of the Chambishi Copper Mine is presented to demonstrate the effectiveness of the proposed model. The initial plan was generated using the multi-equipment task assignment model for the horizontal stripe pre-cut mining method. After equipment breakdown, the proposed model was used to reschedule the initial plan. Then, a comparative analysis was carried out. The results show that the proposed model effectively reduces the impact of equipment failures on production operations and improves overall mining execution at a low management cost. In general, the proposed model can assist schedulers in allocating equipment, coping with the disturbing effects of equipment failure, and improving mine production efficiency. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report a case of subcutaneous implantable cardioverter-defibrillator implantation in a morbidly obese pediatric patient with hypertrophic cardiomyopathy for the primary prevention of sudden cardiac death. During routine defibrillator threshold testing of the newly placed subcutaneous implantable cardioverter defibrillator, normal sinus rhythm could not be restored despite repeated attempts at defibrillation using the subcutaneous implantable cardioverter defibrillator and transcutaneous pads. Here, we describe the successful intraoperative resuscitation and management after failure to restore normal sinus rhythm using the newly placed subcutaneous implantable cardioverter defibrillator and repeated transcutaneous defibrillation attempts.

BackgroundExcessive electrocardiographic alarms contribute to "alarm fatigue," which can lead to patient harm. In a prior study, one-third of audible electrocardiographic alarms were for accelerated ventricular rhythm (AVR), and most of these alarms were false. It is uncertain whether true AVR alarms are clinically relevant.ObjectivesTo determine from bedside electrocardiographic monitoring data (1) how often true AVR alarms are acknowledged by clinicians, (2) whether such alarms are actionable, and (3) whether such alarms are associated with adverse outcomes ("code blue," death).MethodsSecondary analysis using data from a study conducted in an academic medical center involving 5 adult intensive care units with 77 beds. Electronic health records of 23 patients with 223 true alarms for AVR were examined.ResultsThe mean age of the patients was 62.9 years, and 61% were white and male. All 223 of the true alarms were configured at the warning level (ie, 2 continuous beeps), and 215 (96.4%) lasted less than 30 seconds. Only 1 alarm was acknowledged in the electronic health record. None of the alarms were clinically actionable or led to a code blue or death.ConclusionsTrue AVR alarms may contribute to alarm fatigue. Hospitals should reevaluate the need for close monitoring of AVR and consider configuring this alarm to an inaudible message setting to reduce the risk of patient harm due to alarm fatigue. Prospective studies involving larger patient samples and varied monitors are warranted.

ObjectivesThe purpose of this study was to evaluate the effect of different ambient temperatures on cyclic fatigue (CF) life of two NiTi rotary systems and correlate the results with martensitic transformation temperatures.Materials and methodsHeat-treated NiTi Vortex Blue (VB) and EdgeSequel Sapphire (SP) instruments (tip sizes no. 20, 25, 30, 35, 40) were tested for CF resistance at room and body temperature (n = 20 each group) in a simulated canal (angle of curvature 60°; radius 3 mm; center from instrument tip 4.5 mm) with a motor controlled by an electric circuit. Mean half-life, beta and eta Weibull parameters were determined and compared. Two further instruments of each brand were subjected to differential scanning calorimetry (DSC).ResultsTemperature had an effect on fatigue behavior: all instruments lasted significantly longer at room than at body temperature. All VB significantly outlasted those of SP at body temperature; while smaller diameters of VB (size no. 20) were also significantly more resistant than SP when tested at room temperature; SP with larger diameters (sizes no. 30, no. 35, and no. 40) lasted significantly longer than VB did.ConclusionsImmersion in water at body temperature was associated with a marked decrease in the fatigue life of all rotary instruments tested. VB instruments were significantly more CF resistant at body temperature and showed the highest predictability in terms of fracture resistance.Clinical relevanceRotary instruments manufactured with different post-machining heat treatment responded differently to changed ambient temperatures. DSC assessment of martensitic conversion temperatures helps to predict the behavior of nickel titanium rotaries in different environments.

Abstract Background Total hip arthroplasty(THA)is widely used to treat end-stage hip disorders. Ceramic-on-ceramic total hip prostheses are widely used because of their durability. Alumina matrix composite (AMC), known as the fourth-generation ceramics, reduces implant fracture and wear rate compared to their predecessors. However, ceramic acetabular liner dissociation is a complication that necessitates revision of the AMC prostheses. To date, only few cases of AMC liner dissociation have been reported and all of which have been treated with revision surgery. Therefore, the prognosis of non-operated AMC liner dissociation remains unknown so far. Case presentation A 57-year-old man with avascular necrosis of the femoral head was treated with THA, wherein a Pinnacle® (DePuy, J&J, Warsaw, IN) acetabular cup and AMC liner were implanted. Intraoperative examination confirmed proper seating of the liner, whereas the initial postoperative radiograph revealed liner dissociation. The patient refused surgical revision due to the absence of symptoms and was discharged and followed-up. The patient made an uneventful recovery, and radiographic follow-up at 6-month post-operation showed that the liner was re-seated to its right position. No clinical or radiographic anomaly was found at the 15-month of postoperative follow-up. Conclusions Here, we report an unprecedented case of AMC ceramic liner dissociation with spontaneous resolution. This case shows that ceramic liner dissociation could be asymptomatic, and careful postoperative examination of the patient is important. Spontaneous resolution is possible, but the underlying mechanism and the eligible patient to benefit from it must be investigated. Before clarifying these questions, revision surgery should be the first-line treatment.

Aim: To discover the perceived level of nursing interruptions during care activities. The study evaluates the contributing factors of alarms, equipment failures, visitors, and telephone calls in predicting interruptions according to the site of nurses' work. It also examines the potential association of demographic factors of nurses with interruption levels. Design: A cross-sectional study. Methods: The study included nurses working at a tertiary hospital in Amman, the capital of Jordan. Data collections were carried out between May and July 2020. The analysis was performed using 257 valid questionnaires, compromising 128 male and 129 female respondents. The study used a nursing interruptions scale and an interruptions scale related to patients and hospitals. Results: Results indicated that the participating nurses generally experienced a high level of interruptions during nursing care activities. Visitors were found to be the main predictor of nursing interruptions on the surgical / medical floor; whereas equipment failure was found to be the main predictor of nursing interruptions in intensive care units. Finally, the demographic factors of marital status and educational level were associated with interruptions. Conclusion: Visitors and equipment failures are the main predictors of interruptions during nursing care activities. Our results provide a clear explanation for organizations, nurse managers, and clinicians of the factors behind nursing interruptions.

Objective: Serious device-related complications for hypoglossal nerve stimulators are rare, but surgeons should implement a prompt and systematic approach to quickly troubleshoot a non-functioning device. Method: Records were queried at a single academic tertiary referral centre between January 2019 and June 2021. Results: The authors present four cases of non-functioning hypoglossal nerve stimulator devices: one case in which migration of the stimulation lead required a revision implantation, one in which the implantable pulse generator was found to be non-functional intra-operatively, one case of an intramuscular sensory lead tract causing pain and one case of implantable pulse generator failure that was probably triggered by implantable cardiac device discharge. In this study, computed tomography imaging was critical to the diagnosis for the first and third cases. Conclusion: Given the limited complication reporting available for hypoglossal nerve stimulators, these cases highlight management and unique imaging findings. The authors present an algorithm to work-up non-functioning hypoglossal nerve stimulator devices. [ABSTRACT FROM AUTHOR]

According to existing study into the remote fault diagnosis procedure, the current diagnostic approach has an imperfect decision model, which only supports communication in a close distance. An Internet of Things (IoT)- based remote fault diagnostic approach for wind power equipment is created to address this issue and expand the communication distance of fault diagnosis. Specifically, a decision model for active power coordination is built with the mechanical energy storage of power generation equipment with a remote diagnosis mode set by decision tree algorithms. These models help calculate the failure frequency of bearings in power generation equipment, summarize the characteristics of failure types and detect the operation status of wind power equipment through IoT. In addition, they can also generate the point inspection data and evaluate the equipment status. The findings demonstrate that the average communication distances of the designed remote diagnosis method and the other two remote diagnosis methods are 587.46 m, 435.61 m, and 454.32 m, respectively, indicating its application value. [ABSTRACT FROM AUTHOR]

Abstract Background Surgical instrument packaging quality directly affects the safety and performance of surgery. We aimed to investigate the factors causing defects in surgical instrument packaging and recommend strategies to prevent defects in surgical instrument packaging. Methods We collected surgical instrument packaging data regarding age, gender, length of service, educational background, number of staff dealing with packaging, time period of packaging, instrument specification, where the wrap was intact, whether the wrap reached the required quality of cleaning, and whether the instruments were satisfactorily cleaned in compliance with guidelines from 5000 surgical instrument packages during June-December 2018 at Central Sterile Supply Department of the West China Second University Hospital, Sichuan University. Meanwhile, a questionnaire survey completed by the operating room staff using surgical instruments was used to measure the level of their satisfaction with the instruments in the packages. We utilized single-factor analysis to investigate possible factors that might cause defects in surgical instrument packaging, and conducted multivariate logistic regression analysis of the factors associated with defects in packaging. Results Length of service, educational background, number of staff dealing with packaging, time period of packaging, instrument structure, whether the wrap was intact, whether the wrap reached the required quality of cleaning, and whether the surgical instruments were satisfactorily cleaned in compliance with guidelines were the factors significantly (P < 0.05) associated with defects in surgical instrument packaging. Conclusion This study reveals that various factors are associated with defects in surgical instrument packaging. Recommendations for reducing incidences of defects include improved scheduling of packaging workload, greater provision of training in packaging skills, and standardization of packaging procedure.

Context: The refined mechanics of a flexible ureteroscope (fURS) are vulnerable to damage. Sending the fURS for repair is costly and has driven interest toward estimating the resources used for fURS repairs. Objective: To systematically review available literature and to estimate the total weighted repair rate of an fURS and the average repair cost per ureteroscopy. Evidence acquisition: A systematic review was conducted by searching the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The average costs of all repairs identified in the included studies were extracted. A random-effect model was used to calculate the pooled total fURS repair rate. The total weighted repair rate and average cost per repair were multiplied to provide an average cost of repair per ureteroscopy procedure. Evidence synthesis: We identified 18 studies that fulfilled the inclusion criteria, which included 411 repairs from 5900 investigated ureteroscopy procedures. The calculated weighted repair rate was 6.5% ± 0.745% (95% confidence interval: 5.0–7.9%; I2 = 75.3%), equivalent to 15 ureteroscopy procedures before repair. The average cost per repair was 6808 USD; according to the weighted repair rate of 6.5%, this corresponds to an average repair cost of 441 USD per procedure. Egger’s regression test did not reveal a significant publication bias (p = 0.07). Conclusions: This is the first meta-analysis to estimate the repair rate of the fURS used for ureteroscopy. Our analysis demonstrates a repair rate of 6.5%, equivalent to 15 ureteroscopy procedures between fURS repairs and a repair cost of 441 USD per procedure. Ureteroscopy practices should consider fURS breakage rates and repair costs to optimize the use of reusable versus disposable devices. Patient summary: We reviewed available literature investigating the repair rate of a flexible ureteroscope (fURS). We found that fURSs are sent for repair after every 15 ureteroscopy procedures, corresponding to 441 USD per procedure in repair cost.

Abstract Aim To investigate an association between failure of initial peripheral intravascular catheter (PIVC) insertion and adverse events in patients admitted to the intensive care unit (ICU) from the emergency room (ER). Methods This study was a post hoc analysis of the AMOR‐VENUS study, a multicenter cohort study that included 22 institutions and 23 ICUs in Japan between January and March of 2018. Study participants included consecutive adult patients admitted to the ICU with PIVCs inserted in ICU during the study period exclusively from the ER. The primary outcome was adverse events. Adverse events were composite of arterial puncture, hematoma, extravasation, nerve injury, tendon injury, compartment syndrome, pain, redness, bad location, and effusion. Multivariate logistic regression analyses were performed to assess the association between adverse events and the failure of initial PIVC insertion. Results In total, 363 patients and 1121 PIVCs were analyzed. Moreover, 199 catheters failed to insert properly, and 36 patients and 107 catheters experienced adverse events. After performing multivariate logistic regression analysis, there were statistically significant associations in the odds ratio (OR) and 95% confidence interval (CI) for the failure of initial insertion (OR, 1.66 [1.02–2.71]; p = 0.04). Conclusion Failure of initial insertion may be a risk factor for adverse events. We could potentially provide various interventions to avoid failure of initial PIVC insertion. For example, PIVC insertion could be performed by experienced practitioners.

The growth of global competition has led to significant changes in the way manufacturing companies operate. These changes have affected maintenance and made its role even more important for business success. To remain competitive, manufacturing companies must constantly improve the efficiency of their production processes. The fact that maintenance is becoming increasingly important for the industrial sector is evident from the ongoing discussions on national industrialization programs. At the same time, despite the growing demand for reliable production equipment, some manufacturers are engaged in the development of strategic services. Moreover, traditional maintenance strategies, such as reactive maintenance, are no longer sufficient to meet industrial needs, such as maximizing the reduction in failures and fatigue of production systems. This article presents an analysis of maintenance strategies. The review aims to point out the importance of unplanned downtime that may occur during the operation of the equipment at the production plant. To maintain the working condition of the machine, various maintenance strategies have been developed, among which the most popular are reactive maintenance, planned maintenance and condition-based maintenance. The predicted condition method is more effective for the maintenance of complex and responsible machines, but planned maintenance remains the most common maintenance program.

In this study, accident cause analysis was used to generate a number of design failure elements (DFEs) that highlight the general classification of design errors. Then, a database of cases, suggesting design changes from unsafe to safe design, was compiled from journals, accident corrective action, and patents to identify the chemical industry design issues (DIs). The DIs were then classed under DFEs and into five main equipment categories, namely, reaction, separation, heat transfer, storage, and pipe and piping system. The database analysis reveals that the layout accounts for 17.4 % of DFEs, followed by equipment error (17.29 %) and reaction and reactive condition (16.86 %). For the equipment category, the reaction equipment had the highest DI which was related to the DFE of reaction and the reactive condition. [ABSTRACT FROM AUTHOR]

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Middle meningeal artery embolization (MMAE) is an effective adjunctive treatment for chronic subdural hematomas and carries a low risk of significant complications.1 Here we describe the management of a retained and fractured microcatheter following liquid embolic MMAE. A patient with chronic recurrent subdural hematomas underwent bilateral MMAE with Onyx liquid embolic material (Medtronic). The Headway Duo (Microvention) microcatheter was placed in a small distal frontal branch of the middle meningeal artery to aid in reflux into the posterior middle meningeal artery branches. Following successful MMAE, the microcatheter became trapped within the Onyx cast and, on attempted removal, the microcatheter fractured, resulting in a retained fragment extending from the middle meningeal artery cast to the guide catheter in the common carotid artery.To retrieve the fractured microcatheter, a stent retriever was deployed and resheathed multiple times until the retained microcatheter became visibly entangled with the stent retriever. Next, the stent retriever was pulled back into the guide catheter and continuous aspiration was performed through the guide catheter, and the fragmented microcatheter was successfully removed in entirety. Final angiography demonstrated no further catheter fragments, vessel damage, extravasation, flow limitation, or thromboembolic complications.Methods to avoid the complication include using a detachable tip microcatheter, dual lumen balloon microcatheter, allowing less reflux, embolizing from a larger caliber branch, and a slower microcatheter pull. Additional methods for managing the complication include using a snare, leaving the retained microcatheter and putting the patient on aspirin, and carotid stenting to tack the fractured portion down (video 1). neurintsurg;16/12/1214/V1F1V1Video 1 Management of a fractured microcatheter during middle meningeal artery embolization This case demonstrates the successful use of a stent retriever and aspiration to retrieve a retained and fractured microcatheter following liquid embolic MMAE., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different suture diameters. A total of 150 knots were fabricated using polyamide sutures with diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5, and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way with a device and weights, then subjected to a controlled tension. The knots that became untied were: 1=1, 1×1, 2=1, and 2×1, whereas the remaining knots broke. Notably, at least three throws were required to prevent untying, but separately, as in 1=1=1 or 1×1×1. The mean tension needed to break the knots in 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < .05), and they were independent of the knot type. The results from this study demonstrate that the knots with geometries of 2=2/2×2 and 1=1=1/1×1×1 were secure, and having additional throws does not increase their security. Further, tensile strength reduces with decreased suture size.

Functional and efficient medical equipment is at the core of modern healthcare delivery, particularly in medical imaging. Growing healthcare costs and constrained budgets can delay equipment renewal. Aging equipment risks malfunction, potentially causing injury to patients and staff, and downtimes delaying patient care and impacting departmental revenue. Extensive equipment failure can lead to significant operational disruption which can compromise the delivery of timely and quality healthcare. Although extensive equipment failure is uncommon, 2 interventional radiology divisions at tertiary academic hospitals in Canada and the UK recently faced such a crisis. Their experiences of crisis and recovery inform this review of angiography equipment failure, and the principles learned. The concept of organizational resilience is introduced as a framework through which we review the crises. This concept can be split into successive and cooperative stages of anticipation, coping, and adaptation. Resilient organizations can identify potential threats, cope with unexpected crises, and recover swiftly to ensure future success. The author's experience of critical angiography unit failure, their response, and lessons learned are reviewed. We find these principles are broadly applicable to other medical imaging divisions and relevant to any system reliant on technology for healthcare delivery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A male in his 20s was referred to the neurosurgical service with headaches, vomiting and personality changes. He had a previous history of bilateral ventriculoperitoneal (VP) shunts and bitemporal decompressive surgery for neonatal intraventricular haemorrhage. There were appearances of slit-ventricles on his CT head scan typically associated with adequate cerebrospinal fluid drainage and normal intracranial pressure (ICP), which ordinarily will have limited further investigation. However, an X-ray shunt series demonstrated a right shunt disconnection at the neck and ICP monitoring confirmed raised ICP with poor brain compliance. He underwent revision of the right VP shunt with distal catheter replacement. Postoperatively, his symptoms, ICP and brain compliance improved.This case highlights the value of obtaining shunt series in patients presenting with symptoms of shunt obstruction regardless of a normal CT head. It emphasises awareness of slit-ventricle syndrome in adult patients with shunts, particularly those with complex childhood hydrocephalus., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The development of microcatheters capable of advancing through long, calcified, and tortuous vessels, produced an increase in the success rate of complex percutaneous coronary interventions. However, the aggressive manipulation of these materials may lead to potentially severe and threatening complications. We present a case of Turnpike Spiral (Teleflex) tip fracture, which caused an acute occlusion of the proximal right coronary artery. The coronary artery was tortuous and had two heavily calcified lesions in the proximal segment, uncrossable to both small angioplasty balloons and standard microcatheters. After the incarceration of the tip of the Turnpike Spiral in the calcium, it got fractured during the attempt of removing it from the vessel. This led to ST-segment elevation and patient instability. Due to the impossibility of advancing a second guidewire into the true lumen, we decided to proceed to antegrade dissection and re-entry using the scratch-and-go and subintimal tracking and re-entry technique. We placed a guide-extension and we used a Gaia II (Asahi Intecc) to enter the subintimal space and advance over the fractured tip. The wire was exchanged for a Gladius MG (Asahi Intecc), which re-entered the true lumen at the level of the acute margin of the heart. Intravascular ultrasound was used to confirm the re-entry point, and three drug eluting stents were placed. In this way we rapidly restored the flow in the right coronary artery, and we prevented a myocardial infarction., (© 2024 Wiley Periodicals LLC.)

Background: Cardiovascular devices account for one third of all Class I recalls, the U.S. Food and Drug Administration's (FDA) most severe designation, indicating a reasonable probability of "serious adverse health consequences or death." Understanding recalls and their causes is important for patient safety., Objective: To characterize Class I recalls of cardiovascular devices and the clinical evidence supporting authorization., Design: In this cross-sectional study, cardiovascular device recalls from 1 January 2013 through 31 December 2022 were identified using the FDA's annual log. Information about devices was extracted from publicly available FDA decision summaries., Setting: The FDA Medical Device Recalls database., Participants: Cardiovascular devices with Class I recalls., Measurements: Recalls were characterized by their causes and scope. Devices were characterized by their regulatory history (product code, special designations) and clinical evidence (premarket testing, postmarket surveillance). Clinical studies were analyzed for quality, including end point selection (clinical vs. surrogate, use of composites)., Results: From 2013 to 2022, there were 137 Class I recall events affecting 157 unique cardiovascular devices, of which 112 (71.3%) were moderate-risk 510(k) devices and 45 (28.7%) were high-risk premarket approval (PMA) devices. Recalls affected a median of 7649 units (IQR, 953 to 28 446) and were most commonly attributed to device design (43 [31.4%]). Forty-two (26.8%) devices had multiple Class I recalls. Thirty (19.1%) devices underwent premarket clinical testing (7 [6.2%] 510(k) devices, 17 [85.0%] PMA devices, and 6 [24.0%] PMA supplement devices). Most studies used surrogate (27 [79.4%]) and composite (24 [70.6%]) measures as primary end points. Twenty-two (48.9%) PMA devices had required postapproval studies, with 14 reporting delays. No 510(k) devices were subject to postmarket surveillance., Limitation: Details about clinical testing may be missing from FDA summaries., Conclusion: Cardiovascular devices with Class I recalls were infrequently subjected to premarket or postmarket testing, with recalls affecting thousands of patients annually., Primary Funding Source: None., Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosure forms are available with the article online.

IntroductionEvaluation of shunt for malfunction and blockage is a common neurosurgical clinical scenario in day-to-day paediatric neurosurgery practice. Parental concern for shunt malfunction is normally considered a reliable indication for undertaking further assessment of a child with a shunt. Accuracy of parental diagnosis of shunt malfunction likely is dependent on combination of parental knowledge and patient symptomatology and familiarity of symptoms in relation to previous shunt malfunction symptoms. There are currently no UK studies on accuracy of parental diagnosis of shunt malfunction. We undertook this study to investigate sensitivity and specificity of parental diagnosis in our tertiary paediatric neurosurgical unit to identify any factors that can be used for further education and raising awareness in parents with children with shunts.MethodsWe undertook a review of all referrals with suspected shunt malfunction to our tertiary paediatric neurosurgical unit over a period of 10 months. All referrals and presentations were evaluated for parental concern for likelihood of shunt malfunction and marked as yes or no. Further information gathered included demographics, age, sex, symptoms at presentation, previous history of shunt revision, cases of shunt malfunction and part of the shunt revised. Sensitivity, specificity, positive and negative predictive values and accuracy were then calculated and factors associated with positive diagnosis of shunt malfunction analysed.ResultsOverall, 100 referrals with suspected shunt malfunction were made over 10 months period. Mean age for children at the time of referral was 6.3 years with an M/F ratio of 42M:58F. Twenty-one shunt malfunction cases were identified leading to overall revision rate of 21%. Parental evaluation of shunt function had sensitivity of 90.4%, specificity of 10.1%, positive predictive value of 21.1% and negative predictive value of 80%. Drowsiness and higher number of symptoms at presentation were associated with true positive diagnosis of shunt malfunction. No link was identified with true diagnosis of shunt malfunction with other symptoms of shunt malfunction or previous history of shunt revision and age of the patient.ConclusionParental diagnosis of shunt malfunction has high sensitivity and negative predictive value and low specificity and positive predictive value. Increased number of symptoms as well as drowsiness were associated with correct parental diagnosis of shunt malfunction. Educational programs and parental training can be valuable in increasing awareness about shunt malfunction signs., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)