Effect of digital tools to promote hospital quality and safety on adverse events after discharge.

OBJECTIVES: Post-discharge adverse events (AEs) are common and heralded by new and worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR)-integrated digital tools designed to promote quality and safety in hospitalized patients on NWS and AEs after discharge. MATERIALS AND METHODS: Adult general medicine patients at a community hospital were enrolled. We implemented a dashboard which clinicians used to assess safety risks during interdisciplinary rounds. Post-implementation patients were randomized to complete a discharge checklist whose responses were incorporated into the dashboard. Outcomes were assessed using EHR review and 30-day call data adjudicated by 2 clinicians and analyzed using Poisson regression. We conducted comparisons of each exposure on post-discharge outcomes and used selected variables and NWS as independent predictors to model post-discharge AEs using multivariable logistic regression. RESULTS: A total of 260 patients (122 pre, 71 post [dashboard], 67 post [dashboard plus discharge checklist]) enrolled. The adjusted incidence rate ratios (aIRR) for NWS and AEs were unchanged in the post- compared to pre-implementation period. For patient-reported NWS, aIRR was non-significantly higher for dashboard plus discharge checklist compared to dashboard participants (1.23 [0.97,1.56], P = .08). For post-implementation patients with an AE, aIRR for duration of injury (>1 week) was significantly lower for dashboard plus discharge checklist compared to dashboard participants (0 [0,0.53], P < .01). In multivariable models, certain patient-reported NWS were associated with AEs (3.76 [1.89,7.82], P < .01). DISCUSSION: While significant reductions in post-discharge AEs were not observed, checklist participants experiencing a post-discharge AE were more likely to report NWS and had a shorter duration of injury. CONCLUSION: Interventions designed to prompt patients to report NWS may facilitate earlier detection of AEs after discharge. CLINICALTRIALS.GOV: NCT05232656.

In vivo evaluation of efficacy and safety of Coagulansin-A in treating arthritis.

The current study aimed to determine the safety and efficacy of Coag-A through in vivo analysis in CFA induced mice model. Treatment of CFA induced arthritis in mice with Coagulansin-A (10 mg/kg i.p. daily for 28 days), a withanolide obtained from Withania coagulans, as well as standard drug treatment with Dexamethasone (5 mg/kg i.p) was provided. The effect of Coag-A on body weight, relative organ weight, hematology, serum biochemistry, survival rate, oxidative stress markers, and antioxidant enzymes was evaluated. The liver and kidney histopathology were also assessed to ascertain its safety profile. Treatment of arthritic mice with Coag-A considerably improved body weight, relative organ weight of liver, kidney, and spleen, ameliorated hematology and serum biochemistry, and increased survival and antioxidant potential. Coag-A was found to be safer with fewer adverse effects showing hepato-protective, nephroprotective, and anti-inflammatory effect. It also significantly (p < 0.001) improved histopathology of CFA-induced mice when compared with Dexa. In conclusion, compared to dexamethasone, Coag-A has demonstrated a greater therapeutic benefit and fewer side effects in the treatment of arthritis against the CFA-induced model.

Role of vaccination in patients with human monkeypox virus and its cardiovascular manifestations.

Human monkeypox, caused by the monkeypox virus (MPXV), is an emerging infectious disease with the potential for human-to-human transmission and diverse clinical presentations. While generally considered milder than smallpox, it can lead to severe cardiovascular complications. The virus primarily spreads through contact with infected animals or through human-to-human transmission. Cardiovascular involvement in human monkeypox is rare but has been associated with myocarditis, pericarditis, arrhythmias, and even fulminant myocardial infarction. Vaccination plays a crucial role in preventing and controlling monkeypox, but the eradication of smallpox has left global populations vulnerable. This review explores the cardiovascular manifestations of human monkeypox, the role of vaccination in disease prevention, and the importance of continued research and development of effective vaccines to protect against this emerging infectious threat. The global impact of monkeypox outbreaks, particularly on vulnerable populations, further highlights the importance of understanding and addressing this disease.

Advancements in gene therapy approaches for atrial fibrillation: Targeted delivery, mechanistic insights and future prospects.

Atrial fibrillation (AF) remains a complex and challenging arrhythmia to treat, necessitating innovative therapeutic strategies. This review explores the evolving landscape of gene therapy for AF, focusing on targeted delivery methods, mechanistic insights, and future prospects. Direct myocardial injection, reversible electroporation, and gene painting techniques are discussed as effective means of delivering therapeutic genes, emphasizing their potential to modulate both structural and electrical aspects of the AF substrate. The importance of identifying precise targets for gene therapy, particularly in the context of AF-associated genetic, structural, and electrical abnormalities, is highlighted. Current studies employing animal models, such as mice and large animals, provide valuable insights into the efficacy and limitations of gene therapy approaches. The significance of imaging methods for detecting atrial fibrosis and guiding targeted gene delivery is underscored. Activation mapping techniques offer a nuanced understanding of AF-specific mechanisms, enabling tailored gene therapy interventions. Future prospects include the integration of advanced imaging, activation mapping, and percutaneous catheter-based techniques to refine transendocardial gene delivery, with potential applications in both ventricular and atrial contexts. As gene therapy for AF progresses, bridging the translational gap between preclinical models and clinical applications is imperative for the successful implementation of these promising approaches.

Association of burnout and harassment among cardiology trainees: Pakistan's perspective.

OBJECTIVE: This study explores the relationship between sexual harassment and burnout among cardiology trainees, shedding light on the prevalence and impact of these experiences in medical practice. METHODS: A cross-sectional online survey was conducted among 518 respondents, with 420 responding to the Sexual Experience Questionnaire (SEQ). The survey measured harassment experiences and their impact on burnout, especially among female physicians. Correlations were analyzed to understand the association between these variables. RESULTS: Out of 1,375 invitees, we received 671 (48.8 %) responses. The study population was divided into two main groups: males (359) and females (312). The study identified a high prevalence of sexual harassment experiences among female physicians, with incidents occurring primarily during training. Moderate to large correlations were observed between SEQ subscales related to colleagues and patients and their families. While sexual harassment was not significantly related to burnout, this study suggests the need for interventions to create a safer medical workplace. Approximately 22 % of male participants (n = 359) reported career-related inappropriate sexual incidents, with 28 % of male physicians experiencing weekly burnout. Among female participants (n = 312), around 37 % reported inappropriate incidents, while 42 % of female physicians felt weekly burnout. CONCLUSION: Sexual harassment in medicine is a pervasive issue with potential implications for physician well-being. Initiatives aimed at changing the organizational response and fostering a more equitable environment are warranted to address this critical concern.

Anxiety and Depression in Heart Failure: An Updated Review.

Anxiety and depression are commonly experienced by individuals with heart conditions, significantly impacting their overall well-being and prognosis. This review aims to provide an updated examination of the relationship between anxiety, depression, and heart disease. The review begins by exploring the prevalence of anxiety and depression in heart patients, highlighting the substantial rates at which these mental health disorders co-occur in this population. It further elucidates the risk factors that contribute to the development and exacerbation of anxiety and depression in individuals with heart conditions, including biological, psychological, and social factors. The impact of anxiety and depression on cardiac outcomes is a central focus of this review. It explores the intricate bi-directional relationship between mental health and cardiovascular health, discussing the mechanisms through which anxiety and depression can lead to adverse cardiac events and worsen existing heart conditions. Additionally, it examines the potential impact of anxiety and depression on treatment adherence, lifestyle modifications, and overall quality of life in heart patients. The review also investigates the diagnostic and assessment methods for anxiety and depression in heart patients, emphasizing the importance of implementing comprehensive screening protocols in clinical settings. In conclusion, this updated review provides valuable insights into the prevalence, impact, assessment, and management of anxiety and depression in heart patients. It underscores the importance of recognizing and addressing these mental health disorders within the context of cardiac care, ultimately aiming to enhance the overall well-being and prognosis of individuals living with heart conditions.

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Objective: To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. Materials and Methods: Three interventions were prioritized for development: a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by DSC logic compared to risk perceived by a clinician working group; DTO testing sessions with clinicians; PDQ responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions. Mixed methods analysis of participant responses was used to identify final requirements and potential implementation barriers. Results: Final requirements from analysis of 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses included the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. Analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ). Discussion: A user-centered approach led to evolution of requirements for 3 interventions targeting key diagnostic process failures in hospitalized patients at risk for DE. Conclusions: We identify challenges and offer lessons from our user-centered design process.

Association of Deja vu With Cardiovascular Diseases.

Recent studies have suggested a link between déjà vu and cardiovascular diseases (CVDs). While the mechanism for this association is not fully understood, 1 theory suggests that déjà vu may be a result of a disruption in the temporal lobe, which is also responsible for regulating blood pressure and heart rate. Another theory suggests that there may be a shared genetic factor between the 2 conditions, with certain individuals being predisposed to experiencing both. The Apolipoprotein E (APOE) gene, in particular, has been associated with memory processing, Alzheimer's disease, and an increased risk of CVD. The protein encoded by this gene is involved in the metabolism of lipoproteins, including cholesterol and triglycerides, and is also involved in the development of atherosclerosis, which is a key risk factor for CVD. Several hypotheses have been proposed to explain how the APOE4 isoform contributes to CVD, including impairing the clearance of lipoproteins, promoting inflammation, and causing endothelial dysfunction. Psychological factors such as stress may also contribute to the development of CVD, and déjà vu may be associated with emotional arousal and stress. Further research is needed to fully understand the link between déjà vu and CVDs and to explore potential treatment options for individuals who experience both conditions.

Biosynthesizing Cassia fistula Extract-Mediated Silver Nanoparticles for MCF-7 Cell Lines Anti-Cancer Assay.

The unique consequence of green synthesis is that the mediator plant is able to release chemicals that are efficacious as reducing as well as stabilizing agents. In this work, the fruit pulp and leaf essences of Cassia fistula have been used to manufacture silver nanoparticles through the green synthesis technique. The sculpturing of nanoparticles was accomplished by utilizing the reduction phenomenon that ensued due to the reaction between plant essences and the precursor solution. These biosynthesized silver nanoparticles were examined, where we used scanning electron microscopy, UV-vis spectroscopy, and X-ray diffraction techniques as means to analyze the structure, optical properties, and crystalline behavior, respectively. The absorption spectra for fruit and leaf extracts obtained from the UV-vis analyses peaked at 401 and 397 nm, and these peaks imply the appearance of optical energy gaps of 2.12 and 2.58 eV, accompanying spherical shapes of particles with diameters in the ranges of 12-20 and 50-80 nm, respectively. These silver nanoparticles together with the adopted green technique have a vast array of applications, specifically in the biomedical realm. In particular, they are being used to treat several diseases and are manifested as strong anti-tumor agents to medicate MCF-7 breast cancer cell lines in order to minimize the cell growth rate depending on their concentrations.

Improving the efficiency of dye-sensitized solar cells based on rare-earth metal modified bismuth ferrites.

This study reports light energy harvesting characteristics of bismuth ferrite (BiFeO3) and BiFO3 doped with rare-earth metals such as neodymium (Nd), praseodymium (Pr), and gadolinium (Gd) dye solutions that were prepared by using the co-precipitation method. The structural, morphological, and optical properties of synthesized materials were studied, confirming that 5-50 nm sized synthesized particles have a well-developed and non-uniform grain size due to their amorphous nature. Moreover, the peaks of photoelectron emission for bare and doped BiFeO3 were observed in the visible region at around 490 nm, while the emission intensity of bare BiFeO3 was noticed to be lower than that of doped materials. Photoanodes were prepared with the paste of the synthesized sample and then assembled to make a solar cell. The natural and synthetic dye solutions of Mentha, Actinidia deliciosa, and green malachite, respectively, were prepared in which the photoanodes were immersed to analyze the photoconversion efficiency of the assembled dye-synthesized solar cells. The power conversion efficiency of fabricated DSSCs, which was confirmed from the I-V curve, is in the range from 0.84 to 2.15%. This study confirms that mint (Mentha) dye and Nd-doped BiFeO3 materials were found to be the most efficient sensitizer and photoanode materials among all the sensitizers and photoanodes tested.

Rare case of mixed epithelial and stromal tumor (MEST) of the kidney and its diagnostic and therapeutic approach: A case report.

INTRODUCTION AND IMPORTANCE: Mix epithelial and stromal tumor (MEST) is a benign biphasic renal lesion composed of solid as well as cystic components lining tubular and cystic spaces of kidney. There are very few cases of such variety have been reported with perspective to renal involvement. Herein we have reported a rare case of MEST involving left renal tissue and sparing surrounding tissues. CASE PRESENTATION: A 20 years old female presented to surgical outpatient department with complaint of amenorrhea and left flank pain as well as heaviness for 1 year. Patient was vitally stable and cooperative. On physical examination left flank mass was palpated and ultrasound and CT scan imaging was also showing left renal mass confined to upper, middle and lower portion of the kidney while renal capsule, adrenal gland and ureter were spared. On histological examination showed multi-cystic structures with variably sized simple cysts lined by hobnailed epithelium with clear cells. Septa show ovarian type fibrous stroma with variable inflammation and immature nephrogenic elements. A final diagnosis of MEST was made. Therefore, radical nephrectomy with trans-peritoneal approach was done. CLINICAL DISCUSSION: MEST is a benign tumor of renal tissue that is confined to the renal parenchyma rather than involvement of surrounding structures as occurred in our case. Due to benign nature of the disease involvement of renal capsule and adrenal gland is less likely. The choice of treatment is radical nephrectomy through transperitoneal approach. CONCLUSION: MEST is a rare diagnosis thought case now start reporting since last decade, however, it's still a rare entity to be reported. USG and CT scan are investigating modalities along with histopathological correlation to reach the diagnosis.

Correction: Unveiling concentration effects on the structural and optoelectronic characteristics of Zn1-x Cd x S (x = 0, 0.25, 0.50, 0.75, 1) cubic semiconductors: a theoretical study.

[This corrects the article DOI: 10.1039/D2RA03850A.].

Unveiling concentration effects on the structural and optoelectronic characteristics of Zn1-x Cd x S (x = 0, 0.25, 0.50, 0.75, 1) cubic semiconductors: a theoretical study.

The structural and optoelectronic characteristics of Zn1-x Cd x S (x = 0, 0.25, 0.50, 0.75, 1) semiconductors are reported using density functional theory within GGA, EV-GGA, and mBJ functionals. These semiconductors are observed in cubic symmetry at all Cd-concentrations and the lattice constant increases linearly with Cd-concentration while the bulk modulus shows a reverse behavior. These materials are direct bandgap semiconductors at all Cd-concentrations and their bandgap energy decreases from 3.67 eV to 2.59 eV. The isotropic optical properties of these direct bandgap semiconductors vary with Cd concentration as well, with absorption coefficients decreasing and absorbed near-UV light converting to visible blue light. Optical properties like refractive index, dielectric constant, conductivity, extinction coefficient, and reflectance are also displayed and discussed. These results provide useful theoretical understanding for the application of CdZnS semiconductors in photonic, photovoltaic, and optoelectronic devices.

Synthesis and Characterization of Polyvinyl Chloride Matrix Composites with Modified Scrap Iron for Advanced Electronic, Photonic, and Optical Systems.

In this study, Fe2O3 powder was synthesized using the co-precipitation method from scrap iron, which was then treated with varying concentrations of copper. Afterwards, the modified Fe2O3 was reinforced in the PVC matrix by using the solution-casting method to synthesize PVC composite films, which were subjected to a UV-visible spectrophotometer, a Fourier transform infrared spectrophotometer, an X-ray diffractometer, and a thermal gravimetric analyzer to evaluate the optical, chemical, structural, and thermal properties. FTIR analysis reveals the formation of the composite through vibrational bands pertaining to both components present, whereas no significant changes in the XRD patterns of PVC were observed after the doping of modified iron oxide, which reveals the compatibility of fillers with the PVC matrix. The optical properties of the copper-doped iron oxide-PVC composites, including absorbance, refractive index, urbach energy, and optical as well as electrical conductivity are measured, and show an increase in optical activity when compared to the pure PVC compound. Moreover, the increased thermal stability of the synthesized composite was also observed and compared with conventional compounds, which, in accordance with all the other mentioned properties, makes the copper-dopped iron oxide-PVC composite an effective material for electronic, photonic, and optical device applications.

A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts.

OBJECTIVES: To test a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. METHODS: We adapted validated tools (Safer Dx, Diagnostic Error Evaluation Research [DEER] Taxonomy) to assess the diagnostic process during the hospital encounter and categorized 13 postulated e-triggers. We created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and underwent our institution's mortality case review process. After excluding patients with a length of stay of more than one month, each case was reviewed by two blinded clinicians trained in our process and by an expert panel. Inter-rater reliability was assessed. We compared the frequency of DE contributing to death in both cohorts, as well as mean DPFs and e-triggers for DE positive and negative cases within each cohort. RESULTS: Twenty-seven (96.4%) preventable and 24 (85.7%) non-preventable cases underwent our review process. Inter-rater reliability was moderate between individual reviewers (Cohen's kappa 0.41) and substantial with the expert panel (Cohen's kappa 0.74). The frequency of DE contributing to death was significantly higher for the preventable compared to the non-preventable cohort (56% vs. 17%, OR 6.25 [1.68, 23.27], p<0.01). Mean DPFs and e-triggers were significantly and non-significantly higher for DE positive compared to DE negative cases in each cohort, respectively. CONCLUSIONS: We observed substantial agreement among final consensus and expert panel reviews using our structured EHR case review process. DEs contributing to death associated with DPFs were identified in institutionally designated preventable and non-preventable cases. While e-triggers may be useful for discriminating DE positive from DE negative cases, larger studies are required for validation. Our approach has potential to augment institutional mortality case review processes with respect to DE surveillance.

Ab-initio study of pressure influenced elastic, mechanical and optoelectronic properties of Cd0.25Zn0.75Se alloy for space photovoltaics.

The optoelectronic properties of the ternary Cd0.25Zn0.75Se alloy are reported under the influence of a high pressure ranging from 0 to 25 GPa, within a modified Becke-Jhonson potential using density functional theory. This alloy has a cubic symmetry, is mechanically stable, and its bulk modulus rises with pressure. It is observed to be a direct bandgap material with a bandgap energy that increases from 2.37 to 3.11 eV with rise in pressure. Pressure changes the optical and electronic properties, causing the absorption coefficient to rise and absorb visible green-to-violet light. The static dielectric constant, along with the static index of refraction, both increase under the influence of pressure. Optical constants, including dielectric constant, optical conductivity, refractive index, extinction coefficient, and reflection, are also investigated and discussed. This DFT forecast explores important research directions for the usage of the CdZnSe semiconductor alloys in the manufacturing of space photovoltaic and optoelectronic devices operating at different pressures.

2D Materials for Efficient Photodetection: Overview, Mechanisms, Performance and UV-IR Range Applications.

Two-dimensional (2D) materials have been widely used in photodetectors owing to their diverse advantages in device fabrication and manipulation, such as integration flexibility, availability of optical operation through an ultrabroad wavelength band, fulfilling of photonic demands at low cost, and applicability in photodetection with high-performance. Recently, transition metal dichalcogenides (TMDCs), black phosphorus (BP), III-V materials, heterostructure materials, and graphene have emerged at the forefront as intriguing basics for optoelectronic applications in the field of photodetection. The versatility of photonic systems composed of these materials enables their wide range of applications, including facilitation of chemical reactions, speeding-up of responses, and ultrasensitive light detection in the ultraviolet (UV), visible, mid-infrared (MIR), and far-infrared (FIR) ranges. This review provides an overview, evaluation, recent advancements as well as a description of the innovations of the past few years for state-of-the-art photodetectors based on two-dimensional materials in the wavelength range from UV to IR, and on the combinations of different two-dimensional crystals with other nanomaterials that are appealing for a variety of photonic applications. The device setup, materials synthesis, operating methods, and performance metrics for currently utilized photodetectors, along with device performance enhancement factors, are summarized.

Performance Analysis and Optimization of a PBDB-T:ITIC Based Organic Solar Cell Using Graphene Oxide as the Hole Transport Layer.

The hole transport layer (HTL) in organic solar cells (OSCs) plays an imperative role in boosting the cell's performance. PEDOT:PSS is a conventional HTL used in OSCs owing to its high design cost and instability issues. It can be replaced with graphene oxide to increase the cell performance by overcoming instability issues. Graphene oxide (GO) has gained popularity in recent years for its practical use in solar energy due to its remarkable mechanical, electrical, thermal, and optical properties. This work uses SCAPS-1D to examine the results of graphene oxide (GO)-based organic solar cells by giving a comparison between the performance of absorber layers and a GO-based HTL to see which absorber material interacts more strongly with GO. The absorber layer PBDB-T:ITIC paired with GO as HTL outperforms the other absorber layers due to its better optical and electrical characteristics. Numerical simulations are performed within the SCAPS software at various absorber layer thicknesses, defect densities, and doping values to assess the influence on device performance and efficiency. After cell optimization, the best efficiency of an improved OSC is found to be 17.36%, and the outcomes of the simulated OSC are referenced to the results of the experimentally implemented OSC. These results provide a possible future direction for developing GO-based OSCs with higher efficiency.

Pressure-Induced Bandgap Engineering and Tuning Optical Responses of Cd0.25Zn0.75S Alloy for Optoelectronic and Photovoltaic Applications.

The manipulation of composition and pressure, which affect the structure and, as a result, lead to new desired properties, is particularly significant for optimizing device performance. By considering the importance of pressure treatment, this study explores bandgap engineering and tuned optical responses of the ternary Cd0.25Zn0.75S alloy over a pressure range of 0-20 GPa using density functional theory. The functional material exhibits cubic symmetry at all pressures, and its bulk modulus increases with pressure. It is a direct bandgap semiconductor at Γ symmetry point, and its bandgap energy increases from 3.35 eV to 3.86 eV with an increase in pressure. Optical properties change with pressure, such that the absorption coefficient increases and absorbs near-ultraviolet light, while the static dielectric constant and static refractive index both increase with pressure. The effects of pressure on other optical parameters such as dielectric constant, extinction coefficient, refractive index, optical conductivity, and reflection are also explored. These findings provide significant theoretical guidance for the use of the Cd0.25Zn0.75S semiconductor in fabricating optoelectronic and photovoltaic devices functioning at varying pressure ranges and altitudes.