Violation of identity-specific action-effect prediction increases pupil size and attenuates auditory event-related potentials at P2 latencies when action-effects are behaviorally relevant.

Self-initiated sensory action effects are widely assumed to lead to less intense perception and reduced neural responses compared to externally triggered stimuli (sensory attenuation). However, it is unclear if sensory attenuation occurs in all cases of action-effect prediction. Specifically, when predicted action-effects are relevant to determine follow-up actions attenuation could be detrimental. We quantified auditory event-related potentials (ERP) in electroencephalography (EEG) when human participants created two-sound sequences by pressing two keys on a keyboard associated with different pitch, giving rise to identity-specific action-effect prediction after the first keypress. The first sound corresponded to (congruent) or violated (incongruent) the predicted pitch and was either relevant for the selection of the second keypress to correctly complete the sequence (Relevance) or irrelevant (Control Movement), or there was only one keypress and sound (Baseline). We found a diminished P2-timed ERP component in incongruent compared to congruent trials when the sound was relevant for the subsequent action. This effect of action-effect prediction was due to an ERP reduction for incongruent relevant sounds compared to incongruent irrelevant sounds at P2 latencies and correlated negatively with modulations of pupil dilation. Contrary to our expectation, we did not observe an N1 modulation by congruency in any condition. Attenuation of the N1 component seems absent for predicted identity-specific auditory action effects, while P2-timed ERPs as well as pupil size are sensitive to predictability, at least when action effects are relevant for the selection of the next action. Incongruent relevant stimuli thereby take a special place and seem to be subject to attentional modulations and error processing.

Font Matters: Deciphering the Impact of Font Types on Attention and Working Memory.

Introduction Various types of fonts such as serif, sans serif, and script are used during writing and reading, which can affect the reader's attention and working memory, though there is only a subtle difference at the end of the letter. The study aimed to see the effect of font type on working memory and attention. Methods The study included healthy male adults between 18 and 40 years of age. After taking all the necessary precautions, a letter cancellation test and 2-back task in serif, sans serif, and script font types were done to evaluate subjects' attention and working memory. Results A total of 30 subjects participated in the study. The letter cancellation task (LCT) was statistically significant (P<0.05) between the three groups, where the time taken to complete the task was the shortest for serif fonts, indicating heightened attention to serif fonts. However, the accuracy of the N-back test did not show statistically significant differences (P>0.05) among the three font groups, indicating no significant change in working memory. Conclusion The type of font used can impact the reader's attention, with Times New Roman font demonstrating greater attention, particularly in the context of the letter cancellation task.

Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively. Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

Secrecy Performance Enhancement Using Self-Interference Cancellation in Wireless Mutual Broadcast Networks for Proximity-Based Services.

With the increasing demand for data exchange between nearby devices in proximity-based services, enhancing the security of wireless mutual broadcast (WMB) networks is crucial. However, WMB networks are inherently vulnerable to eavesdropping due to the open broadcast nature of their communication. This paper investigates the improvement of secrecy performance in random-access-based WMB (RA-WMB) networks by integrating physical layer security (PLS) techniques with hybrid duplex (HBD) operations under a stochastic geometry framework. The HBD method balances half-duplex (HD) receiving and full-duplex (FD) transceiving, utilizing self-interference cancellation (SIC) to enhance PLS performance. Key operational parameters, including transmission probability (TxPr), friendly jammer density, and conditions for FD operation, are designed to maximize secrecy performance. The analytical and numerical results demonstrate significant improvements in PLS performance, with SIC playing a critical role, particularly in scenarios with dense legitimate nodes, and with TxPr adjusted to balance HD receiving and FD transceiving based on SIC imperfections. The proposed design principles provide a comprehensive framework for enhancing the security of WMB networks, addressing the complex interplay of interference and SIC in various network configurations.

Robodeport or surveillance fantasy?: how automated is automatic visa cancellation in Australia?

Australia has been widely condemned for its harsh and comprehensive external border controls that seek to control the inward mobility of would-be asylum seekers through visa denial, interdiction and offshore detention. Less widely discussed is the fact that internal controls have been repeatedly ramped up over the past two decades. This includes the administrative removal of lawfully-present non-citizens following visa cancellation on character grounds under s501 of the Migration Act 1958 (Cth). Automatic visa cancellation was introduced in 2014 for non-citizens sentenced to a prison term of 12 months or more, or for certain offences, bypassing individualised decision-making and raising the spectre of a visa cancellation pipeline feeding a highly automated deportation machinery. In an age of increasingly automated forms of governance, a key question that arises is the role that has been played by automated systems in achieving what has been a seismic shift in practice, and the normative implications of any developments towards automation within the visa cancellation and removal systems. This paper outlines the shift towards automation in other systems of governance in Australia-most notably the notorious Robodebt scheme-before examining automation in Australia's visa cancellation system. Documentary analysis of recent parliamentary inquiries, independent reports and government policy is used to piece together the development of inter-agency data exchange practices and automation over three specific periods-historical practice pre-2014, post-2014 to the present, and proposed future developments. We conclude that Australia's s501 visa cancellation system is neither automated nor automatic. Rather, the 2014 law reform gave rise to a 'surveillance fantasy' with immense consequences for non-citizens, particularly those who face long days in immigration detention at the conclusion of their prison sentence. We show that while concerns about increasing automation are well-founded, systems based on less sophisticated forms of information handling and reliant on human decision-making nevertheless continue to raise age-old questions concerning efficiency, accuracy and fairness.

A Microwave Photonic 2 × 2 IBFD-MIMO Communication System with Narrowband Self-Interference Cancellation.

Combined in-band full duplex-multiple input multiple output (IBFD-MIMO) technology can significantly improve spectrum efficiency and data throughput, and has broad application prospects in communications, radar, the Internet of Things (IoT), and other fields. Targeting the self-interference (SI) issue in microwave photonic-based IBFD-MIMO communication systems, a microwave photonic self-interference cancellation (SIC) method applied to the narrowband 2 × 2 IBFD-MIMO communication system was proposed, simulated, and analyzed. An interleaver was used to construct a polarization multiplexing dual optical frequency comb with a frequency shifting effect, generating a dual-channel reference interference signal. The programmable spectrum processor was employed for filtering, attenuation, and phase-shifting operations, ensuring amplitude and phase matching to eliminate the two self-interference (SI) signals. The simulation results show that the single-frequency SIC depth exceeds 45.8 dB, and the narrowband SIC depth under 30 MHz bandwidth exceeds 32.7 dB. After SIC, the desired signal, employing a 4QAM modulation format, can be demodulated with an error vector magnitude (EVM) as low as 4.7%. Additionally, further channel expansion and system performance optimization are prospected.

Development and Evaluation of Vibration Canceling System Utilizing Macro-Fiber Composites (MFCs) and Long Short-Term Memory (LSTM) Vibration Prediction AI Algorithms for Road Driving Vibrations.

This study developed an innovative active vibration canceling (AVC) system designed to mitigate non-periodic vibrations during road driving to enhance passenger comfort. The macro-fiber composite (MFC) used in the system is a smart material that is flexible, soft, lightweight, and applicable in many fields as a dual-purpose sensor and actuator. The target vibrations are road vibration data that were collected while driving on standard urban (Seoul) and highway roads at 40 km/s. To predict and cancel the target vibration accurately before passing it, we modeled the vibration prediction algorithm using a long short-term memory recurrent neural network (LSTM RNN). We regenerated vibrations on Seoul and highway roads at 40 km/s using MFCs and measured the displacements of the measured, predicted, and AVC vibrations of each road condition. To evaluate the vibration, we computed the root mean squared error (RMSE) and compared standard deviation (SD) values. The accuracies of LSTM RNN vibration prediction algorithms are 97.27% and 96.36% on Seoul roads and highway roads, respectively, at 40 km/s. Although the vibration ratio compared with the AVC results are different, there was no difference between the values of the AVC vibrations. According to a previous study and the principle of the AVC system, the target vibrations decrease by canceling the inverse vibration of the MFC actuator.

The comparision among euploidy of preimplantation blastocysts in different controlled ovary stimulation (COH) protocols.

PURPOSE: To compare differences in euploidy rates for blastocysts in preimplantation genetic testing for aneuploidy (PGT-A) cycles after gonadotropin-releasing hormone agonist (GnRH-a) long and short protocols, GnRH-antagonist (GnRH-ant) protocol, progestin-primed ovarian stimulation and mild stimulation protocols, and other ovary stimulation protocols. METHODS: This was a retrospective cohort study from the Assisted Reproductive Medicine Department of Shanghai First Maternity and Infant Hospital. A total of 1657 PGT-A cycles with intracytoplasmic sperm injection after different controlled ovary hyperstimulation protocols were analyzed, and a total of 3154 embryos were biopsied. Differences in euploidy rate per embryo biopsied, embryo euploidy rate per oocyte retrieved and cycle cancellation rate were compared. RESULTS: For the PGT-A cycles, the euploidy rate per embryo biopsied was lower in the GnRH-ant protocol than in the GnRH-a long protocol (53.26 vs. 58.68%, respectively). Multiple linear regression showed that the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied (ß = -0.079, p = 0.011). The euploidy rate per embryo biopsied was not affected by total gonadotropin dosage, duration of stimulation and number of oocytes retrieved. The embryo euploidy rate per oocyte retrieved was similar in all protocols and was negatively correlated with the total number of oocytes retrieved (ß = -0.003, p = 0.003). CONCLUSION: Compared with the GnRH-a long protocol, the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied. The total gonadotropin dosage, duration of stimulation and number of oocytes retrieved did not appear to significantly influence euploidy rates.

A retrospective study of the prevalence of isolated prolongation of activated partial thromboplastin time in the preoperative setting.

BACKGROUND: Isolated prolongation of activated partial thromboplastin time (APTT) has various causes including inheritable bleeding disorders, and has medical significance as it can lead to the cancelation of surgery. However, even an emergency surgery can be conducted in a patient presenting with severe APTT prolongation, provided careful evaluation and appropriate measures are taken. Hence, the identification of the underlying etiology of the prolonged APTT is crucial. To date, little evidence exists regarding the prevalence of isolated APTT prolongation in Japanese patients undergoing surgery. Herein, we aimed to clarify the prevalence of isolated prolongation of APTT in the preoperative setting and to identify the reasons underlying isolated, severely prolonged APTT. METHODS: Preoperative coagulation data of all elective and emergent patients who presented to the anesthetic department between January 1, 2020, and June 30, 2023, were retrospectively collected. Isolated prolongation of APTT was defined as an APTT ≥ 37 s with an international normalized ratio of prothrombin time < 1.2. The underlying etiology of the patient with isolated, severely prolonged APTT (≥ 46 s) was investigated, and canceled surgical procedures in relation to the isolated APTT prolongation were searched. RESULTS: Overall, 10,684 measurements from 9413 patients were included, of which 725 (6.8%) were identified as having isolated APTT prolongation. The reasons for the severely prolonged APTT (n = 60) were miscellaneous, with the most frequently detected etiology being antiphospholipid antibody positivity. Preoperative isolated APTT prolongation contributed to the cancellation of surgery in elective five cases. CONCLUSIONS: We clarified the prevalence of preoperative isolated prolongation of APTT. The presence of antiphospholipid antibody was the most frequently detected etiology of the patient with isolated, severely prolonged APTT. The present study provides an important dataset regarding the isolated prolongation of APTT in East Asian patients undergoing surgery.

Protocol change improves live birth and recurrent cycle cancellation rates after a previous IVF cycle cancellation: an analysis of 13 000 autologous cycles reported to SART CORS.

STUDY QUESTION: After an IVF cycle cancellation, does changing the stimulation protocol affect the odds of live birth and recurrent cancellation in the subsequent cycle? SUMMARY ANSWER: After IVF cycle cancellation, compared to those who repeated the same stimulation protocol, those who changed their protocol had higher odds of live birth and lower odds of recurrent cycle cancellation. WHAT IS KNOWN ALREADY: There is limited data addressing the effect of changing the stimulation protocol after an IVF cycle is cancelled during initial stimulation. The odds of live birth outcomes are not known so far in studies addressing the effect of changing the protocol. STUDY DESIGN, SIZE, DURATION: Retrospective Cohort Study using the 2014-2017 Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database. PARTICIPANTS/MATERIALS, SETTING, METHODS: The data included 13 135 patients with a first autologous IVF cycle that resulted in a cycle cancellation and was followed by a second autologous cycle within the study period. We excluded fertility preservation cycles, supernumerary cycle attempts after the second IVF cycle attempt, and cycles with more than one stimulation protocol documented per cycle start. Patients who received the same protocol for both cycles (n = 6434) were compared to those who changed their protocol in the second cycle (n = 6701). Multivariable logistic regression analyses were performed to estimate the adjusted odds of live birth and recurrent cancellation. MAIN RESULTS AND THE ROLE OF CHANCE: Changing the protocol in the second cycle resulted 14% lower odds of recurrent cycle cancellation (P = 0.01) and 17% higher odds of live birth after fresh transfers (P = 0.04). When stratifying the data by specific combinations of protocol change (agonist flare, agonist suppression, antagonist), there was an increase in live birth when switching from antagonist to agonist suppression (odds ratio (OR) = 1.36, P = 0.03) and from agonist suppression to antagonist (OR = 1.73, P = 0.01) compared to those who repeated their same stimulation protocol. Specifically in poor responders, outcomes were worse when using the agonist flare protocol and significantly improved with the agonist suppression protocol. LIMITATIONS, REASONS FOR CAUTION: Comparison of response to stimulation between first and second cycles cannot be made in this study because the index IVF cycle was cancelled during ovarian stimulation, and thus there is no reportable outcome data for that cycle. Additionally, SART only tracks the three stimulation protocols addressed in this study and does not have data on more contemporary protocols that are used in poor responders thus limiting the generalizability of our findings. WIDER IMPLICATIONS OF THE FINDINGS: Using the SART CORS database, which includes >90% of all reported IVF cycles in the USA, provides generalizability to the demographically diverse IVF populations found here. In agreement with prior studies assessing change in IVF protocols, the agonist flare protocol seems to result in worse IVF outcomes, and based on our results, we believe that there is no role for the agonist flare protocol in patients with a prior poor response to stimulation. STUDY FUNDING/COMPETING INTEREST(S): None declared. TRIAL REGISTRATION NUMBER: N/A.

Cancellation of Elective Oral and Maxillofacial Surgery, a Tertiary Hospital Experience.

Background: Cancellation of elective surgery is said to occur when a patient's name appears on the operation list, but the operation is not done on the intended date. Cancelling elective surgeries is a long-standing problem faced by many countries worldwide. Reasons for cancellation of surgery vary from one hospital to another. The goal of this study was to identify factors associated with the cancellation of scheduled Oral and maxillofacial surgeries in the Lagos State University Teaching Hospital. Methodology: Cancellations of elective scheduled operations from January 2021 to July 2022 were reviewed retrospectively. All cancellations were recorded in a predesigned form which included information about the age of the patient, hospital identification number, date of cancellation, type of operation, the Surgeon and the Anaesthetist, preoperative anaesthetic evaluations, any associated medical problems and the presumed reasons for cancellations for in-patients and day case surgery. Patients who died before the time of their scheduled surgery were excluded. Result: 80 patients had their operation cancelled on the day of surgery, and the rate of cancellations was 44.2%. The most common causes of cancellations were patient-related (50%), accounting for up to half of the cancellations. The major reason for cancellation under the administrative category was insufficient time in the theatre to complete the operation list (18.8%). Financial constraint (16.3%) on the day of the surgery was noted more among planned day case procedures and delayed laboratory results (12.5%); oftentimes, covid test results were the major reasons for cancellations under the patient-factors category. Conclusion: The rate of cancellation in this study was high, most of which are patients related. Administrative-related reasons were also identified. However, in most cases, these cancellations can be avoided.

Digital Self-Interference Canceler with Joint Channel Estimator for Simultaneous Transmit and Receive System.

Simultaneous transmit and receive wireless communications have been highlighted for their potential to double the spectral efficiency. However, it is necessary to mitigate self-interference (SI). Considering both the SI channel and remote transmission (RT) channel need to be estimated before equalizing the received signal, we propose two adaptive algorithms for linear and nonlinear self-interference cancellation (SIC), based on a multi-layered joint channel estimator structure. The proposed algorithms estimate the RT channel while performing SIC, and the multi-layered structure ensures improved performance across various interference-to-signal ratios. The M-estimate function enhances the robustness of the algorithm, allowing it to converge even when affected by impulsive noise. For nonlinear SIC, this paper introduces an adaptive algorithm based on generalized Hammerstein polynomial basis functions. The simulation results indicate that this approach achieves a better convergence speed and normalized mean squared difference compared to existing SIC methods, leading to a lower system bit error rate.

Prediction of Reproductive Outcomes of Intracytoplasmic Sperm Injection Cycles Using a Multivariate Scoring System.

Background: Prediction of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) success is crucial in counselling patients about their real chance of getting a live birth before commencing treatment. A multivariate scoring system proposed by Younis et al., 2010, was amongst the predictive models used to evaluate IVF/ICSI success. The score entitles basal endocrine, clinical and sonographic parameters. Aims: The objective of this study is to assess the predictability of the Younis multivariate score for pregnancy outcomes in ICSI cycles. Settings and Design: This prospective observational cohort study (NCT03846388) included patients who pursued IVF or ICSI in a tertiary infertility unit between February 2019 and December 2021. Materials and Methods: The score variables were age, body mass index, antral follicle count, basal follicle-stimulating hormone (FSH), basal FSH/luteinising hormone ratio, infertility duration, number of previous cancellations and mean ovarian volume. For each woman included in the study, Younis multivariate score was calculated. Then, we correlate the different reproductive outcomes with score levels to validate the score predictability. A score of ≤14 was defined as a low score based on the previous study's results. Statistical Analysis Used: The student's t-test and Mann-Whitney test were used to compare numerical variables, whereas categorical variables were analysed using the Chi-square test. A receiver operating curve (ROC) and a multivariate logistic regression model were used to investigate the predictability of the Younis scoring model for cycle outcomes. Results: Two hundred ninety-two ICSI-ET cycles were analysed. Of the total cohort, 143 (48.97%) women included showed a low score (≤14), whereas 149 (51.03%) women showed a high score (>14). Women with low scores had significantly higher pregnancy and live birth rates compared to women with high scores (60.1% vs. 7.4%, respectively, P < 0.001; 44.7% vs. 6.7%, respectively, P < 0.001). The area under the curve (AUC) in the ROC curve analysis showed a higher predictability for the scoring system for live birth rate with an AUC of 0.796, with a sensitivity of 86.5% and specificity of 63.8% when using a cut-off level of ≤14. For pregnancy prediction, the AUC was 0.829, with a sensitivity of 88.66% and a specificity of 70.77% when using the same cut-off. Women who have a low score have a high chance of having frozen embryos. Likewise, women who have a high score have a very high chance of cycle cancellation. Conclusions: The Younis multivariate score can be used for the prediction of ICSI cycle outcomes and to calculate the chance of cycle cancellation, pregnancy and take-home baby before ICSI.

Ultrasonic Through-Metal Communication Based on Deep-Learning-Assisted Echo Cancellation.

Ultrasound is extremely efficient for wireless signal transmission through metal barriers due to no limit of the Faraday shielding effect. Echoing in the ultrasonic channel is one of the most challenging obstacles to performing high-quality communication, which is generally coped with by using a channel equalizer or pre-distorting filter. In this study, a deep learning algorithm called a dual-path recurrent neural network (DPRNN) was investigated for echo cancellation in an ultrasonic through-metal communication system. The actual system was constructed based on the combination of software and hardware, consisting of a pair of ultrasonic transducers, an FPGA module, some lab-made circuits, etc. The approach of DPRNN echo cancellation was applied to signals with a different signal-to-noise ratio (SNR) at a 2 Mbps transmission rate, achieving higher than 20 dB SNR improvement for all situations. Furthermore, this approach was successfully used for image transmission through a 50 mm thick aluminum plate, exhibiting a 24.8 dB peak-signal-to-noise ratio (PSNR) and a about 95% structural similarity index measure (SSIM). Additionally, compared with three other echo cancellation methods-LMS, RLS and PNLMS-DPRNN has demonstrated higher efficiency. All those results firmly validate that the DPRNN algorithm is a powerful tool to conduct echo cancellation and enhance the performance of ultrasonic through-metal transmission.

Frame change technique for phase transient cancellation.

The precise control of complex quantum mechanical systems can unlock applications ranging from quantum simulation to quantum computation. Controlling strongly interacting many-body systems often relies on Floquet Hamiltonian engineering that is achieved by fast switching between Hamiltonian primitives via external control. For example, in our solid-state NMR system, we perform quantum simulation by modulating the natural Hamiltonian with control pulses. As the Floquet heating errors scale with the interpulse delay, δt, it is favorable to keep δt as short as possible, forcing our control pulses to be short duration and high power. Additionally, high-power pulses help to minimize undesirable evolution from occurring during the duration of the pulse. However, such pulses introduce an appreciable phase-transient control error, a form of unitary error. In this work, we detail our ability to diagnose the error, calibrate its magnitude, and correct it for π/2-pulses of arbitrary phase. We demonstrate the improvements gained by correcting for the phase transient error, using a method which we call the "frame-change technique", in a variety of experimental settings of interest. Given that the correction mechanism adds no real control overhead, we recommend that any resonance probe be checked for these phase transient control errors, and correct them using the frame-change technique.

Computationally efficient robust adaptive filtering algorithm based on improved minimum error entropy criterion with fiducial points.

Recently, there has been a strong interest in the minimum error entropy (MEE) criterion derived from information theoretic learning, which is effective in dealing with the multimodal non-Gaussian noise case. However, the kernel function is shift invariant resulting in the MEE criterion being insensitive to the error location. An existing solution is to combine the maximum correntropy (MC) with MEE criteria, leading to the MEE criterion with fiducial points (MEEF). Nevertheless, the algorithms based on the MEEF criterion usually require higher computational complexity. To remedy this problem, an improved MEEF (IMEEF) criterion is devised, aiming to avoid repetitive calculations of the aposteriori error, and an adaptive filtering algorithm based on gradient descent (GD) method is proposed, namely, GD-based IMEEF (IMEEF-GD) algorithm. In addition, we provide the convergence condition in terms of mean sense, along with an analysis of the steady-state and transient behaviors of IMEEF-GD in the mean-square sense. Its computational complexity is also analyzed. Simulation results demonstrate that the computational requirement of our algorithm does not vary significantly with the error sample number and the derived theoretical model is highly consistent with the learning curve. Ultimately, we employ the IMEEF-GD algorithm in tasks such as system identification, wind signal magnitude prediction, temperature prediction, and acoustic echo cancellation (AEC) to validate the effectiveness of the IMEEF-GD algorithm.

Case cancellations and associated factors on the day of surgery in hospitals of Wolaita Zone, South Ethiopia.

BACKGROUND: Cancellations of elective surgery cases are frequent and have significant negative consequences. It causes wasting of valuable resources, patient unhappiness, and psychological stress of patients. Despite this, little is known about the case cancellation and associated factors on the day of surgery in Ethiopia, particularly in the study area. OBJECTIVE: This study aimed to assess the magnitude of case cancellation and associated factors on the day of surgery in hospitals in Wolaita zone, South Ethiopia, from May 17 to June 17, 2023. METHODS: A hospital-based cross-sectional study involving 322 patients was conducted at Wolaita Sodo Zone, South Ethiopia. All elective surgical cases scheduled during the study period were included. The entire number of participants was selected using a systematic random sampling process. Epidata V.3 was used to enter data, and SPSS V.25 was used to analyze it. Binary logistic regression was used to check for a possible association. P-values < 0.05 and 95% CI were used on multi-variable analysis as the threshold for the significant statistical association. RESULT: A total of 313 study participants were scheduled for elective surgical procedures during the study period and gave a response rate of 97.2%. The mean (± SD) age of the study participants was 39.18 (± 10.64) years. The two-third of patients, 53(64%) were rural residents, and more than half (178, or 55.3%) of the participants were female. This finding showed that the case cancellation was 22.4% (95% CI: 19.3 -25.9%). Among the total canceled cases, 49(58.3%) were males. Variables like rural residence (AOR = 3.48 95% CI: 1.22-9.95), Lack of lab result (AOR = 2.33, 95%CI:1.20-4.51), ophthalmology dept. (AOR = 2.53 95% CI:1.52-4.49), HTN (AOR = 2.53, 95% CI:1.52-4.49), patient refusal (AOR = 3.01 95% CI:1.22-5.05), and age b/n 31 and 43 (AOR = 1.50, 95% CI:1.02-2.01) were significantly associated factors with cancellation of elective surgical cases. CONCLUSION: In this study schedule of case cancellation was high. The contributing factors of case cancellation were rural residence, Lack of lab results, ophthalmology dept, HTN, patient refusal, and age. To decrease unnecessary cancellations and increase cost efficiency, hospital administration and medical staff must plan ahead carefully, communicate effectively, and make efficient use of hospital resources.

Visual Evaluation of Plethysmographic Waveforms: Introducing the Simple Systolic Ratio as an Indicator of Fluid Responsiveness.

Objective: For patient safety, maintaining hemodynamic stability during surgical procedures is critical. Dynamic indices [such as systolic pressure variation (SPV) and pulse pressure variation (PPV)], have recently seen an increase in use. Given the risks associated with such invasive techniques, there is growing interest in non-invasive monitoring methods-and plethysmographic waveform analysis. However, many such non-invasive methods involve intricate calculations or brand-specific monitors. This study introduces the simple systolic ratio (SSR), derived from pulse oximetry tracings, as a non-invasive method to assess fluid responsiveness. Methods: This prospective observational study included 25 adult patients whose SPV, PPV, and SSR values were collected at 30-min intervals during open abdominal surgery. The SSR was defined as the ratio of the tallest waveform to the shortest waveform within pulse tracings. The correlations among SSR, SPV, and PPV were analyzed. Additionally, anaesthesia specialists visually assessed pulse oximetry tracings to determine fluid responsiveness using the SSR method. Results: Strong correlations were observed between SSR and both SPV (r = 0.715, P < 0.001) and PPV (r = 0.702, P < 0.001). Receiver operator curve analysis identified optimal SSR thresholds for predicting fluid responsiveness at 1.47 for SPV and 1.50 for PPV. A survey of anaesthesia specialists using the SSR method to visually assess fluid responsiveness produced an accuracy rate of 83%. Conclusion: Based on the strong correlations it exhibits with traditional markers, SSR has great potential as a clinical tool, especially in resource-limited settings. However, further research is needed to establish its role, especially as it pertains to its universal applicability across monitoring devices.

Prevalence and Causes of Elective Surgery Cancellations After Patients are Taken to the Operating Room: A Prospective, Cross-Sectional Study.

Objective: This study aimed to investigate the causes and prevalence of elective surgery cancellations in the operating room, and the clinical outcomes of affected patients. Methods: This prospective, cross-sectional study assessed the prevalence and causes of elective surgery cancellations once patients are in the operating room. A tertiary academic referral center hosted the study between January 2022 and January 2023. The study sample consisted of 7,482 adult patients scheduled for elective surgeries and taken to the operating room. The 7,415 completed procedures were in Group 2, whereas the 67 cancelled surgeries were in Group 1. Patients were divided into two groups on the basis of whether their surgeries were completed or cancelled. Factors such as age, American Society of Anesthesiologists (ASA) status, and surgical department were analyzed. The two groups were compared on the basis of age, ASA status, surgical department, and surgery time (month and day). Results: Elective surgery cancellations occurred in the operating room at a rate of 0.9%. Group 1 was substantially older than Group 2 (p<0.001). Group 1 had a larger number of ASA III patients (p<0.001). The department with the highest cancellation rate was ophthalmology (2.5%), followed by general surgery (2.1%), urology (1.5%), and ear, nose, and throat (1.4%). It was possible to avoid 59.7% of cancelations. Conclusion: The study revealed a 0.9% prevalence rate of elective surgery cancelations in the operating room. Older age and higher ASA status greatly influenced these cancellations. Optimized surgery scheduling and patient assessment processes may prevent many of these cancellation.

The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.

Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.