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Sessea vestioides (Solanaceae) is a hepatotoxic species distributed in Argentina, Paraguay, Brazil, and Uruguay, with very limited documentation in the peer-reviewed scientific literature. We describe an outbreak with 18% mortality in 330 yearling heifers after accidentally entering an invaded paddock. Necropsy revealed serosal petechiae and an enhanced lobular liver pattern, while histopathology showed centrilobular hemorrhagic necrosis. Diagnosis was based on epidemiology, pathology, and plant identification. The toxin of S. vestioides remains unknown.
To explore barriers and enablers to implementing voluntary National Safety and Quality Primary and Community Healthcare Standards in Australian private dietetics practice. Semi-structured interviews with private practice dietitians, guided by the Consolidated Framework for Implementation Research, were conducted. Transcripts were analysed using a deductive-inductive thematic analysis informed by the theory of planned behaviour, with member checking used to refine the themes. Sixteen dietitians completed an interview. Awareness of the standards was low, with weak social norms impeding implementation. Although some dietitians valued benchmarks, business systems, care quality and staff experiences, others questioned the need for formal standards for small practices, preferring to be guided by profession-specific codes of conduct. Barriers to implementing the standards included insufficient time, resources and knowledge, identifying key areas for future intervention. No participants planned to pursue formal accreditation; however, some intended to reference the standards informally to guide their improvements. Without mandatory use or strong incentives, dietitians are unlikely to formally adopt the national quality and safety standards despite acknowledging the potential benefits. Embedding quality concepts in pre- and post-credentialing education, strengthening financial and professional incentives, and providing implementation resources may foster uptake.
Electric scooters (e-scooters) have become a popular means of short-distance transportation for major metropolitan areas in several countries over the past decade. Their eco-friendliness, affordability, and ease of operation are selling points to people of all ages, particularly youth and young adults. Societal normalization has unfortunately overshadowed the risks entailed with their operation including severe injury and death. Alcohol, lack of protective equipment, and inadequate infrastructure appear to be common preventable risk factors. Emergency clinicians and trauma teams experience the aftermath of e-scooter injuries, which promise a rising trajectory. Common injury patterns have been identified by researchers around the world, most notably orthopedic, head, and maxillofacial in nature. Becoming familiar with these injury patterns and risk factors contributing to e-scooter accidents can be advantageous to the emergency physician's preparedness and public officials' approach to injury prevention.
Data of the German Statutory Accident Insurance (VBG) was used, to analyze the occurrence, time loss, the injury mechanism and situational patterns of concussions in German male professional football. Prospective observational open cohort study over nine consecutive seasons between 2014/15 and 2022/23. All concussions during the observation period registered by clubs or physicians with the German statutory accidental insurance for professional athletes (VBG) as part of mandatory occupational accident reporting were included for epidemiological analyses. All match concussions leading to ≥7 days of time loss and/or ≥1000€ healthcare costs were included for a standardized video analysis of injury mechanism and situational patterns. Mean concussion prevalence was 2.9% (95% CI 1.8 to 4.0) resulting in 0.77 concussions (95% CI 0.4 to 1.06) per season for a men's professional football team. The match incidence was 0.84 concussions per 1000 h of match exposure (95% CI 0.72 to 0.96). The odds for a concussion were significantly higher in match-play compared with training (OR 2.82, 95% CI 2.16 to 3.69, p < 0.001). Goalkeepers and defenders were significantly more likely to sustain a concussion compared with midfielders and strikers (p < 0.001). 49.4% of the players returned to play in less than six days without significant differences between BL1 (48.1%, 51/106) and BL2 (50.4%, 63/125). There was no significant difference in mean time loss after concussion between BL1 (7.7 ± 10.6) compared to BL2 (6.9 ± 9.2, p = 0.351). Only 37.5% of the concussions could be identified and validated with public media-based data. Most concussions occurred in head-to-head or hip-to-head collisions and were not judged as foul play by the opponent in 83% of cases. The present study delivers a comprehensive high-quality data set over nine consecutive seasons on concussions in professional German soccer which reveals that the implementation of appropriate RTP strategies seems to be lacking.
Alarm fatigue has been identified as a patient safety concern. This study aimed to explore nurse managers' perceptions of alarm fatigue among nurses and their recommendations for improving clinical alarm management. Using a qualitative descriptive exploratory design, audio-recorded semi-structured interviews were conducted with 11 nurse managers. The interviews were transcribed and analysed using thematic analysis, revealing five central themes: 'The power of alarm fatigue', 'Patient ramifications of alarm fatigue', 'External factors contributing to alarm fatigue', 'Mitigating alarm fatigue', and 'The impact of technology in health care'. The study concluded that addressing alarm fatigue is critical for improving both nurse wellbeing and patient safety. Solutions may include evidence-based clinical alarm protocols, the introduction of guidelines, and educational opportunities to help nurses understand alarm fatigue and take proactive steps to minimise and manage it.
With the rapid development of society, the number of road vehicles has increased significantly, leading to a growing severity of traffic accident issues. Timely and accurate detection of road traffic anomalies or accidents is crucial for reducing fatalities and alleviating traffic congestion. Consequently, the detection of road traffic anomalies has become a focal point of research in recent years. With the assistance of computer technologies such as deep learning, researchers have developed more accurate and effective methods for detecting road traffic anomalies. However, the small proportion of anomaly-prone areas in surveillance video frames, combined with the complex and difficult-to-capture patterns of accidents, presents new challenges for the application of deep models to traffic anomaly detection from a surveillance perspective. In light of this, this paper annotates the TADS dataset we previously proposed, a popular text-assisted video representation learning method, to develop a more efficient detection method. Utilizing the well-known video-text model CLIP, we have constructed a detection model that leverages unique text and eye-gaze annotation data from the TADS dataset to learn anomaly representations more effectively, thereby improving the detection of road traffic anomalies from a surveillance perspective. Experimental results demonstrate the superiority of our model for detecting traffic anomalies from a surveillance perspective, as well as the utility of the text and eye-gaze data included in the dataset.
Falls occur infrequently in critical care where the risk must be balanced against the advantages of physical therapy. Many falls risk assessment tools are not designed for use in critical care and often categorize all patients as "high risk" and thus their usefulness is limited. The Tyndall-Bailey Falls Risk Assessment Tool was specifically designed to be used in the intensive care unit. This tool demonstrated good reliability in an early evaluation and was associated with a reduction in the fall rate. There is ongoing work, some international, to test the psychometrics and opportunities to extend its use to other jurisdictions.
Although many studies have examined temperature-related non-accidental mortality, the impact of heat waves on the mortality burden of chronic kidney disease (CKD) remains poorly understood. This study aimed to assess the CKD mortality burden associated with heat waves in China under global warming. Mortality data on CKD from 2,790 counties/districts in China from 2004 to 2022 were collected from the Chinese Center for Disease Control and Prevention; meteorological data for the same period were obtained from the fifth-generation European Reanalysis Land dataset. A time-stratified case-crossover design combined with a distributed lag nonlinear model was used to examine the association between heat waves and CKD mortality. Future CKD mortality burdens attributable to heat waves under climate change and future population scenarios were projected. In total, 236,260 CKD deaths were included in this study. Compared to that during non-heat wave days, CKD mortality increased by 3.48% (95% confidence interval [ CI]: 1.67% to 5.33%) during heat waves, and the mortality risk escalated by 2.48% (95% confidence interval [ CI]: 0.12% to 4.91%) for each 1 °C increment during heat wave days. Stratified analyses revealed that CKD mortality risks were greater for women (Excess Risk [ER] = 5.52%, 95% CI: 2.71% to 8.40%), individuals aged 65 years and older (ER = 4.60%, 95% CI: 2.30% to 6.96%), and people in mesic/cold regions (ER = 6.20%, 95% CI: 1.13% to 11.53%). The projections showed that the attributable fraction(AF) of CKD mortality due to heat waves would rise from 0.64% (95% CI: 0.52% to 0.78%) in the 2020s to 2.44% (95% CI: 1.97% to 2.95%) in the 2090s under the SSP5-8.5 scenario, with the highest burden in southeastern China, including Hainan (3.31%, 95% CI: 1.66% to 5.02%), Yunnan (3.05%, 95% CI: 1.46% to 4.75%), and Guangdong Province (2.84%, 95% CI: 1.24% to 4.41%). This nationwide study demonstrated that exposure to heat waves significantly increased the mortality risk of CKD, and that women, older individuals, and people in mesic/cold regions are more susceptible to heat waves. Global warming will significantly increase the future CKD mortality burden attributed to heat waves, particularly in southeastern China. Our findings emphasize the need to address CKD in the context of ongoing climate change.
The rapid expansion of urban living has led to increased road congestion, posing significant challenges for maintaining driver attention and ensuring road safety. This study investigates advanced machine learning techniques to assess and predict driver focus by analyzing key metrics such as concentration scores, reaction times, and stress management capabilities. A comprehensive evaluation of various machine learning models was conducted, including Logistic Regression (LR), Linear Discriminant Analysis (LDA), Ridge Classifier, Decision Tree (DT), Light Gradient Boosting Machines (LightGBM), Naive Bayes (NB), Support Vector Machines (SVM), Random Forest (RF), AdaBoost, XGBoost, CatBoost, K-Nearest Neighbors (KNN), and Stacking. To optimize performance, a metaheuristic optimization algorithm was employed for precise hyperparameter tuning. The novelty of this research lies in the introduction of a novel hybrid machine learning algorithm, "CatBoost+Stacking." By integrating the strengths of CatBoost within a stacking framework, this new model significantly enhances the accuracy of predicting driver concentration levels. Experimental results demonstrate that the "CatBoost+Stacking" model outperforms existing baseline models, offering a more effective approach for monitoring driver behaviour. These findings provide practical insights for developing proactive road safety strategies and reducing accidents, highlighting the transformative potential of hybrid models in creating safer driving environments.
Infants experience facial fractures infrequently due to their limited mobility, and when such injuries do occur, the mandible is among the most affected facial bones. Isolated mandibular condylar fractures, however, are rarely reported in this age group. Clinical detection is particularly challenging in nonverbal infants, making careful imaging assessment essential when evaluating facial trauma. This case series presents infants with condylar fractures that were first identified on head CT studies, emphasizing key clinical considerations and the importance of evaluating the mandibular condyles on every head CT.
Piperacillin-tazobactam is a widely used β-lactam antibiotic, yet occupational systemic anaphylaxis remains exceptionally rare. We report the case of a 26-year-old female nurse with persistent atopic dermatitis and previous history of allergic contact dermatitis to nickel and cobalt, who developed occupational anaphylaxis while preparing intravenous cefuroxime and piperacillin-tazobactam. She presented with acute erythematous papules, rhinorrhea, wheezing, dyspnea, and tachycardia, requiring treatment with intramuscular epinephrine, intravenous clemastine, and hydrocortisone, with complete clinical resolution. She later tolerated cefuroxime handling but developed a generalized rash following accidental skin contact with piperacillin-tazobactam powder. No cofactors were identified, and no reactions occurred outside the workplace. Skin prick testing was performed and elicited an exuberant positive response, with a wheal >20 mm, marked erythema, pruritus, and satellite vesicles after 15 minutes. Additional work-up showed positive specific IgE to penicilloyl G and amoxicillin, with negative latex and formaldehyde testing and normal baseline tryptase. This case supports piperacillin-tazobactam as a potential occupational allergen capable of inducing severe IgE-mediated reactions through non-therapeutic exposure, possibly via inhalation or skin contact during drug reconstitution. Early recognition, diagnostic confirmation, exposure avoidance, and workplace adjustments are essential to prevent recurrent reactions and reduce the risk of occupational disability. In selected cases transfer to a low-exposure work environment may be required. This case reinforces that non-therapeutic occupational exposure to piperacillin-tazobactam can lead to life-threatening IgE-mediated anaphylaxis, highlighting the need for increased awareness and structured preventive strategies in healthcare settings.
Water radiolysis plays an important role in radiation effects on materials, including DNA damage in the human body and corrosion processes in nuclear reactors. To quantitatively evaluate radiolytic molecular yields (G-values), several Monte Carlo simulation codes for analyzing chemical species kinetics have been developed worldwide. However, conventional chemical simulation codes are generally limited to room temperature (roughly equivalent to the human body), which differs from the temperatures encountered in nuclear reactor environments. Therefore, incorporating temperature dependence into chemical simulations is essential for evaluating G-values under high-temperature conditions. In this study, we developed a chemical simulation code (PHITS-Chem) based on the general-purpose Monte Carlo code, Particle and Heavy Ion Transport code System (PHITS), applicable to the 0-350 °C temperature range. The present PHITS-Chem code explicitly accounts for the temperature dependences of diffusion coefficients and chemical reaction rate constants. The present code was benchmarked against reported experimental and theoretical G-values for low-LET (~ 0.2 keV/µm), moderate-LET (~ 11.9 keV/µm), and high-LET (~ 63.4 keV/µm) radiations, showing good agreement with the literature. The validated temperature range spans from 0 to 350 °C, covering conditions relevant to the human body, cryosphere, and light water reactors. To further improve the predictive capability and extend the applicability of the model, additional verification and updates will be required in future studies. The renewed PHITS-Chem thus enables high-precision estimation of radiolytic chemical species kinetics across a broad temperature range, which would be valuable for assessing in-core material degradation and mitigating severe accidents in nuclear reactors.
Trauma is a major global cause of morbidity and mortality, with general radiography serving as the first-line diagnostic tool in emergency care. In Zambia, trauma accounts for approximately 20% of premature deaths, largely from road traffic accidents, falls, and assaults, with Lusaka Province reporting the highest incidence. Radiographers are essential in trauma care; however, their experiences in low-resource settings remain underexplored. This study explored diagnostic radiographers' experiences of trauma radiography at a Zambian teaching hospital. Following ethical approval, a qualitative descriptive design was employed to explore the experiences of seven purposively sampled diagnostic radiographers at a major teaching hospital in Lusaka, Zambia. Semi-structured interviews were conducted, transcribed verbatim, and analysed iteratively using Leavy's five-step qualitative analysis framework. Trustworthiness was ensured through prolonged engagement, audit trails, member checking, and thick description. Five themes were developed: (1) professional contribution to trauma diagnosis and care, (2) collaborative practice and communication in trauma radiography, (3) operational and technical constraints in trauma radiography, (4) emotional adaptation and coping in trauma radiography, and (5) opportunities for improving trauma radiography services. Participants highlighted their critical role in trauma diagnosis despite significant equipment limitations, including restricted horizontal beam imaging, demonstrating teamwork, adaptability, and resilience while emphasising the need for improved imaging resources. Zambian radiographers are essential to trauma care, demonstrating resilience, adaptability, and collaborative practice despite significant equipment limitations and operational challenges in trauma imaging. Enhancing trauma radiography in low-resource settings requires investment in dedicated imaging equipment and accessories, strengthening interprofessional collaboration, and implementing structured support mechanisms to safeguard radiographers' well-being and optimise patient care outcomes.
Loxoscelism is a public health issue in tropical countries, particularly in Brazil. It can affect children of all ages and may lead to severe and irreversible injuries. We report the case of an infant who suffered a severe loxoscelism accident in the cervical region, progressing to esophageal stricture requiring multiple dilations. Fortunately, in this case, the outcome was favorable despite the need for surgical and endoscopic interventions. This case highlights the importance of both individual and collective preventive measures to reduce the incidence of such accidents, especially in the pediatric population.
Road traffic accidents cause substantial fatalities and economic losses, yet large-scale severity analysis is often constrained by limited access to high-resolution roadway and geometric data. This study constructs a large-scale, multi-source dataset with fine-grained road-alignment characteristics to support data-driven analysis of accident severity patterns. Unlike prior work that uses coarse road descriptors, we automatically extract fine-grained horizontal and vertical geometry from extensive networks, enabling detailed geometric rarely available at a large scale. In total, 26 features were integrated, spanning environmental, roadway, and geometric alignment dimensions. A soft-voting ensemble integrating XGBoost, Random Forest (RF), CatBoost, and LightGBM (LGBM) is employed to support severity prediction, while SHAP (SHapley Additive exPlanations) is used to derive both severity-level importance rankings and sample-level explanations. Rather than focusing solely on predictive accuracy, this study uncovers mechanism-informed insights under rigorous evaluation settings designed to mitigate spatiotemporal dependence. The results show that environmental conditions are more strongly associated with lower-severity accidents, whereas roadway type and geometric alignment features become increasingly important for higher-severity accidents. Furthermore, Accumulated Local Effects (ALE) analyses reveal nonlinear patterns and threshold regions for key continuous variables, providing complementary evidence on how risk varies across operating conditions. These findings provide mechanism-informed insights that can support the development of targeted road safety strategies.
Contemporary rapid response systems have evolved from crisis-reactive teams into intelligent, predictive intervention programs that orchestrate comprehensive patient safety through precision health care delivery. This article explores revolutionary advances in cognitive computing-enhanced detection systems, ambient monitoring networks, dynamic communication architectures, and precision-guided response protocols. Emerging evidence validates that integrated digital transformation strategies combining predictive intelligence with augmented decision-making frameworks substantially reduce mortality trajectories, optimize resource utilization, and deliver exceptional value propositions while dismantling conventional barriers to optimal therapeutic outcomes.
Background: Peripheral intravenous catheters (PIVCs) is widely considered the most common invasive procedure in hospitals, and it is estimated that these devices are used annually up to two billion times worldwide. The main complication of this procedure is the appearance of phlebitis, which can cause pain, edema, tenderness, erythema, or the development of a palpable cord around the cannulated vein. Premature failure of PIVCs increases the cost of health care. Objective: To describe interventions carried out by nursing professionals aimed at increasing the lifespan of PIVCs. Methods: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was carried out. A bibliographic keyword search was performed on search engines between December 2021 and January 2022. Articles were selected independently by two of the authors. The protocol for this systematic review was properly recorded. Inclusion and exclusion criteria were defined (see "Methods" section). The PEDro scale was used to ensure the quality of the selected studies. Results: Fifty-two articles were screened, with 14 articles ultimately selected. The outcomes were prioritized by the number of articles that mentioned them, divided into primary and secondary outcomes. We found the following as primary outcomes: phlebitis occurrence, PIVC location, occlusion occurrence, PIVC dwell time, bloodstream infection, and infiltration rate. Secondary outcomes were dislodgement occurrence, presence of pain, local venous infection, PIVC colonization, number of PIVCs per patient, and accidental removal. Conclusions: PIVC material or the use of heparin can prevent phlebitis or the occurrence of occlusion. Ultra-long PIVCs show improvements in dwell time. Routine PIVC replacement has fallen into disuse. Implications for Nursing: Knowledge of the different PIVC materials and their lifespan is an area of nursing competence. Some methods increase PIVCs' dwell time. The use of heparin solutions or Vialon catheters may prevent phlebitis occurrence. The use of Vialon catheters or achieving better fixation by adding cyanoacrylate drops under the dressings could reduce occlusion occurrence. Hospital nurses are the main parties responsible for the management of peripheral venous catheters, and their interventions should be aimed at increasing the catheters' dwell time and reducing complications.
Accidental caustic ingestion is a pediatric emergency that may result in severe esophageal injury and long-term complications, including strictures requiring repeated dilation. Cerebral abscess is a rare but potentially fatal condition in children and has only sporadically been reported following esophageal dilation. We report the case of a 3-year-old girl who developed an esophageal stricture following accidental ingestion of sodium hydroxide. After multiple esophageal dilations, the patient presented with electrolyte abnormalities and neurological symptoms. Neuroimaging revealed a large left frontotemporal cerebral abscess with mass effect. Surgical drainage was performed, and Streptococcus intermedius was isolated from the abscess cultures. Prolonged targeted antimicrobial therapy led to clinical stabilization, although residual neurological deficits persisted. This case highlights a rare but severe complication associated with repeated esophageal dilation in pediatric patients. Transient bacteremia caused by mucosal trauma, combined with hematogenous dissemination through the Batson venous plexus, may explain cerebral seeding. Increased clinical vigilance in children with fever and early neuroimaging are crucial if any neurological symptoms develop after esophageal dilation.
Radiotherapy is a complex, multistage process that involves collaboration across professional disciplines (radiographers working in pre-treatment preparation, physicians, physicists, radiation therapists during planning and treatment. While severe errors are uncommon, they can have profound consequences for patients. The Danish Society for Medical Physics supports a Special Interest Group dedicated to improving patient safety by analysing unintended events (UEs) and near misses in radiotherapy. Here we report on the work conducted with an updated system for categorising UEs in radiotherapy in Denmark. An updated reporting system based on the English Radiotherapy Pathway Coding (RPC) system has been taken into use in 2025. This system, including the use of a Danish system that ranks the UEs from the patients perspective, called Patient Centred Coding, is outlined and UEs reported in 2025 are summarised. Radiotherapy is generally a safe treatment modality, a conclusion further supported by our results from 2025. In 2025 only 339 UEs were reported, 315 of these with low risk and 24 with medium risks. The lesson learned is that the main focus in order to prevent the most harmful UEs should be on the delineation and the planning process. Based on our experience from this work, we recommend the development of a national system for categorising and ranking UEs. We further recommend establishing a national working group that meets regularly and focuses on UEs at a national level.