Transaction verification is essential to blockchain security. As blockchain data continue to grow, resource limited nodes may be forced to operate as non-full nodes, which weakens independent verification and may increase centralization risk. To address this issue, the stateless blockchain technology has been proposed, which uses the accumulators to combine the UTXO set into one fixed-size commitment. However, they suffer from two critical limitations: (i) the inability to support script validation duo to the lack of scriptSig, and (ii) the absence of an outsourcing mechanism to ensure that task executors reliably provide the appropriate witness for the nodes just recovered from failures. We propose LSTVS, a lightweight stateless transaction verification architecture for UTXO based blockchains, which extends RSA accumulator based stateless verification with script-based authorization verification, cache assisted stale proof tolerance, and outsourced witness updates. First, we incorporate UTXO fields associated with transactions into the membership witness to enable digital signature verification. Second, we reconstruct the transaction data format to prevent the exponential growth of transaction reference fields. Finally, we introduce an outsourcing mechanism to improve the transaction verification rate while minimizing computational resource consumption. Experimental results show that the proposed architecture supports the core validation dimensions of UTXO based stateless verification, including existence verification, unspent status verification, and script-based authorization verification, while avoiding UTXO scale dependent proof growth and introducing input dependent transient witness overhead. Compared with existing state of the art RSA accumulator-based schemes, LSTVS improves the transaction verification rate and reduces the local witness update overhead for intermittently online nodes.
Experiencing racism and anti-immigrant discrimination has a negative impact on health, including healthcare utilization. A growing body of research has connected vicarious experiences of racism and anti-immigrant discrimination to health decline; however, there is a dearth of literature examining the impact of these vicarious experiences on healthcare utilization. Using data from the 2023 and 2024 California Health Interview Survey (n = 46,481), we examined the association between vicarious experiences of hate incidents in the last 12 months motivated by race or skin color and immigration status and indicators of healthcare utilization in the past 12 months. Logistic regression models were used to calculate adjusted odds ratios (AORs) of all study outcomes. Analyses were stratified by white and Black, Indigenous, and People of Color (BIPOC) for hate incidents motivated by race or skin color, and by United States (US) born citizens, naturalized citizens, and noncitizens for hate incidents motivated by immigrant status. After accounting for confounders, among all participants, witnessing a hate incident motivated by the race or skin color of the target was associated with higher odds of foregoing or delaying healthcare services, receiving care from telemedicine, and visiting the emergency room. Among the entire sample, witnessing a hate incident motivated by immigration status of the target was associated with higher odds of foregoing or delaying healthcare services and receiving care from telemedicine. Witnessing hate incidents motivated by race, skin color, or immigrant status has a negative impact on healthcare utilization for everyone, regardless of racial background or citizenship status.
Mental health professionals (MHPs) play important roles in providing expert opinions in courts; however, dated studies indicate that legal professionals prefer psychiatrists as mental health expert witnesses as well as mental health testimony on ultimate opinions, clinical diagnosis, and interpreting the legal standard for mental conditions. This mixed-methods study surveyed 132 judges and lawyers in the United States and Canada to examine their preferences for mental health testimony elements and MHPs as expert witnesses. Updating previous research conducted between the 1980s to 2010s, respondents were presented with 11 questions describing different elements of mental health testimonies and were asked to rate the importance of these testimonies and rank their preference for psychiatrists, psychologists or social work experts. Legal professionals preferred expert testimony on clinical diagnosis, psychological testing, and descriptive testimonies. American legal professionals considered testimony on crime statistical data related to diagnosis as more essential than did Canadians, and Canadians ranked testimony on measure of dangerousness higher. Overall, American legal professionals preferred having psychologists as expert witnesses, whereas Canadian legal professionals preferred psychiatrists. Using a qualitative reflexive thematic analysis of participants' comments on factors that contribute to a useful testimony, four themes summarized the indicators of useful expert testimony: Qualified and Engaged Experts, Relevant and Useful Information, Empirical Rigor in Testimony, and Clarity and Accessibility. Results reveal that American legal professionals are increasingly understanding the value of forensic psychologists as expert witnesses, whereas Canadians hold preferences for psychiatrists.
Viewer engagement is central to the live-streaming economy. While existing literature primarily examines the dyadic relationship between a viewer and a streamer, it largely overlooks the social context: viewers simultaneously witness the streamer's real-time interactions with peers. Drawing on Leader-Member Exchange (LMX) differentiation and Social Comparison Theory, we introduce Perceived Closeness Difference (PCD), defined as the cognitive gap between a viewer's perceived closeness to the streamer and their perception of a peer's closeness. Across six experimental studies (N = 1,980), we examine how PCD is associated with engagement behaviors. Study 1 shows that witnessing a streamer favor a peer (Negative PCD) is associated with lower engagement, whereas witnessing peer rejection (Positive PCD) is associated with higher engagement, partly mediated by participants' subjectively measured PCD scores. Studies 2 and 3 identify boundary conditions, indicating that these effects are stronger in emotional (vs. utility) contexts and among more emotionally oriented viewers. Study 4 shows that the pattern varies with the peer's group identity (in-group vs. out-group). Study 5 indicates that PCD is more strongly related to public/social engagement (e.g., commenting) than to private/financial engagement. Finally, Study 6 links PCD to long-term loyalty via perceived streamer trustworthiness. Together, these findings extend one-and-a-half-sided relationship perspectives and offer implications for community management in interactive media.
Recent studies demonstrate that individuals who attend psychiatric services in adolescence, especially inpatient care, have an increased risk of psychotic disorders in adulthood. Given the extensive literature demonstrating a relationship between developmental trauma and psychosis, we investigated whether trauma history would help to identify elevated psychosis risk within a clinical cohort. The sample consisted of patients admitted to a regional adolescent inpatient psychiatric unit (Oulu, Finland) between April 2001 and March 2006. The Kiddie Schedule for Affective Disorders and Schizophrenia was used to assess history of developmental trauma. Primary analyses investigated childhood sexual and/or physical abuse and secondary analyses investigated other types of traumatic events (car accident, other accident, fire, witness of a disaster, witness of a violent crime, victim of a violent crime, confronted with traumatic news, witness to domestic violence, other). Diagnoses from specialist healthcare were followed up in the national healthcare register until June 2023. Logistic regression was used to assess the relationship between childhood trauma and subsequent schizophrenia-spectrum disorders (SSDs). Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 14% reported a history of childhood sexual abuse and 27% reported a history of childhood physical abuse. Exposure to childhood sexual or physical abuse was not associated with a subsequently increased risk of SSDs (adjusted OR = 1.05, 95% CI = 0.59-1.83). Similarly, none of the other developmental adversities were associated with a subsequently increased risk of SSDs. In a clinical cohort made up of non-psychotic adolescent psychiatry inpatients, a group known to be at elevated risk of psychosis, none of the assessed developmental adversities were prognostic factors for subsequent psychotic disorders.
In Japan, providing reasonable accommodation for people with intellectual disabilities became mandatory on 1 April 2024, but evidence from non-psychiatric hospital care is limited. We conducted semi-structured interviews with nine hospital-based non-psychiatric physicians in Japan (October 2023-March 2024) and analysed data using inductive thematic analysis. Physicians described accommodations in (1) medication management tailored to understanding, preferences, and home support; (2) relationship-centred communication to elicit symptoms and confirm comprehension; and (3) flexible care processes, including time, environment, and team roles. They mitigated risks through witnessed explanations, clear documentation, and proactive coordination with nurses and family members. Practical, workflow-embedded accommodations are common in non-psychiatric settings and could be strengthened by structured communication supports and systematic information sharing. Non‐psychiatric hospital doctors in Japan described practical ways to adjust care for people with intellectual disabilities. Helpful changes included clearer step‐by‐step explanations, extra time, and medication plans that match support available at home. Risk was reduced by witnessed explanations, clear documentation, and proactive coordination with nurses and family members. Future work should test structured communication tools and hospital workflows that make reasonable accommodation more consistent and safer.
To investigate the association between low-flow time (LFT) and outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with prehospital extracorporeal cardiopulmonary resuscitation (ECPR). This retrospective study included OHCA patients receiving prehospital ECPR (July 2023-August 2024). LFT, defined as the interval from conventional CPR start to ECPR flow initiation, was analyzed continuously (per 10 min increment). Due to limited events (13 favorable neurological outcomes), the primary logistic regression adjusted for two prespecified confounders (age, initial shockable rhythm). A sensitivity analysis was performed in patients with witnessed arrest and bystander CPR (no-flow time of approximately 0). All analyses are exploratory. Among 76 patients (mean age 58.80 ± 14.84 years, mean LFT 60.33 ± 13.89 min), survival to hospital discharge was 34.2% (26/76) and favorable neurological outcome 17.1% (13/76). Each 10 min LFT increase was associated with lower survival (aOR 0.557; 95% CI 0.368-0.844; P = 0.006) and favorable neurological outcome (aOR 0.461; 95% CI 0.255-0.834; P = 0.011). In the sensitivity subgroup (witnessed + bystander CPR, n = 44, 9 favorable outcomes), the univariable OR for favorable outcome was 0.395 (95% CI 0.176-0.886; P = 0.024), consistent with the primary estimate. Exploratory ROC analysis for favorable neurological outcome gave an AUC of 0.750 (95% CI 0.603-0.896), but the derived cutoff (55.5 min) is not proposed for clinical use. In this single-center study, longer LFT (per 10 min) was associated with worse outcomes, consistent in a no-flow-time-controlled subgroup. Given the exploratory design, external validation is required. No definitive LFT threshold can be recommended.
Purpose of ResearchLucidity is the transient recovery of abilities and communication that were seemingly lost among people living with dementia (PLWD). This study describes lucid episodes reported by Alzheimer's dementia (AD) and Lewy Body Dementias (LBD) caregivers. We analyzed survey data from 212 current AD (n = 191) and LBD caregivers who reported the frequency, duration, and characteristics of 653 lucid episodes witnessed in the past month.Major FindingsMost AD caregivers (67%) and LBD caregivers (81%) witnessed a lucid episode within the past month. LBD caregivers reported lucid episodes with greater changes in awareness and communication, compared to AD caregivers. LBD caregivers reported longer lucid episodes and that the PLWD knew about their change in lucidity, compared to AD caregivers.ConclusionsFindings suggest that differences in lucid episode intensity, timing, and meta-awareness between AD and LBD are possible and may inform care strategies for PLWD.
Compressed air-induced colonic barotrauma is a rare but potentially fatal injury type with distinctive forensic significance. Non-iatrogenic pneumatic injuries of the gastrointestinal tract are infrequently documented, yet are associated with high morbidity and mortality, frequently arising in occupational settings because of workplace misconduct or the misuse of pneumatic equipment. We report a fatal case of transanal high-pressure compressed air insufflation in a 15-year-old adolescent. Witness testimony and the accused's confession established that a compressed air hose was inserted transanally on two occasions while the victim was fully clothed. The second instance of insufflation resulted in immediate collapse at the scene with subsequent death. Medicolegal autopsy was conducted at the Egyptian Forensic Medicine Authority. External examination revealed a grossly distended abdomen as well as a grossly distended scrotum, and two vital perianal lacerations with contused and abraded margins, accompanied by perianal bruising. Internal examination demonstrated tension pneumoperitoneum, multiple colonic and mesenteric lacerations, and intraperitoneal hemorrhage. Toxicological analysis and anal swabs for evidence of sexual assault were negative. The cause of death was attributed to hemorrhagic shock secondary to extensive multiple colonic and mesenteric lacerations. Compressed air-induced colonic barotrauma, though rare, represents a forensically significant injury pattern. The current case illustrates the severe, potentially fatal effects of using pneumatic devices improperly and emphasizes the importance of considering scene evidence, witness statements, external examinations, and comprehensive internal autopsy findings to accurately reconstruct the mechanism, manner, and cause of death.
Insulinomas and functional pancreatic neuroendocrine tumours (pNETs) are rare but important causes of endogenous hyperinsulinaemic hypoglycaemia whose neuroglycopenic manifestations can closely mimic neurological disorders, leading to considerable diagnostic delay. We present the case of a 74-year-old man with epilepsy, seizure-free for 11 years on carbamazepine, and a background of metastatic well-differentiated grade 3 pNET (Ki-67: 40-50%), who was admitted with a 2-3-week history of nocturnal confusion, cold sweats, nightmares, increasing agitation, and an episode of abnormal limb movements. The presentation was initially attributed to possible seizure recurrence or delirium. Routine investigations, including CT brain, carbamazepine levels, and type 1 antineuronal nuclear autoantibody antibody testing, were unremarkable, and blood glucose on admission was normal. The correct diagnosis was reached only during a witnessed ward episode on day two, when capillary blood glucose was found to be critically low and symptoms resolved immediately with intravenous dextrose. Subsequent biochemical evaluation demonstrated markedly elevated serum insulin (42 µU/L; reference: 2-24 µU/L), C-peptide (2,464 pmol/L; reference: <90 pmol/L), and on formal supervised 72-hour fast, which provoked symptomatic hypoglycaemia after just three hours, insulin was 180 µU/L, proinsulin was 730 pmol/L (reference: <10 pmol/L), and C-peptide was 2,136 pmol/L, with a negative sulphonylurea screen, fulfilling the diagnostic criteria for endogenous hyperinsulinaemia. Somatostatin receptor scintigraphy (single-photon emission computed tomography-computed tomography) identified multifocal hepatic metastases and focal uptake in the pancreatic tail, confirming an insulin-secreting primary. The patient was managed with diazoxide and monthly lanreotide but experienced rapid deterioration and died on palliative care. This case underscores the need to consider a functional pNET as a cause of seizure-like episodes even in patients with established epilepsy, and highlights that capillary blood glucose measurement during any witnessed neurological episode is a simple but potentially life-saving clinical step that should never be omitted.
This study evaluated the effectiveness of a standardized Simultaneous, Aloud, inFormation, Electronic witnessing, Monitoring, One by one, and DocumEnt (SAFE MODE)-based training program in improving embryologists' patient safety awareness and procedural performance, aiming to reduce the risk of gamete and embryo misidentification. This multicenter, cross-sectional pre-post survey study was conducted across six in vitro fertilization (IVF) centers within the CHA University Global IVF Group in South Korea. Ninety-nine embryologists provided valid responses, and 53.5% had less than 1 year of experience. Participants completed a 14-session online training program (40 min/session) based on the SAFE MODE framework: simultaneous checking, calling aloud together, information double-checking, electronic witnessing, visual monitoring together, one-by-one handling, and document cross-checking. A 17-item, 5-point Likert scale questionnaire was used to assess safety awareness and procedural performance. Analyses included paired and independent t-tests, Pearson correlation analysis, and multiple regression analysis (SPSS ver. 25.0). Safety awareness scores increased significantly from 3.65 to 3.97 (p<0.05); procedural performance scores increased from 3.82 to 4.17 (p<0.01). Embryologists with less than 1 year of experience showed the greatest improvement, with scores increasing from 3.43 to 4.00 (p<0.05). Completion of all 14 sessions was associated with higher performance scores than mid-term training completion (4.17 vs. 3.85, p<0.01). Post-training safety awareness was positively correlated with post-training performance (r=0.215, p<0.05). SAFE MODE-based training was associated with significant improvements in safety awareness and procedural performance, particularly among embryologists with less than 1 year of experience. This approach may offer a practical strategy for reducing laboratory error risk and strengthening patient safety in IVF.
Nguyễn Phan Quế Mai's Dust Child (2023) provides a transgenerational narrative of the Vietnam civil war repercussions in the context of restorative justice, offering a critical discussion of how first-person accounts serve as a sociological tool for storytelling, testimony, and reconciliation within post-war Vietnam. Methodologically situated within a sociology of literature framework, this research article utilizes a multi-layered theoretical approach combining Rob Nixon's Slow Violence, Stacy Alaimo's Transcorporeality, and John Braithwaite's Restorative Justice, supplemented by frameworks of Trauma and Testimonial Witnessing. Through this lens, the study evaluates the bodily trauma of Phong, an Amerasian child, Dan, an American Veteran, and war-survivors Trang and Quỳnh, revealing how the novel depicts embodied and ecological trauma as a site of collective social and moral accountability. The textual results demonstrate that slow violence persists across bodies, landscapes, and generations while actively challenging the historical silence surrounding chemical warfare. Ultimately, this article discusses how narrating intergenerational trauma through intimate personal testimonies positions storytelling as a vital sociological process of acknowledgment, ethical witnessing, and restorative reconciliation in contemporary post-war Vietnam.
The present study investigated whether the timing and type of domestic violence exposure were associated with adolescents' peer violence involvement. Data were drawn from the sixth wave (2023) of the 2018 Korean Children and Youth Panel Survey, a nationally representative cohort (Mage = 18.4 years; 53.4% male; N = 2,224). Race/ethnicity was not collected as part of this nationwide panel survey, likely reflecting the high ethnic homogeneity of the South Korean population. Retrospective items captured the first developmental period in which youth experienced caregiver-to-child corporal punishment, verbal abuse, and physical abuse, and witnessed interparental verbal and physical violence. A multiple event process survival mixture model identified three exposure-timing classes: late childhood risk spike (1.1%), multi-period multi-type violence risk (3.6%), and low risk (95.3%). Youth in the multi-period multi-type violence risk class reported higher levels of traditional bullying and cyberbullying perpetration and victimization during the past year of high school compared with the other classes. Findings suggest that onset exposure to multiple forms of domestic violence across developmental periods may serve as an important marker of heightened risk for later peer violence involvement, and support developmentally timed, family- and school-based prevention efforts. Many young people who grow up with violence at home also report peer violence, but the timing and form of home violence may matter. Using survey data from 2,224 Korean adolescents in their final year of high school, we examined when they first experienced or witnessed different kinds of domestic violence (verbal and physical). We identified three groups: youth with a late childhood spike in violence onset, youth with onset exposure to multiple forms of violence across developmental periods, and youth with low exposure. Adolescents in the multi-period multi-type violence group reported the highest levels of bullying and cyberbullying, as both perpetrators and victims. Results highlight the importance of developmentally timed prevention and support for families and schools.
The integration of Artificial Intelligence (AI) into modern medicine has revolutionised diagnostic accuracy, yet it generates a critical ethical dilemma: as healthcare becomes more data-driven, it risks eroding the high-touch essence of care. As algorithms increasingly shape clinical decision-making, patients risk being reduced to data points rather than persons with unique life stories. This paper examines the tension between AI's calculative logic and the narrative nature of illness, introducing the Processing-Witnessing Model. This framework distinguishes between algorithmic processing (speed, optimisation) and human witnessing (presence, interpretation, and narrative understanding). While AI excels at managing disease as biological dysfunction, it cannot address illness as the lived experience of suffering. This paper argues that the opacity of black-box systems creates a contextual void, enabling a form of epistemic violence that renders the patient's story invisible. Furthermore, the normalization of the screen gaze threatens the therapeutic alliance. Ironically, studies rating AI chatbots as 'more empathetic' are interpreted here not as evidence of machine moral agency, but as a symptom of systemic burnout. This makes narrative ethics a priority for medical education. The physician's role should evolve from data supervisor to cultural mediator, ensuring that while machines process the biological hardware, clinicians provide the interpretive software of meaning.
Endodontics has witnessed a significant acceleration in innovation. However, the pace at which these innovations are validated through scientific research has not kept up, creating what is referred to as the 'speed of innovation versus speed of validation gap'. This incongruence raises critical concerns about the foundation of evidence-based practice, patient safety and professional accountability. Currently, many innovations are adopted in clinical practice based on preliminary data, anecdotal evidence or popularity on digital platforms, often before thorough clinical validation is achieved. This trend challenges traditional knowledge translation frameworks and reveals significant limitations within existing governance models in dentistry. This article draws on principles of responsible innovation and healthcare regulations to examine the factors contributing to this gap in endodontics and its implications. Although recognising the necessity of innovation for the advancement of the discipline, it cautions against the uncritical and premature adoption of new techniques and technologies, as this may jeopardise clinical outcomes and erode public trust. The article advocates for a more integrated approach that combines innovation with anticipatory governance, critical appraisal and professional reflexivity. Closing this gap is imperative to ensure that advancements in endodontics are founded on robust scientific evidence and conducted in a socially responsible manner.
Adverse childhood experiences (ACEs) are increasingly recognised as key determinants of self-harm among adolescents, particularly within psychiatric and mental health service settings in Malaysia, where coping resources may shape vulnerability and resilience. A cross-sectional study was conducted among adolescents referred to psychiatry and mental health services in Malaysia. Of 1244 eligible patients aged 10-24 years, 1164 completed a clinician-administered, interviewer-guided questionnaire. Self-harm status was assessed in clinical care and was compared across ACE burden, individual ACE domains and coping-related protective factors through a clinician-led interview. Multivariable logistic regression was used to examine adjusted associations with self-harm. Among 1164 participants, 827 (71.0%) reported lifetime self-harm. In adjusted analyses, a greater burden of ACEs was strongly associated with higher odds of self-harm. Compared with participants with no ACE exposure, the odds increased in a dose-response manner, from an adjusted OR (aOR) of 2.54 (95% CI 1.27 to 5.20) among those with 2-3 ACEs to 6.14 (95% CI 3.13 to 12.40) among those with ≥4 ACEs. Several coping-related factors were associated with lower odds of self-harm, including the ability to cope with stress (aOR 0.32, 95% CI 0.23 to 0.45), a sense of responsibility towards children, loved ones or pets (aOR 0.71, 95% CI 0.51 to 0.98) and perceived social support (aOR 0.63, 95% CI 0.40 to 0.97). In secondary analyses of individual ACE components, violence against household members, emotional abuse, sexual abuse, bullying and witnessing community violence were independently associated with higher odds of self-harm. This study showed high prevalence of self-harm among adolescents attending the psychiatric and mental health services. A greater cumulative burden of ACEs was associated with increased odds of self-harm, whereas protective factors including effective stress coping, a sense of responsibility towards loved ones or pets and social support were associated with reduced odds. These findings emphasised the importance of trauma-informed assessment and interventions that enhance coping capacities and social connectedness among young people presenting to mental health services.
Yinxing Mihuan Oral Solution (YMOS) is extensively utilized in the clinical treatment of cardiovascular and cerebrovascular diseases (CCVDs), with flavonols and their glycosides identified as the primary active ingredients. Currently, there are relatively few established quantitative methods available for analyzing flavonols and their glycosides, and the research regarding their transformation patterns under simulated gastrointestinal conditions is still limited. In this study, network pharmacology was employed to predict the active compounds and targets of YMOS associated with cardiovascular and cerebrovascular protection. A comprehensive network integrating compounds, targets, bioactivities, and CCVDs was meticulously constructed for 10 flavonol glycosides and their aglycones. It revealed that these compounds exert their blood circulation-promoting and blood stasis-eliminating effects by modulating 20 key targets, highlighting their therapeutic potential in CCVDs treatment. Furthermore, we quantitatively analyzed the 10 targeted flavonols and their glycosides in YMOS using ultra-performance liquid chromatography (UPLC), demonstrating consistent flavonoid levels across all tested samples. This method was also employed to investigate biotransformation rules between flavonol glycosides and their aglycones in vitro. Notably, it was observed that flavonol glycosides undergo a deglycosylation reaction in the rat's intestinal microbial culture medium, which was witnessed in a relatively stable manner under the simulated artificial gastrointestinal fluid. These findings provide important scientific insights into the mechanism of action and the quality control of YMOS.
Mitral annular disjunction (MAD) is increasingly recognized as a structural abnormality associated with ventricular arrhythmias and sudden cardiac arrest, particularly in the setting of bileaflet mitral valve prolapse (MVP). A 43-year-old man with a history of migraines presented following a witnessed out-of-hospital cardiac arrest and was successfully resuscitated with a single AED shock. Transthoracic echocardiography showed mitral regurgitation with bileaflet prolapse and suspected MAD. An implantable cardioverter-defibrillator was placed for secondary prevention, and the patient was discharged in stable condition with outpatient surgical follow-up where robotic-assisted mitral valve repair was successfully performed. Advanced imaging plays a pivotal role in diagnosis and risk stratification when MAD presents as sudden cardiac arrest.
Pediatric seizures are an alarming presentation to the emergency department (ED) that can be caused by a multitude of etiologies. It is important to differentiate life-threatening conditions from more benign causes. A 19-month-old girl presented to the ED after a witnessed seizure. This case offers a differential diagnosis for pediatric seizures and uses history, exam, laboratory findings, and imaging to hone the differential in the ED setting. The surprising final diagnosis and case outcome are then revealed and discussed.
Errors in intravitreal fluorinated gas selection or dilution can result in unintended expansile concentrations, causing irreversible visual loss. We aimed to quantify the problem using national incident reporting, published literature and a UK surgeon survey, developing expert consensus recommendations on safe storage, handling and intraocular use. NHS England patient safety incident repositories (National Reporting and Learning System and Learn from Patient Safety Events) were searched for events related to intravitreal gas use (2010-2025), followed by thematic analysis. A targeted literature review identified sight-threatening complications associated with incorrect gas concentration. In parallel, a national survey of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) assessed preparation practices, complications, management strategies, storage and environmental considerations. An expert panel synthesised findings into consensus recommendations. National reporting identified 47 relevant incidents; 29 cases involved incorrect gas concentration due to preparation errors. 14 cases resulted in at least moderate harm, including eight with blindness or severe visual impairment; pure gas concentration (100%) administration was documented in six cases. The literature review identified 20 severe cases across 11 publications. Among 108 BEAVRS respondents, 38.9% recalled at least one significant complication related to incorrect gas concentration; 16.7% reported witnessing sight-threatening outcomes, most commonly central retinal artery occlusion. Recommendations focused on clear labelling/colour coding, standardised dilution protocols, staff training, mandatory two-person checks, appropriate use and segregation of pre-mixed iso-expansile gases and adjunctive safety measures (gas cards/wristbands). Incorrect intraocular gas concentration is likely under-reported but can cause devastating, preventable harm. Standardised systems for storage, preparation, verification and postoperative review may reduce risk while supporting environmentally responsible practice.