Preventable deaths related to haemorrhage in England and Wales, 2013–2022:A systematic case series of coroners’ reports

ObjectivesTo identify preventable haemorrhage-related deaths, classify coroner concerns and explore organisational responses.Study designRetrospective systematic case series of coroners’ Prevention of Future Deaths (PFD) reports from 1st July 2013 to 16 November 2022, in England and Wales.MethodsReports were acquired from the Courts and Tribunals Judiciary website and screened for haemorrhage-related deaths using a reproducible automated computer code. Demographic information, coroners’ concerns, and organisational responses to PFDs were extracted and analysed, including risk factors predisposing to haemorrhage.Results339 PFDs (8 % of all PFDs) involved a haemorrhage event contributing to death. The average age of death was 78 years, and 57 % were male. The majority of haemorrhages were intracranial (64 %). 31 % of haemorrhage-related PFDs reported the use of anticoagulation, most often warfarin. Coroners reported 942 concerns directly relevant to the haemorrhage event, including failures to follow protocols, guidelines, or risk assessments (17 %), failures in communication or handovers (14 %), and failures in providing appropriate care, including investigations and observations (13 %). Just under half (48 %) of PFDs did not have responses published on the Judiciary website. Of the organisations who responded, 85 % reported plans to initiate new changes to address these concerns. Improvements most frequently focused on improving protocols, pathways and guidance documents, as well as education and training.ConclusionsCoroner PFDs offer unique insights into haemorrhage-related deaths, highlighting the systems and processes which fail in everyday practice. Improving awareness and dissemination of these reports to clinicians and policymakers nationally may improve patient safety and save lives.<p/

Stretchable wideband dipole antenna using machine learning assisted optimization for soft electronics

In this paper, we present a machine learning-assisted optimization approach, combining artificial neural networks (ANN) with particle swarm optimization (PSO), for the design of a stretchable wideband dipole antenna tailored for soft electronics. The stretchable antenna is critical for next-generation wearable and flexible devices, where maintaining stable electromagnetic (EM) performance during deformation is challenging. To address the complex nonlinear coupling between EM performance and mechanical behavior, we propose a tri-branch ANN as a surrogate model to decouple the interdependencies between EM and mechanical properties, thereby improving prediction accuracy and reliability. Furthermore, the PSO algorithm is integrated to optimize the geometric parameters of the antenna, ensuring robust mechanical performance and stable EM characteristics. This optimization is achieved through an integrated co-simulation using an EM simulator, a mechanical simulator, and Python. The proposed method not only demonstrates significant improvements in efficiency, automation, and time savings over traditional design techniques but also offers a scalable solution for developing high-performance stretchable electronics.</p

Correlated decoherence and thermometry with mobile impurities in a one-dimensional Fermi gas

We theoretically investigate the correlated decoherence dynamics of two mobile impurities trapped within a gas of ultracold fermionic atoms. We use a mean-field approximation to self-consistently describe the effect of impurity-gas collisions on impurity motion, while decoherence of the impurities' internal state is computed exactly within a functional determinant approach. At equilibrium, we find that the impurities undergo bath-induced localization as the impurity-gas interaction strength is increased. We then study the nonequilibrium dynamics induced by a sudden change of the impurities' internal state, which can be experimentally probed by Ramsey interferometry. Our theoretical approach allows us to investigate the effect of impurity motion on decoherence dynamics, finding strong deviations from the universal behavior associated with Anderson's orthogonality catastrophe when the mass imbalance between impurity and gas atoms is small. Finally, we show that mobile impurities can be used as thermometers of their environment, and that bath-mediated correlations can be beneficial for thermometric performance at low temperatures, even in the presence of nontrivial impurity motion. Our results showcase the interesting open quantum dynamics of mobile impurities dephasing in a common environment, and they can help to provide more precise temperature estimates of ultracold fermionic mixtures

Volumetric ultrasound imaging with a sparse matrix array and integrated fiber-optic sensing for robust needle tracking in interventional procedures

Objective: Accurate visualization of interventional devices, such as medical needles, in relation to the procedural target is critical for the safe and effective guidance of interventional procedures. Ultrasound (US) imaging is widely used for guiding percutaneous needle interventions, but the 2D nature of most clinical US probes limits accurate 3D localization, particularly of the needle tip. In this work, we introduce a novel system that combines both volumetric US imaging and 3D needle tracking. Method: The proposed novel system integrates a fiber-optic hydrophone (FOH) into the needle and employs a 2D sparse spiral US array with 256 active elements. Real-time volumetric US imaging was achieved by plane-wave imaging with the sparse array, while 3D needle tip tracking was enabled through communications between the US probe and the FOH. Results: The system achieved spatial resolutions (mean ± standard deviation) of 2.06 ± 0.29mm (lateral), 2.26 ± 0.23mm (elevational), and 0.69 ± 0.12mm (axial) at depths ranging from 10 to 40mm. The tracking accuracy was better than 0.30 ± 0.21mm. The clinical potential of the system was demonstrated using a nerve block training phantom. Conclusions: This study presents a proof-of concept for an integrated solution that enables simultaneous volumetric anatomical imaging and precise 3D needle tip tracking. Significance: The proposed system holds strong potential to enhance the efficacy and safety of image-guided interventional procedures by providing real-time 3D anatomical visualization and accurate needle tracking

In Vivo Glx Measurements From GABA-Edited HERMES at 3 T Are Not Consistent With Those From Short-TE PRESS Across Scanners, Brain Regions, Diagnostic and Age Groups

1H-Magnetic resonance spectroscopy (1H-MRS) is a noninvasive technique for quantifying brain metabolites, including glutamate, glutathione (GSH), and γ-aminobutyric acid (GABA), which are essential for brain function and implicated in various neurodevelopmental conditions. As such, 1H-MRS methods that enable reliable and accurate measurement of these metabolites are of considerable clinical value. Hadamard Encoding and Reconstruction of MEGA-Edited Spectroscopy (HERMES; echo time [TE] = 80 ms) is a spectral editing technique that allows for the simultaneous quantification of GABA and GSH, using subtraction approaches to resolve these metabolites in a difference spectrum. Additionally, glutamate plus glutamine resonances (Glx) can be resolved either from the HERMES GABA-edited difference spectrum (GABA-DIFF) or from the sum of all HERMES transients (SUM spectrum). However, the reliability of 80-ms HERMES for quantification of Glx has not been systematically assessed. Here, we evaluate the agreement between Glx obtained from HERMES GABA-DIFF and SUM spectra with Glx derived from short-TE PRESS (TE = 35 ms), which is conventionally used for Glx estimation and has demonstrated reproducibility. Data were acquired from 139 participants across two brain regions (ACC and Thalamus voxels), three scanners, two diagnostic groups (autism and neurotypical development) and two age groups (adolescent/adult and preschooler). Comparisons were made using both creatine-scaled and tissue-corrected Glx estimates. Our findings demonstrate significant systematic and proportional bias between Glx estimates from HERMES (SUM and GABA-DIFF) and short-TE PRESS, consistent across scanners, voxels, age groups and diagnostic categories. These findings indicate that Glx estimates derived from HERMES are not directly comparable to those from short-TE PRESS, and this discrepancy is consistent across a multisite study setting. This underscores the importance of sequence selection and careful methodological consideration when integrating and interpreting data from 1H-MRS across different acquisition protocols.</p

More Than Bargaining Chips:How Jabhat Al-Nusra and Islamic State Kidnapped and Used Hostages in Lebanon

This paper presents an empirical examination of the Arsal hostage crisis in Lebanon, when Jabhat Al-Nusra and Islamic State kidnapped over 35 soldiers and police officers in 2014. Following interviews with 30 hostages’ families and analysis of the jihadists’ propaganda, three themes emerge. First, the hostage-taking had intrinsic emotional value for the jihadists and was not only a means to secure extrinsic concessions. Second, the crisis was often shaped by local, micro-level factors that guided how and when violence was used against hostages. Third, the jihadists coerced the captives’ families, leveraging them against the Lebanese State and local communities

The truths of dispossession in the Western Himalaya

In this chapter I focus on the distinctiveness of the notions of property among the Gaddis, a pastoralist community in the western Himalaya, to understand the encompassment of property and ownership in structures of ordinary life, the different scales at which ideas and relations of ownership become manifest, the variety of modes, the temporalities and axes of ownership and accumulation and why ownership matters. I discuss Gaddi categories and concepts of property to explore not just the relational possibilities made by ownership but also to understand the obverse: dispossession and its political charge. I examine the different modes, scales and temporalities under which ownership works and property is accumulated and disaccumulated among the Gaddis, to understand the limits of the law and, in turn, the limits of the state

Do entrepreneurs' values make them “happy”? The role of personal and cultural values for entrepreneurs' wellbeing

Despite increasing attention to entrepreneurs' wellbeing, we know little about the role of entrepreneurs' personal values representing intrinsic and extrinsic motivations for their wellbeing. In this paper, we introduce a contextualized values perspective on entrepreneurs' wellbeing that considers both their personal values and the ways these values interact with cultural values in the regions they operate in. In a multilevel study (3038 entrepreneurs across 143 European regions), we find intrinsic personal values (openness to change) foster positive wellbeing and decrease negative wellbeing, whereas extrinsic personal values (self-enhancement) undermine positive wellbeing and increase negative wellbeing. We also find initial evidence of person–culture congruence effects regarding intrinsic, but not extrinsic, values, with high congruence resulting in higher positive (less negative) wellbeing. Overall, our findings suggest entrepreneurs' wellbeing may be shaped both by “who they are” and “where they operate.” Executive summary Despite increasing attention to entrepreneurs' wellbeing, we know little about the role of entrepreneurs' personal values representing intrinsic and extrinsic motivations for their wellbeing. On the one hand, acting on any values (reflecting intrinsic or extrinsic motivation) can be a source of wellbeing. On the other hand, expressing values reflecting extrinsic motivation may undermine wellbeing because of the lack of self-determination associated with extrinsic motivation. Clarifying the wellbeing effects of values representing extrinsic motivation is particularly important in entrepreneurship, because these values are linked to growth, profitability, and innovation which underpin the economic contributions of entrepreneurship. Drawing on Schwartz's theories of personal and cultural values and person-culture value congruence, we introduce a contextualized values perspective on entrepreneurs' wellbeing that considers both their personal values and the ways these values interact with cultural values in the regions they operate in. In a multilevel study (3038 entrepreneurs across 143 European regions), we find the personal values central to entrepreneurial activity can be a double-edged sword for the wellbeing of practicing entrepreneurs, highlighting the role of intrinsic (vs. extrinsic) motivation for entrepreneurs' positive and negative wellbeing. We also find initial evidence of person–culture congruence effects regarding intrinsic, but not extrinsic, values, with high congruence resulting in higher positive (less negative) wellbeing. Overall, our findings suggest entrepreneurs' wellbeing may be shaped both by “who they are” and “where they operate.”</p

Beyond Gestational Diabetes:Maternal and Offspring Health and Lifestyle 3 years Postnatally in a secondary analysis of the UPBEAT Trial Cohort

Background: Gestational diabetes (GDM) is associated with increased future obesity risk in affected mothers and children. Objective: We assessed if dietary behaviours learnt during a GDM pregnancy positively impact maternal and child health 3 years postpartum. Method: In a secondary analysis, we included women with obesity recruited to the UPBEAT randomised controlled trial with 3-year follow-up postnatally (n = 441). Maternal and offspring anthropometry and dietary data were recorded antenatally and at follow-up. Data were assessed using linear/logistic regression, adjusting for confounders. Results: Women with GDM (22%) had higher BMI (median 35.6 vs. 34.2 kg/m 2; p = 0.049) and energy intake (1738.2 vs. 1551.6 kcal/day; p = 0.005) at ~16 weeks' gestation compared to unaffected women, but lower gestational weight gain (4.5 kg vs. 6.6 kg; p &lt; 0.001). However, at 3 years postpartum BMI was similar between groups (35.8 vs. 35.2 kg/m 2; p &gt; 0.5). GDM-exposed infants had a higher birthweight (55.4 vs. 45.9th centile; p = 0.008) than unexposed infants and at 3 years of age were more likely to be overweight/obese (International Obesity Task Force, IOTF, standards; OR 2.32; 95% CI 1.38, 3.91) but with similar skinfold thicknesses and dietary patterns. Conclusion: Women with GDM demonstrated reduced gestational weight gain, and despite a higher BMI than women without GDM in early pregnancy, this difference was not evident at 3 years postpartum. However, while maternal and offspring dietary behaviours were comparable between groups, exposed offspring were at increased risk of overweight/obesity at 3 years of age.</p