Cardiac arrest due to accidental overdose with norepinephrine dissolved in crystalloid.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadVasoactive agents should be administered through a controlled well-marked infusor pump, ideally via a central venous catheter if given over longer periods of time. During transfer of haemodynamically unstable patients with limited staffing and resources on site, a peripheral vasopressor infusion is sometimes resorted to as a temporary measure of optimising haemodynamic parameters. We report a case of accidental norepinephrine overdose after such practice, resulting in cardiac arrest. It illustrates the importance of careful use and labelling of vasoactive agents during the transport and handover of critically ill patients. Finally, we explore human factor issues associated with transfer from the pre-hospital to the in-hospital environment when such preparations are used. Keywords: adult intensive care; anaesthesia; resuscitation; safety; toxicology

Visual Tactile Sensor Based Force Estimation for Position-Force Teleoperation

Vision-based tactile sensors have gained extensive attention in the robotics community. The sensors are highly expected to be capable of extracting contact information i.e. haptic information during in-hand manipulation. This nature of tactile sensors makes them a perfect match for haptic feedback applications. In this paper, we propose a contact force estimation method using the vision-based tactile sensor DIGIT, and apply it to a position-force teleoperation architecture for force feedback. The force estimation is done by building a depth map for DIGIT gel surface deformation measurement and applying a regression algorithm on estimated depth data and ground truth force data to get the depth-force relationship. The experiment is performed by constructing a grasping force feedback system with a haptic device as a leader robot and a parallel robot gripper as a follower robot, where the DIGIT sensor is attached to the tip of the robot gripper to estimate the contact force. The preliminary results show the capability of using the low-cost vision-based sensor for force feedback applications.Comment: IEEE CBS 202

Unravelling the complexity of ventilator-associated pneumonia:a systematic methodological literature review of diagnostic criteria and definitions used in clinical research

BackgroundVentilator-associated pneumonia (VAP) is a prevalent and grave hospital-acquired infection that affects mechanically ventilated patients. Diverse diagnostic criteria can significantly affect VAP research by complicating the identification and management of the condition, which may also impact clinical management.ObjectivesWe conducted this review to assess the diagnostic criteria and the definitions of the term “ventilator-associated” used in randomised controlled trials (RCTs) of VAP management.Search methodsBased on the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search on MEDLINE/PubMed and Cochrane CENTRAL for RCTs, published or registered between 2010 and 2024.Selection criteriaWe included completed and ongoing RCTs that assessed pharmacological or non-pharmacological interventions in adults with VAP.Data collection and synthesisData were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were summarised in a narrative and tabular form.ResultsIn total, 7,173 records were identified through the literature search. Following the exclusion of records that did not meet the eligibility criteria, 119 studies were included. Diagnostic criteria were provided in 51.2% of studies, and the term “ventilator-associated” was defined in 52.1% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (96.7%), fever (86.9%), hypothermia (49.1%), sputum (70.5%), and hypoxia (32.8%). The different criteria were used in 38 combinations across studies. The term “ventilator-associated” was defined in nine different ways.ConclusionsWhen provided, diagnostic criteria and definitions of VAP in RCTs display notable variability. Continuous efforts to harmonise VAP diagnostic criteria in future clinical trials are crucial to improve quality of care, enable accurate epidemiological assessments, and guide effective antimicrobial stewardship

Robust Reinforcement Learning: A Review of Foundations and Recent Advances

Reinforcement learning (RL) has become a highly successful framework for learning in Markov decision processes (MDP). Due to the adoption of RL in realistic and complex environments, solution robustness becomes an increasingly important aspect of RL deployment. Nevertheless, current RL algorithms struggle with robustness to uncertainty, disturbances, or structural changes in the environment. We survey the literature on robust approaches to reinforcement learning and categorize these methods in four different ways: (i) Transition robust designs account for uncertainties in the system dynamics by manipulating the transition probabilities between states; (ii) Disturbance robust designs leverage external forces to model uncertainty in the system behavior; (iii) Action robust designs redirect transitions of the system by corrupting an agent’s output; (iv) Observation robust designs exploit or distort the perceived system state of the policy. Each of these robust designs alters a different aspect of the MDP. Additionally, we address the connection of robustness to the risk-based and entropy-regularized RL formulations. The resulting survey covers all fundamental concepts underlying the approaches to robust reinforcement learning and their recent advances

SK2 channels in cerebellar Purkinje cells contribute to excitability modulation in motor-learning-specific memory traces

Neurons store information by changing synaptic input weights. In addition, they can adjust their membrane excitability to alter spike output. Here, we demonstrate a role of such "intrinsic plasticity" in behavioral learning in a mouse model that allows us to detect specific consequences of absent excitability modulation. Mice with a Purkinje-cell-specific knockout (KO) of the calcium-activated K+ channel SK2 (L7-SK2) show intact vestibulo-ocular reflex (VOR) gain adaptation but impaired eyeblink conditioning (EBC), which relies on the ability to establish associations between stimuli, with the eyelid closure itself depending on a transient suppression of spike firing. In these mice, the intrinsic plasticity of Purkinje cells is prevented without affecting long-term depression or potentiation at their parallel fiber (PF) input. In contrast to the typical spike pattern of EBC-supporting zebrin-negative Purkinje cells, L7-SK2 neurons show reduced background spiking but enhanced excitability. Thus, SK2 plasticity and excitability modulation are essential for specific forms of motor learning

Reception Test of Petals for the End Cap TEC+ of the CMS Silicon Strip Tracker

The silicon strip tracker of the CMS experiment has been completed and was inserted into the CMS detector in late 2007. The largest sub system of the tracker are its end caps, comprising two large end caps (TEC) each containing 3200 silicon strip modules. To ease construction, the end caps feature a modular design: groups of about 20 silicon modules are placed on sub-assemblies called petals and these self-contained elements are then mounted onto the TEC support structures. Each end cap consists of 144 such petals, which were built and fully qualified by several institutes across Europe. Fro

Integration of the End Cap TEC+ of the CMS Silicon Strip Tracker

The silicon strip tracker of the CMS experiment has been completed and inserted into the CMS detector in late 2007. The largest sub-system of the tracker is its end cap system, comprising two large end caps (TEC) each containing 3200 silicon strip modules. To ease construction, the end caps feature a modular design: groups of about 20 silicon modules are placed on sub-assemblies called petals and these self-contained elements are then mounted into the TEC support structures. Each end cap consists of 144 petals, and the insertion of these petals into the end cap structure is referred to as TEC integration. The two end caps were integrated independently in Aachen (TEC+) and at CERN (TEC--). This note deals with the integration of TEC+, describing procedures for end cap integration and for quality control during testing of integrated sections of the end cap and presenting results from the testing

Reduction of chlorite in potable water by ferrous chloride

Abstract not availabl