Physical fitness profile of a large urban fire department: Exploring age and rank dynamics.

BACKGROUND: Firefighter physical fitness (PF) plays a crucial role in mitigating health issues and supporting occupational performance. The influence of rank on firefighter PF remains understudied and previous research is often limited by small sample sizes of firefighters volunteering for research studies, potentially biasing results towards fitter firefighters not representative of entire departments. OBJECTIVE: To examine the PF profile of firefighters in a large urban fire department and the influence of age and rank on PF. METHODS: Data, including muscular fitness, estimated aerobic capacity (VO2max), and body fat percentage (BF%) measures from 1361 firefighters (90% male; age: 37.4±10.1yrs; 60 recruits, 973 firefighters, 290 lieutenants/captains, 38 chiefs) were analyzed. Correlation and ANCOVAs were conducted to examine the impact of rank on PF while controlling for age. Score distributions were scrutinized to profile the PF of the department. RESULTS: Age was negatively associated with pull-ups (r = - 0.39), sit-ups (r = - 0.39), and push-ups (r = - 0.32), but positively associated with relative VO2max (r = 0.17) and BF% (r = 0.39). Rank had a statistically significant, but trivial effect size, on pull-ups (p = 0.028, η2 = 0.007) and sit-ups (p = 0.034, η2 = 0.005). Firefighters with lower PF levels were older, had higher BF%, lower fat-free mass, and were a greater proportion of females. CONCLUSIONS: Firefighters exhibited diverse levels of PF. Age, not rank, appeared to influence firefighters' PF. The findings that firefighters who were older, female, with poorer body composition are more likely to have lower PF levels highlights the need for individualized PF training to enhance occupational performance and health across the fire department.

Comprehensive wheat coccinellid detection dataset: Essential resource for digital entomology.

Wheat (Triticum aestivum) is a major cereal crop planted in the Southern Great Plains. This crop faces diverse pests that can affect their development and reduce yield productivity. For example, aphids are a significant pest in wheat, and their management relies on pesticides, which affect the sustainability and biodiversity of natural predators that prey on aphids. Coccinellids, commonly named lady beetles, are the most abundant natural predators of wheat. These natural enemies contribute to the natural predation of aphids, which can reduce the use of excessive pesticides for aphid management. Usually, visual observations of these natural enemies are performed during pest sampling; however, it is time-consuming and requires manual labor, which can be expensive. An automation system or detection models based on machine learning approaches that can detect these insects is needed to reduce unnecessary pesticide applications and manual labor costs. However, developing an automation system or computer vision models that automatically detect these natural enemies requires imagery to train and validate this cutting-edge technology. To solve this research problem, we collected this dataset, which includes images and label annotations to help researchers and students develop this technology that can benefit wheat growers and science to understand the capabilities of automation in Entomology. We collected a dataset using mobile devices, which included a diverse range of coccinellids on wheat images. The dataset consists of 2,133 images with a standard size of 640 × 640 pixels, which can be used to train and develop detection models for machine learning purposes. In addition, the dataset includes annotated labels that can be used for training models within the YOLO family or others, which have been proven to detect small insects in crops. Our dataset will increase the understanding of machine learning capabilities in entomology, precision agriculture, education, and crop pest management decisions.

A Scoping Review of the Evidence on Prevalence of Feline Upper Respiratory Tract Infections and Associated Risk Factors.

Feline upper respiratory tract infections (URI) are of concern, especially in animal shelters. This scoping review identifies epidemiological literature on URI as caused by feline herpesvirus (FHV), feline calicivirus (FCV), Chlamydia felis, Mycoplasma felis and Bordetella bronchiseptica. Four databases were searched, studies were screened, and data were extracted on a standardised template. We described patterns in spatial locations of the studies, the range of pathogens and diagnostic tests, cohort characteristics and the findings of risk factor analyses. A total of 90 articles were selected for final data extraction. There was diversity in sampling methods, precluding quantitative meta-analysis of prevalence reports. FHV was most frequently studied (n = 57/90). The most popular sampling site was conjunctival swabbing (n = 43). Most studies (n = 57) used polymerase chain reaction (PCR) to confirm diagnosis. Approximately one-third (n = 32/90) of the studies included sheltered felines. This review explores the current state of knowledge on the epidemiology and risk factors of feline URI. Assessing the impact of risk factors has the potential to alleviate the severity of disease, especially in shelters; however, the results were not easily pooled as the studies used inconsistent approaches. We present recommendations for ongoing epidemiological research on feline URI to provide a more structured framework and define research questions for future systematic reviews.

Factors influencing canine rabies vaccination among dog-owning households in Nigeria.

Rabies perpetuates in Nigeria despite initiatives like the Regional Disease Surveillance System Enhancement Project, with evidence indicating suboptimal canine vaccination rates as a contributing factor. To inform effective planning of mass dog vaccination campaigns, it is crucial to understand the factors associated with variation in canine vaccination rates. We conducted a cross-sectional study in 2022 to understand factors associated with canine vaccination. We used stratified random sampling of the streets and dog-owning households to survey 4162 households from three states and the Federal Capital Territory (FCT). We then built a joint probabilistic model to understand factors associated with dog vaccination and non-vaccination. First, we modelled rabies knowledge as a latent variable indirectly measured with several targeted survey questions. This method allowed a respondent's unobserved understanding of rabies to be estimated using their responses to a collection of survey questions that targeted different aspects of rabies epidemiology and took various possible response distributions (i.e., ordinal, categorical, binary). Second, we modelled factors influencing pet owners' decisions to vaccinate their dogs against rabies and barriers to dog vaccination among dog owners whose dogs were not vaccinated against rabies. Posterior distributions revealed that the probability of dog vaccination was positively associated with the owner's latent knowledge of rabies, civil servant service employment, residence in the FCT, ownership of a single dog, providing care to dogs, and a preference for contemporary treatment following a dog bite. Conversely, non-vaccination was positively associated with private employment, residing in Anambra and Enugu states, owning multiple dogs, allowing dogs to search for leftovers, and a preference for traditional treatment after a dog bite. Cost was the primary barrier against vaccination for dog owners in Anambra and Enugu, while mistrust posed a major challenge for those in the FCT. Owners in areas with veterinary establishments cited cost as a barrier, while those without a veterinary establishment cited access as the primary barrier. Our study underscores the need to enhance rabies knowledge, tailor vaccination campaigns to specific demographics, address financial and access barriers, and combat hesitancy to improve rabies vaccination rates in Nigeria.

Tunnel junctions based on interfacial two dimensional ferroelectrics.

Van der Waals heterostructures have opened new opportunities to develop atomically thin (opto)electronic devices with a wide range of functionalities. The recent focus on manipulating the interlayer twist angle has led to the observation of out-of-plane room temperature ferroelectricity in twisted rhombohedral bilayers of transition metal dichalcogenides. Here we explore the switching behaviour of sliding ferroelectricity using scanning probe microscopy domain mapping and tunnelling transport measurements. We observe well-pronounced ambipolar switching behaviour in ferroelectric tunnelling junctions with composite ferroelectric/non-polar insulator barriers and support our experimental results with complementary theoretical modelling. Furthermore, we show that the switching behaviour is strongly influenced by the underlying domain structure, allowing the fabrication of diverse ferroelectric tunnelling junction devices with various functionalities. We show that to observe the polarisation reversal, at least one partial dislocation must be present in the device area. This behaviour is drastically different from that of conventional ferroelectric materials, and its understanding is an important milestone for the future development of optoelectronic devices based on sliding ferroelectricity.

Absolute quantitation of human wild-type DNAI1 protein in lung tissue using a nanoLC-PRM-MS-based targeted proteomics approach coupled with immunoprecipitation.

BACKGROUND: Dynein axonemal intermediate chain 1 protein (DNAI1) plays an essential role in cilia structure and function, while its mutations lead to primary ciliary dyskinesia (PCD). Accurate quantitation of DNAI1 in lung tissue is crucial for comprehensive understanding of its involvement in PCD, as well as for developing the potential PCD therapies. However, the current protein quantitation method is not sensitive enough to detect the endogenous level of DNAI1 in complex biological matrix such as lung tissue. METHODS: In this study, a quantitative method combining immunoprecipitation with nanoLC-MS/MS was developed to measure the expression level of human wild-type (WT) DNAI1 protein in lung tissue. To our understanding, it is the first immunoprecipitation (IP)-MS based method for absolute quantitation of DNAI1 protein in lung tissue. The DNAI1 quantitation was achieved through constructing a standard curve with recombinant human WT DNAI1 protein spiked into lung tissue matrix. RESULTS: This method was qualified with high sensitivity and accuracy. The lower limit of quantitation of human DNAI1 was 4 pg/mg tissue. This assay was successfully applied to determine the endogenous level of WT DNAI1 in human lung tissue. CONCLUSIONS: The results clearly demonstrate that the developed assay can accurately quantitate low-abundance WT DNAI1 protein in human lung tissue with high sensitivity, indicating its high potential use in the drug development for DNAI1 mutation-caused PCD therapy.

The Nature of Rehabilitation Programs to Improve Musculoskeletal, Biomechanical, Functional, and Patient-Reported Outcomes in Athletes With ACL Reconstruction: A Scoping Review.

CONTEXT: After anterior cruciate ligament (ACL) reconstruction (ACLR), athletes commonly undergo prolonged rehabilitation (eg, 9-12 months), but few actually return to preinjury sports activities. The nature (composition, configuration) of an ACL rehabilitation program (ACL-RP) is an important factor in determining rehabilitation outcomes; however, details about the nature of ACL-RPs are reported inconsistently in research studies. To guide future research reporting to support clinical translation and implementation of ACL-RPs, it is necessary to describe the nature, reporting, and outcomes of ACL-RPs in the current literature. OBJECTIVE: The purpose of this scoping review was to understand the nature and reporting of various ACL-RPs that address musculoskeletal, biomechanical, functional, or patient-reported outcome measures in adult and pediatric athletes with ACLR. DATA SOURCES: Articles were selected from searches in 5 electronic databases (PubMed, EbscoHost [MEDLINE, SportDiscus, CINAHL Plus], PROQuest, Cochrane, and Embase). STUDY SELECTION: Studies were included if they evaluated a post-ACL-RP that implemented strength, balance, plyometric, change of direction running, and/or agility running and included self-reported physical function, quality of life, or pain outcomes. STUDY DESIGN: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data were extracted and synthesized to evaluate the reporting of acute program variables (APVs) and exercise descriptors (EDs); 17 studies were included in the final synthesis. RESULTS: Studies reported between 0% and 67% of the APVs and EDs combined. Only 2 studies were considered to have adequate reporting of both APVs and EDs. CONCLUSION: Inadequate reporting of APVs and EDs in past studies restricts the translation and implementation of existing research-based ACL-RPs to present-day clinical contexts.

Facial fillers: Relevant anatomy, injection techniques, and complications.

Objective: The aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications. Data Sources: Clinical experience and scientific papers. Conclusions: Reversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.

Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction.

OBJECTIVES: The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DESIGN: Repeated measures. SETTING: University. PARTICIPANTS: 8 female, 4 male with unilateral autogenous ACLr. MAIN OUTCOME MEASURES: Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50-0.75), good (0.75-0.90). RESULTS: ACLr-side intra-rater/inter-rater ICCs ranged: LT, -0.27-0.80/-0.01-0.84; VS, 0.12-0.90/0.25-0.90; PPT, 0.49-0.98/0.86-0.99; AJPS, 0.15-0.79/0.55-0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12-0.66/-0.09-0.64; VS, 0.35-0.89/0.05-0.81; PPT, 0.65-0.99/0.45-0.95; AJPS, 0.07-0.81/0.37-0.99; ACHD, 0.99/0.98. CONCLUSIONS: Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.

The Insulin Receptor and Insulin like Growth Factor Receptor 5' UTRs Support Translation Initiation Independently of EIF4G1.

IRES mediated translation initiation requires a different repertoire of factors than canonical cap-dependent translation. Treatments that inhibit the canonical translation factor EIF4G1 have little or no effect on the ability of the Insr and Igf1r cellular IRESes to promote translation. Transcripts for two cellular receptors contain RNA elements that facilitate translation initiation without intact EIF4G1. Cellular IRES mechanisms may resemble viral type III IRESes allowing them to promote translate with a limited number of initiation factors allowing them to work under stress conditions when canonical translation is repressed.

Functional and structural analyses reveal that a dual domain sialidase protects bacteria from complement killing through desialylation of complement factors.

The complement system is the first line of innate immune defense against microbial infections. To survive in humans and cause infections, bacterial pathogens have developed sophisticated mechanisms to subvert the complement-mediated bactericidal activity. There are reports that sialidases, also known as neuraminidases, are implicated in bacterial complement resistance; however, its underlying molecular mechanism remains elusive. Several complement proteins (e.g., C1q, C4, and C5) and regulators (e.g., factor H and C4bp) are modified by various sialoglycans (glycans with terminal sialic acids), which are essential for their functions. This report provides both functional and structural evidence that bacterial sialidases can disarm the complement system via desialylating key complement proteins and regulators. The oral bacterium Porphyromonas gingivalis, a "keystone" pathogen of periodontitis, produces a dual domain sialidase (PG0352). Biochemical analyses reveal that PG0352 can desialylate human serum and complement factors and thus protect bacteria from serum killing. Structural analyses show that PG0352 contains a N-terminal carbohydrate-binding module (CBM) and a C-terminal sialidase domain that exhibits a canonical six-bladed ß-propeller sialidase fold with each blade composed of 3-4 antiparallel ß-strands. Follow-up functional studies show that PG0352 forms monomers and is active in a broad range of pH. While PG0352 can remove both N-acetylneuraminic acid (Neu5Ac) and N-glycolyl-neuraminic acid (Neu5Gc), it has a higher affinity to Neu5Ac, the most abundant sialic acid in humans. Structural and functional analyses further demonstrate that the CBM binds to carbohydrates and serum glycoproteins. The results shown in this report provide new insights into understanding the role of sialidases in bacterial virulence and open a new avenue to investigate the molecular mechanisms of bacterial complement resistance.

Sex differences in knee extensor torque control.

There is currently equivocal evidence regarding sex-related differences in measures of muscle force and torque control. To that end, we investigated sex differences in knee extensor muscle torque control, using both magnitude- and complexity-based measures, across contraction intensities typical of activities of daily living. 50 participants (25 male, median age [and interquartile range] 23.0 [20.0-33.0]; 25 female, median age [and interquartile range] 21.0 [20.0-40.5]) performed a series of intermittent isometric knee extensor contractions at 10, 20 and 40% maximal voluntary contraction (MVC). Torque was measured in N·m and torque control was quantified according to the magnitude (standard deviation [SD], coefficient of variation [CV]) and complexity (approximate entropy [ApEn], detrended fluctuation analysis [DFA] α) of torque fluctuations. Males exhibited a significantly greater absolute magnitude (i.e., SD) of knee extensor torque fluctuations during contractions at 10% (P = 0.011), 20% (P = 0.002) and 40% MVC (P = 0.003), though no sex differences were evident when fluctuations were normalised to mean torque output (i.e., CV). Males exhibited significantly lower ApEn during contractions at 10% (P = 0.002) and 20% MVC (P = 0.024) and significantly greater DFA α during contractions at 10% (P = 0.003) and 20% MVC (P = 0.001). These data suggest sex differences in muscle torque control strategies and highlight the need to consider both the magnitude and complexity of torque fluctuations when examining sex differences in muscle force control.

Soft Tissue Trauma: Critical Recognition and Timing of Intervention in Emergency Presentations.

The facial trauma surgeon will see a variety of facial injuries. Recognition of emergency cases and proper intervention is and this article aims to highlight those cases and the respective proper interventions.

Location and appearance of dysplastic Barrett's esophagus recurrence after endoscopic eradication therapy: no additional yield from random biopsy sampling neosquamous mucosa.

BACKGROUND AND AIMS: Surveillance after complete remission of intestinal metaplasia (CRIM) is essential. Current recommendations are to sample visible lesions first, followed by random 4-quadrant biopsy sampling of the original Barrett's esophagus (BE) length. To inform post-CRIM surveillance protocols, we aimed to identify the anatomic location, appearance, and histology of BE recurrences. METHODS: We performed an analysis of 216 patients who achieved CRIM after endoscopic eradication therapy for dysplastic BE at a Barrett's Referral Unit between 2008 and 2021. The anatomic location, recurrence histology, and endoscopic appearance of dysplastic recurrences were evaluated. RESULTS: After a median of 5.5 years (interquartile range, 2.9-7.2) of follow-up after CRIM, 57 patients (26.4%) developed nondysplastic BE (NDBE) recurrence and 18 patients (8.3%) developed dysplastic recurrence. From 8158 routine surveillance biopsy samplings of normal-appearing tubular esophageal neosquamous epithelium, the yield for recurrent NDBE or dysplasia was 0%. One hundred percent of dysplastic tubular esophageal recurrences were visible and in BE islands, whereas 77.8% of gastroesophageal junction dysplastic recurrences were nonvisible. Four distinct endoscopic features suspicious for recurrent advanced dysplasia or neoplasia were identified: buried or subsquamous BE, irregular mucosal pattern, loss of vascular pattern, and nodularity or depression. CONCLUSIONS: The yield of routine surveillance biopsy sampling of normal-appearing tubular esophageal neosquamous epithelium was zero. BE islands with indistinct mucosal or loss of vascular pattern, nodularity or depression, and/or signs of buried BE should raise clinician suspicion for advanced dysplasia or neoplasia recurrence. We suggest a new surveillance biopsy sampling protocol with a focus on meticulous inspection, followed by targeted biopsy sampling of visible lesions and random 4-quadrant biopsy sampling of the gastroesophageal junction.

Body shape and performance on the US Army Combat Fitness Test: Insights from a 3D body image scanner.

OBJECTIVE: To identify relationships between body shape, body composition, sex and performance on the new US Army Combat Fitness Test (ACFT). METHODS: Two hundred and thirty-nine United States Military Academy cadets took the ACFT between February and April of 2021. The cadets were imaged with a Styku 3D scanner that measured circumferences at 20 locations on the body. A correlation analysis was conducted between body site measurements and ACFT event performance and evaluated using Pearson correlation coefficients and p-values. A k-means cluster analysis was performed over the circumference data and ACFT performance were evaluated between clusters using t-tests with a Holm-Bonferroni correction. RESULTS: The cluster analysis resulted in 5 groups: 1. "V" shaped males, 2. larger males, 3. inverted "V" shaped males and females, 4. "V" shaped smaller males and females, and 5. smallest males and females. ACFT performance was the highest in Clusters 1 and 2 on all events except the 2-mile run. Clusters 3 and 4 had no statistically significant differences in performance but both clusters performed better than Cluster 5. CONCLUSIONS: The association between ACFT performance and body shape is more detailed and informative than considering performance solely by sex (males and females). These associations may provide novel ways to design training programs from baseline shape measurements.

Associations between canine hookworm infection and dog owners' awareness, perception, and behaviour: A cross-sectional study in Brisbane, Queensland, 2019-2020.

Canine hookworms are found globally, and infections have been recorded in domestic dogs visiting dog parks in Queensland, Australia. Some canine hookworms also present a risk of zoonotic transmission to humans. Potential transmission of hookworms can occur in the household and at public places because of lack of owner awareness and poor coverage of canine deworming. Between April 2019 and March 2020, faecal samples from owned dogs were collected from 39 dog parks in metropolitan Brisbane, Queensland, and tested for the presence of hookworm eggs using faecal floatation technique. Dog owners who provided samples were requested to complete a survey on their awareness, perceptions and behaviour regarding the risks and consequences of canine parasitic infection. Associations between dog owner demographics and responses to the survey were measured using Goodman and Kruskal's gamma. Statistical associations between canine hookworm infection in dogs and their owner's responses were quantified using a two-sample Wilcoxon rank-sum test. A total of five canine faecal samples from 175 respondents were found positive for hookworm eggs, corresponding to a sample- and park-level prevalence of 2.86% and 12.82%, respectively. Female dog owners were found to be more aware of the importance of regular deworming of their dogs (|γ| = 0.405). Our results indicate that hookworm infection was associated with a lower awareness of the importance of deworming (p = 0.007), less diligence in administration of deworming (p = 0.004), lower awareness of the risk of acquiring parasites from raw meat (p = 0.010), less likelihood of cooking meat before feeding it to their dogs (p = 0.028), and less likelihood to properly dispose their dog's faeces (p = 0.027). This study not only indicates a need for improving owner education towards the importance of deworming but also a need for changing owner's behaviours to reduce potential environmental contamination with infective hookworms. The latter in particular indicates a broader public health risk of disease transmission in public places due to improper disposal of dog faeces, especially in areas with higher canine hookworm infections.

Direct and indirect viral associations predict coexistence in wild plant virus communities.

Viruses are a vastly underestimated component of biodiversity that occur as diverse communities across hierarchical scales from the landscape level to individual hosts. The integration of community ecology with disease biology is a powerful, novel approach that can yield unprecedented insights into the abiotic and biotic drivers of pathogen community assembly. Here, we sampled wild plant populations to characterize and analyze the diversity and co-occurrence structure of within-host virus communities and their predictors. Our results show that these virus communities are characterized by diverse, non-random coinfections. Using a novel graphical network modeling framework, we demonstrate how environmental heterogeneity influences the network of virus taxa and how the virus co-occurrence patterns can be attributed to non-random, direct statistical virus-virus associations. Moreover, we show that environmental heterogeneity changed virus association networks, especially through their indirect effects. Our results highlight a previously underestimated mechanism of how environmental variability can influence disease risks by changing associations between viruses that are conditional on their environment.

Reducing the Frequency of Pulse Oximetry Alarms at a Children's Hospital.

BACKGROUND AND OBJECTIVES: Alarm fatigue is exacerbated by frequent, nonactionable physiologic monitor alarms. Overutilization of pulse oximetry (SpO2) compounds this alarm burden. Narrow default alarm limits and overutilization of continuous (CSpO2) rather than intermittent monitoring contribute to nonactionable alarms. There were 1.12 million SpO2 alarms on included units during the baseline period, of which 41.0% were for SpO2 ≥ 88%. We aimed to decrease SpO2 alarms per patient day by 20% within 12 months. METHODS: This quality improvement study included patients admitted January 2019 to June 2022. Intensive care and cardiology units were excluded. Interventions included (1) changing default alarm SpO2 limits on monitors from <90% to <88%, (2) changing SpO2 order default from continuous to intermittent, and (3) adding indication requirements for CSpO2. Outcome measures were total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day. Balancing measures were high acuity transfers and code blues without CSpO2 ordered. Control charts were used for each. RESULTS: Our study included 120 408 patient days with 2.98 million SpO2 alarms. Total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day decreased by 5.48 (30.57 to 25.09; 17.9%) and 4.48 (12.50 to 8.02; 35.8%), respectively. Special cause improvement was associated with changing default monitor alarm parameters. Balancing measures remained stable. CONCLUSIONS: SpO2 monitors alarm frequently at our children's hospital. Widening default alarm limits was associated with decreased SpO2 alarms, particularly nonactionable alarms (≥88%). This high-reliability intervention may be applied, when appropriate, to other monitor alarm parameters to further mitigate alarm burden.