Do Death Certificate Errors Decrease as Clinical Experience in an Emergency Department Increases?

BACKGROUND: This study aimed to evaluate the relationship between clinical experience and death certificate (DC) errors by analyzing DCs written by experienced emergency physicians (EPs). METHODS: DCs issued by four experienced EPs over a 10-year period were retrospectively reviewed. DC errors were divided into major and minor errors based on whether they affected the cause of death (COD) determination. The errors were judged through first and second evaluations. Basic information regarding DCs and 10-year changes in DC errors were analyzed. RESULTS: A total of 505 DCs were analyzed, with an average of 34 to 70 for each study year. The number of CODs written in the DCs tended to decrease over time. The presentation of major DC errors did not show a tendency to change over time. However, the sum of the major and minor errors tended to increase over time. Secondary conditions as the underlying COD tended to increase, and the incompatible causal relationships between CODs tended to decrease over time in the detailed analysis of major errors. The increasing tendency for incorrect other significant conditions, incorrect type of accident, incorrect intention of the external cause, no record of the trauma mechanism, and record of the trauma mechanism without another COD were found in the detailed analysis of minor errors. CONCLUSION: DC errors did not decrease as clinical experience increased. Education to reduce DC errors and a feedback process for written DCs are necessary, regardless of clinical experience.

Factors Associated with Major Errors on Death Certificates.

The objective of this study was to investigate errors on death certificates and factors associated with the occurrence of major errors. A retrospective analysis was conducted for six months in 2020 at a university training hospital. Errors were judged as major and minor errors according to the contribution to the process of determining the cause of death. Death certificates were classified into two groups with major errors (ME group) and without major errors (non-ME group). General characteristics of the death certificates, the main cause of death (cancer, cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, genitourinary disease, intentional self-harm, external causes, and other causes), the number of causes of deaths written on the death certificate, and major and minor errors were investigated. The ME group had 127 cases out of 548 death certificates. The number of causes of deaths written on the death certificates and the total number of errors were higher in the ME group than in the non-ME group. Cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, external causes, and other diseases as causes of deaths had higher risks of major errors on death certificates than cancer as a cause of death. The group with cancer as a cause of death had the lowest incidence of major errors and fewer causes of deaths. To reduce major errors, continuous education and feedback are needed for those who are qualified to issue a death certificate.

Direct Growth of Highly Conductive Large-Area Stretchable Graphene.

The direct synthesis of inherently defect-free, large-area graphene on flexible substrates is a key technology for soft electronic devices. In the present work, in situ plasma-assisted thermal chemical vapor deposition is implemented in order to synthesize 4 in. diameter high-quality graphene directly on 10 nm thick Ti-buffered substrates at 100 °C. The in situ synthesized monolayer graphene displays outstanding stretching properties coupled with low sheet resistance. Further improved mechanical and electronic performances are achieved by the in situ multi-stacking of graphene. The four-layered graphene multi-stack is shown to display an ultralow resistance of ≈6 Ω sq-1, which is consistently maintained during the harsh repeat stretching tests and is assisted by self-p-doping under ambient conditions. Graphene-field effect transistors fabricated on polydimethylsiloxane substrates reveal an unprecedented hole mobility of ≈21 000 cm2 V-1 s-1 at a gate voltage of -4 V, irrespective of the channel length, which is consistently maintained during the repeat stretching test of 5000 cycles at 140% parallel strain.

Synthesis, Characterization, and CO2/N2 Separation Performance of POEM-g-PAcAm Comb Copolymer Membranes.

Alcohol-soluble comb copolymers were synthesized from rubbery poly(oxyethylene methacrylate) (POEM) and glassy polyacrylamide (PAcAm) via economical and facile free-radical polymerization. The synthesis of comb copolymers was confirmed by Fourier-transform infrared and proton nuclear magnetic resonance spectroscopic studies. The bicontinuous microphase-separated morphology and amorphous structure of comb copolymers were confirmed by wide-angle X-ray scattering, differential scanning calorimetry, and transmission electron microscopy. With increasing POEM content in the comb copolymer, both CO2 permeability and CO2/N2 selectivity gradually increased. A mechanically strong free-standing membrane was obtained at a POEM:PAcAm ratio of 70:30 wt%, in which the CO2 permeability and CO2/N2 selectivity reached 261.7 Barrer (1 Barrer = 10-10 cm3 (STP) cm cm-2 s-1 cmHg-1) and 44, respectively. These values are greater than those of commercially available Pebax and among the highest separation performances reported previously for alcohol-soluble, all-polymeric membranes without porous additives. The high performances were attributed to an effective CO2-philic pathway for the ethylene oxide group in the rubbery POEM segments and prevention of the N2 permeability by glassy PAcAm chains.

Strategic Approaches for Colon Targeted Drug Delivery: An Overview of Recent Advancements.

Colon targeted drug delivery systems have gained a great deal of attention as potential carriers for the local treatment of colonic diseases with reduced systemic side effects and also for the enhanced oral delivery of various therapeutics vulnerable to acidic and enzymatic degradation in the upper gastrointestinal tract. In recent years, the global pharmaceutical market for biologics has grown, and increasing demand for a more patient-friendly drug administration system highlights the importance of colonic drug delivery as a noninvasive delivery approach for macromolecules. Colon-targeted drug delivery systems for macromolecules can provide therapeutic benefits including better patient compliance (because they are pain-free and can be self-administered) and lower costs. Therefore, to achieve more efficient colonic drug delivery for local or systemic drug effects, various strategies have been explored including pH-dependent systems, enzyme-triggered systems, receptor-mediated systems, and magnetically-driven systems. In this review, recent advancements in various approaches for designing colon targeted drug delivery systems and their pharmaceutical applications are covered with a particular emphasis on formulation technologies.

Defect-Free Graphene Synthesized Directly at 150 °C via Chemical Vapor Deposition with No Transfer.

Direct graphene synthesis on substrates via chemical vapor deposition (CVD) is an attractive approach for manufacturing flexible electronic devices. The temperature for graphene synthesis must be below ∼200 °C to prevent substrate deformation while fabricating flexible devices on plastic substrates. Herein, we report a process whereby defect-free graphene is directly synthesized on a variety of substrates via the introduction of an ultrathin Ti catalytic layer, due to the strong affinity of Ti to carbon. Ti with a thickness of 10 nm was naturally oxidized by exposure to air before and after the graphene synthesis, and the various functions of neither the substrates nor the graphene were influenced. This report offers experimental evidence of high-quality graphene synthesis on Ti-coated substrates at 150 °C via CVD. The proposed methodology was applied to the fabrication of flexible and transparent thin-film capacitors with top electrodes of high-quality graphene.

Interstitial Lung Disease and Lung Cancer Development: A 5-Year Nationwide Population-Based Study.

PURPOSE: In this nationwide 5-year longitudinal population-based study, we aimed at investigating the incidence of lung cancer among patients with interstitial lung disease. MATERIALS AND METHODS: Data was collected from the Korean National Health Insurance Research Database from 49,773,195 Korean residents in 2009. Thirteen thousand six hundred and sixty-six patients with interstitial lung disease diagnosed January-December 2009. The end of follow-up was June 30, 2014. Up to four matching chronic obstructive pulmonary disease controls were selected to compare the lung cancer high-risk group based on age, sex, diagnosis date (within 30 days), and hospital size. The number of patients with newly developed lung cancer was determined. RESULTS: The incidences of lung cancer were 126.98, 156.62, and 370.38 cases per 10,000 person-years (2,732, 809, and 967 cases of cancer, respectively) in the chronic obstructive pulmonary disease, interstitial lung disease, and chronic obstructive pulmonary disease with interstitial lung disease groups, respectively. Of the 879 patients with idiopathic pulmonary fibrosis, 112 developed lung cancer (incidence, 381.00 cases per 10,000 person-years). CONCLUSION: Incidence of lung cancer among patients with interstitial lung disease was high. Interstitial lung diseases have a high potential for developing into lung cancer, even when concurrent with chronic obstructive pulmonary disease.

Wrinkle-free graphene electrodes in zinc tin oxide thin-film transistors for large area applications.

Wrinkle-free graphene was used to form the source-drain electrodes in thin film transistors based on a zinc tin oxide (ZTO) semiconductor. A 10 nm thick titanium adhesion layer was applied prior to transferring a conductive graphene film on top of it by chemical detachment. The formation of an interlayer oxide between titanium and graphene allows the achievement of uniform surface roughness over the entire substrate area. The resulting devices were thermally treated in ambient air, and a substantial decrease in field effect mobility is observed with increasing annealing temperature. The increase in electrical resistivity of the graphene film at higher annealing temperatures may have some influence, however the growth of the oxide interlayer at the ZTO/Ti boundary is suggested to be most influential, thereby inducing relatively high contact resistance.

Achieving Antifingerprinting and Antibacterial Effects in Smart-Phone Panel Applications Using ZnO Thin Films without a Protective Layer.

When crystalline ZnO films with a thickness of 30 nm and hydrophilic properties were deposited at room temperature onto a glass substrate via radio frequency sputtering, they exhibited antifingerprinting qualities following annealing treatment that was simple and accomplished at low temperature (100 °C). Hydrophobic properties were achieved using as-deposited ZnO films with hydrophilic properties via annealing treatment without the deposition of a protective layer with hydrophobic properties. The annealed 30 nm ZnO films showed a high transmittance (∼91.3%) comparable to that of a glass substrate at a wavelength of 550 nm. The annealed films showed strong antibacterial activity against E. coli and S. aureus bacteria. The ZnO films with a thickness of 30 nm showed predominant mechanical durability with strong antibacterial activity for smart-phone panel applications.

Realization of large-area wrinkle-free monolayer graphene films transferred to functional substrates.

Structural inhomogeneities, such as the wrinkles and ripples within a graphene film after transferring the free-standing graphene layer to a functional substrate, degrade the physical and electrical properties of the corresponding electronic devices. Here, we introduced titanium as a superior adhesion layer for fabricating wrinkle-free graphene films that is highly applicable to flexible and transparent electronic devices. The Ti layer does not influence the electronic performance of the functional substrates. Experimental and theoretical investigations confirm that the strong chemical interactions between Ti and any oxygen atoms unintentionally introduced on/within the graphene are responsible for forming the clean, defect-free graphene layer. Our results accelerate the practical application of graphene-related electronic devices with enhanced functionality. The large-area monolayer graphenes were prepared by a simple attachment of the Ti layer with the multi-layer wrinkle-free graphene films. For the first time, the graphene films were addressed for applications of superior bottom electrode for flexible capacitors instead of the novel metals.

Enhanced transparency, mechanical durability, and antibacterial activity of zinc nanoparticles on glass substrate.

Homogeneously distributed zinc nanoparticles (NPs) on the glass substrate were investigated for the transmittance, mechanical durability, and antibacterial effect. The buffered Ti NPs between Zn NPs and glass substrate were studied for an enhancement of the transmittance and mechanical endurance. The Ti NPs buffered Zn NPs showed a high transmittance of approximately 91.5% (at a wavelength of 550 nm) and a strong antibacterial activity for Staphylococcus aureus and Escherichia coli bacteria. The buffered Ti NPs are attractive for an excellent mechanical endurance of the Zn NPs. The Zn NPs did not require the protection layer to prevent the degradation of the performance for both the antibacterial effect and the transmittance.