Proactive risk assessment of intrahospital transport of critically ill patients from emergency department to intensive care unit in a teaching hospital and its implications.

AIMS AND OBJECTIVES: To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU). BACKGROUND: Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. DESIGN: A qualitative action research study combined with a quantitative cross-sectional method. METHODS: According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. RESULTS: The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05). CONCLUSION: Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients' condition. RELEVANCE TO CLINICAL PRACTICE: Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients' IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects.

π-Stacked Donor-Acceptor Dendrimers for Highly Efficient White Electroluminescence.

π-Stacked dendrimers consisting of cofacially aligned donors and acceptors are developed by introducing three dendritic teracridan donors with orthogonal configuration and three triazine acceptors in periphery of hexaphenylbenzene skeleton. The dendritic structure and orthogonal configuration of teracridan not only make their outer acridan segments approaching to acceptor in close distance, but also fix donor and acceptor in face-to-face alignment, leading to through-space charge transfer emission with thermally activated delayed fluorescence (TADF) effect. By regulating charge transfer strength via substituent effect of acceptor, emission color of the dendrimers can be tuned from blue to yellow/red region. Solution-processed two-color white organic light-emitting diodes (OLEDs) based on blue and yellow π-stacked donor-acceptor dendrimers exhibit the maximum external quantum efficiency of 20.6 % and maximum power efficiency of 58.9 lm W-1 , representing the state-of-the-art efficiency for all-TADF white OLEDs by solution process.

Through-Space Charge-Transfer Polynorbornenes with Fixed and Controllable Spatial Alignment of Donor and Acceptor for High-Efficiency Blue Thermally Activated Delayed Fluorescence.

Through-space charge transfer polynorbornenes with fixed and controllable spatial alignment of donor and acceptor in edge-to-face/face-to-face stacking patterns are developed for achieving high-efficiency blue thermally activated delayed fluorescence (TADF). The alignment is realized by using the cis, exo-configuration of norbornene to confine donor and acceptor in close proximity, and utilizing orthogonal and dendritic structures of donors to provide either perpendicular or parallel stacking motif relative to acceptors. Compared to edge-to-face counterparts, polynorbornenes with face-to-face aligned donor and acceptor exhibit much larger oscillator strength and higher photoluminescence quantum yield. The resulting polymers exhibit deep blue (422 nm) to sky blue (482 nm) emission and TADF effect with reverse intersystem crossing rates of 0.4-5.9×106  s-1 , giving the maximum external quantum efficiency of 18.8 % for non-doped blue organic light-emitting diodes by solution process.

Fulminant myocarditis induced by immune checkpoint inhibitor nivolumab: a case report and review of the literature.

BACKGROUND: Nivolumab, an anti-programmed cell death protein 1 antibody, is commonly used as an immune checkpoint inhibitor in various cancers. Various adverse events are associated with these therapies, including hepatitis, dermatitis, and myocarditis. Myocarditis is a relatively rare but potentially fatal immune-mediated adverse reaction. CASE PRESENTATION: We report a case of colon cancer in a 56-year-old Chinese patient with lung and liver metastasis who developed fulminant myocarditis by nivolumab and survived with the support of extracorporeal membrane oxygenation. After six cycles (within 3 months) of nivolumab treatment, the patient developed chest tightness and was hospitalized. A diagnosis of fulminant myocarditis associated with immunotherapy was confirmed based on the clinical manifestations and laboratory examinations. He recovered well and was discharged on day 45 after management with extracorporeal membrane oxygenation, intravenous methylprednisolone, and immunoglobulin. CONCLUSIONS: This case illustrates a severe cardiovascular complication of immunotherapy, strongly suggesting the necessity of close monitoring for outpatient usage of nivolumab. Additionally, our experience provided an efficient management strategy of extracorporeal membrane oxygenation in terms of life-threatening conditions.

Simultaneous normal and parallel incidence planar left-handed metamaterial.

We investigate numerically the negative refraction of a simultaneous normal and parallel incidence planar left-handed metamaterial (LHM) in this paper. This LHM is comprised of fourfold C-shaped rings, which are printed on both sides of the substrates symmetrically, and it can exhibit left-handed properties with electromagnetic wave incident in three different directions. The retrieved result and the simulated result verify the left-handed properties of the fourfold C-shaped metamaterial very well. Then the different electric responses of the normal and parallel incidence cases to the incident electromagnetic wave are discussed, and it is due to the different distribution of the induced currents in the metallic wires.

Numerical studies of a low-loss and broad-pass-band single-sided-structure left-handed metamaterial.

A single-sided structure left-handed metamaterial (LHM), of which the symmetric paired split-ring resonators are connected directly through cut wires, is discussed in this paper. This connected single-sided LHM can exhibit a low loss and broad negative refraction passband. Good agreement of the retrieved result and the simulated result verify the above conclusion by comparison with the in-plane case and the off-plane case [T. Koschny, M. Kafesaki, E. N. Economou, and C. M. Soukoulis, Phys. Rev. Lett. 93, 107402 (2004)].

Through-space charge transfer hexaarylbenzene dendrimers with thermally activated delayed fluorescence and aggregation-induced emission for efficient solution-processed OLEDs.

Through-space electron interaction plays a critical role in determining the optical and charge transport properties of functional materials featuring π-stacked architectures. However, developing efficient organic luminescent materials with such interactions has been a challenge because of the lack of well-established prototypical molecules. Here we report the design of through-space charge transfer hexaarylbenzenes (TSCT-HABs) containing circularly-arrayed electron donors (acridan/dendritic triacridan) and acceptors (triazine), which exhibit both thermally activated delayed fluorescence (TADF) and aggregation-induced emission (AIE) effects for high-efficiency solution-processed organic light-emitting diodes (OLEDs). Spatial separation of donors and acceptors in the TSCT-HABs induces a small singlet-triplet energy splitting of 0.04-0.08 eV, leading to delayed fluorescence with microsecond-scale lifetimes. Meanwhile, the TSCT-HABs display the AIE effect with emission intensity enhanced by 6-17 fold from solution to the aggregation state owing to their propeller-shaped configuration. Solution-processed OLEDs based on the TSCT-HABs show maximum external quantum efficiency up to 14.2%, making them among the most efficient emitters for solution-processed TADF OLEDs.

Realization of high-power-efficiency white electroluminescence from a single polymer by energy-level engineering.

Single white light-emitting polymers (SWPs) represent a high-fidelity system for generating white light emission from polymers without phase separation compared to polymer blend systems. However, their device performance so far has been limited because of the unwanted hole scattering caused by an energy-level mismatch between emitters and hosts, and the large injection barrier at the polymer/anode interface. Here, we report novel poly(arylene phosphine oxide)-based all-phosphorescent SWPs by using the combination of a high-HOMO-level blue phosphor and high-HOMO-level poly(arylene phosphine oxide) host to achieve a low turn-on voltage of 2.8 V, high external quantum efficiency of 18.0% and remarkable power efficiency of 52.1 lm W-1, which makes them the most efficient SWPs so far. This record power efficiency is realized by using the high-HOMO-level blue phosphor to eliminate the hole scattering effect and by using the high-HOMO-level polymer host to reduce the hole injection barrier. This result represents an important progress in SWPs to achieve efficiency surpassing that of the polymer blends currently used for solution-processed white organic light-emitting diodes (WOLEDs) and even comparable with that of the small molecules used for vacuum-deposited WOLEDs.