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Electrochemical impedance spectroscopy (EIS) is a very powerful tool for exploitation as a  rich  source  of Proton  Exchange  Membrane  Fuel  Cell  (PEMFC)  diagnostic  information.A primary goal of this work was to develop a suitable PEMFC impedance model, which can be used in the analysis for flooding and drying of fuel cell. For this one a novel optimization method based on factorial Design methodology is used. It was applied for parametric analysis of electrochemical impedance Thus it is possible to evaluate the relative importance of each parameter to the simulation accuracy. Furthermore this work presents an analysis of the PEMFC impedance behavior in the case of flooding and drying.

This study investigates the liquid–liquid extraction behavior of a ternary system composed of water, formic acid, and 1-octanol in the presence of inorganic salts (NaCl and KCl) at varying concentrations of 0%, 5%, 10%, and 15%. Each salt was examined individually to assess its impact on the extraction efficiency. Experimental solubility data and tie-line compositions were obtained. The results demonstrate that the addition of salt significantly improves the efficiency of extraction. NaCl was found to induce a stronger salting-out effect than KCl, especially at 10% concentration, where the highest selectivity and distribution coefficient were observed. To model the phase behavior, both the Non-Random Two-Liquid (NRTL) thermodynamic model and an Artificial Neural Network (ANN) were employed based on the experimental results. A Neural Architecture Search approach was implemented to optimize ANN structure. Both models exhibited strong predictive capability; however, the ANN model demonstrated superior performance, achieving higher accuracy and lower prediction errors than the NRTL model, particularly at high salt concentrations.

PurposeOur aim was to highlight the presence and the frequency of posterior staphyloma (PS) in non-highly myopic retinitis pigmentosa (RP) patients and to study the relationship between PS and choroidal thickness (CT).MethodsThis was a retrospective case–control study of 77 eyes (39 patients) with RP, axial length inferior to 26 mm and clinically preserved macular area. All patients underwent fundus photography, A- and B-scan ocular ultrasonography, fundus autofluorescence (FAF) and swept source optical coherence tomography (SS-OCT). PS was defined by an outward bowing of the sclera on SS-OCT and B-scans. The relationship between the PS and SS-OCT layers thicknesses was determined.ResultsOver 77 RP eyes of 39 patients studied, a PS was identified in 17 eyes (22%) of nine patients. Fifteen eyes had a narrow macular staphyloma (NMS), and two eyes had a wide macular staphyloma (WMS). Mean age in this group was 34.2 years (range 19–53 years), mean axial length was 23.60 ± 0.61 mm and mean CT was 185.7 ± 71 um versus 259.7 um in eyes without PS. The staphyloma edges corresponded to area of outer retina loss on SS-OCT and were larger than the hyperautofluorescent ring on FAF.We found a significant association between PS and CT in our RP patients (p = 0.003).The mean CT was significantly thinner in PS eyes compared to eyes without staphyloma. There was no significant association between PS and with visual acuity, years of progression, retinal thickness nor FAF findings.ConclusionsPS was present in 22% of non-highly myopic eyes with RP. Narrow macular staphyloma was the most common type observed in our series. A marked thinning of the choroid was noted in PS eyes when compared to RP eyes without PS, as well as the outer retina degeneration.

The main exclusion criteria were an estimated life expectancy <12 months for extra-cardiac pathology, isolated right heart failure, pregnancy, end-stage or severe renal insufficiency with creatinine clearance <15ml/ min, hemodialysis patient, cardiac surgery scheduled within 3 months and congenital heart disease. All variables that were statistically significant at univariate analysis (Log-rank Kaplan-Meier), and those considered of relevant clinical interest with a risk of error of 20% were included in a multivariable model (Cox model) to identify the independent predictors with adjusted Odds Ratio (aOR) of all-cause death, death and rehospitalization/ HF from the study entry to 1-year follow-up, separately for AHF and CHF. Age, systolic blood pressure and ejection fraction (EF) were considered as continuous variables while the remaining were considered as categorical variables. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year composite events of rehospitalization and mortality (Table 5).

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Purpose: To analyze microvascular changes in patients with retinitis pigmentosa (RP) with relatively preserved visual acuity (VA), using swept source optical coherence tomography (SS-OCT) angiography to correlate results to macular function and structure. Methods: This was a case-control study conducted over 70 eyes of 35 RP patients with relatively preserved VA. All patients underwent a complete ophthalmic examination, including SS-OCT, OCT angiography (OCT-A), fundus autofluorescence (FAF), and multifocal electroretinogram (mfERG). Thirty-four eyes of 34 healthy controls of age-, sex-, and axial length-matched (control group), were also analyzed. The main outcome measures were foveal and parafoveal vascular densities (FVDs and PFVDs) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ) and its enlargement coefficient and their correlation with macular function (by means of VA and mfERG), and structure (by means of FAF and SS-OCT). Results: In the RP group, PFVD was 25.99 ± 5.2% in the SCP and 34.47 ± 2.37% in the DCP and were significantly lower as compared to control group (P < 0.0001; P = 0.0026, respectively). Enlargement coefficient of FAZ was 1.78 ± 0.79. We found a statistically significant correlation between VA and PFVD in the DCP (P < 0.0001), FAZ disruption in the SCP (P = 0.006) and enlargement coefficient of FAZ (P = 0.01). The parafoveal DCP density was significantly correlated with P1 amplitude (P = 0.005) in rings 2, 3, 4, and 5 of the mfERG. We found a statistically significant correlation between parafoveal density in the DCP, thickness of ganglion cell complex (GCC) (P = 0.001), and the width of ellipsoid band (P = 0.041). Parafoveal SCP density was also correlated to GCC (P = 0.033). Conclusions: We showed that vascular alteration in RP begins at the level of the DCP, which affects the outer retina and leads to a narrowing of the ellipsoid. The alteration of the SCP would occur later in the evolution of the disease. Vascular changes occur early during RP and were highly correlated to retinal function and structure. OCT-A seems to be a good tool to quantify vascular network loss and could play a central role in staging, prognosis, and monitoring disease progression.

BackgroundElectronic Patient Care Records (e-PCR) have been the object of research since the 1980’s.1 Documentation of all the events, information shared, and medical interventions performed by pre-hospital clinicians is crucial and has been identified as important supplementation to verbal handover.2 Ambulance services play a crucial role in prehospital emergency medical care delivery. In order to provide an optimal level of centered patient care, accurate, and comprehensive documentation of the medical record is important. This project aims to improve the accuracy of the Scheduled Ambulance Service (SAS) e-PCR documentation by staff from the 1% baseline in November 2021 to 65% in October 2022, then up to 95% by July 2023.MethodsTo ensure SAS staff are continuously providing a high level of patient care, a robust and sustainable process was developed focusing on improving the accuracy of e-PCR documentation. A multi-disciplinary team used the Institute for Healthcare Improvement3 (IHI) Model of Improvement and a Cause-and-Effect Diagram revealed potential causes limiting the documentation quality and proposed viable countermeasures such as review checklist, documentation guide, Customized Improvement feedbacks and e-PCR version updating which all went through a series of Plan-Do-Study-Act (PDSA) cycles.ResultsPost-intervention data in phase 1 identified an improvement up to 80% (figure 1). From November to December 2022 data collection was on hold due to the FIFA World Cup tournament. Phase 2 data from January 2023 identified that 72% of SAS e-PCRs were completed accurately. Post-intervention data showed an improvement up to 96% by July 2023 (figure 2).ConclusionThe goal of improving the accuracy of SAS e-PCR was achieved by implementing multiple countermeasures such as revised SAS Clinical Practice Guidelines, e-PCR Documentation Guide, and implementing the top performers poster as an encouragement system to motivate the staff.Abstract 89 Figure 1Control chart of accurate scheduled ambulance service (SAS) electronic patient care records (e-PCR) documentation from November 2021 to October 2022 (UCL: upper control limit; LCL: lower control limit)[Figure omitted. See PDF]Abstract 89 Figure 2Control chart of accurate scheduled ambulance service (SA) electronic patient care records (e-PCR) documentation from January to July 2023 (UCL: upper control limit; LCL: lower control limit)[Figure omitted. See PDF]ReferencesGreenhalgh T, Potts HWW, Wong G, Bark P, Swinglehurst D. Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. Milbank Q 2009;87:729–788. doi: 10.1111/j.1468-0009.2009.00578.xOwen C, Hemmings L, Brown T. Lost in translation: maximizing handover effectiveness between paramedics and receiving staff in the emergency department. Emerg. Med. Australas. 2009;21:102–107. doi: 10.1111/j.1742-6723.2009.01168.x.Crowl A, Sharma A, Sorge L, Sorensen T. Accelerating quality improvement within your organization: applying the model for improvement. Journal of the American Pharmacists Association 2015 Jul 1;55(4):e364–76 doi: 10.1331/JAPhA.2015.15533.Ethical Approval/IRB StatementThis is a quality Improvement project conducted during the Clinical Care Improvement Training Program, approved by the Hamad Healthcare Quality Institute, Doha, Qatar.Disclosures and AcknowledgmentsThe author would like to thank Dr. Ian Howard who assisted in reviewing and implementing of the e-PCR documentation Guide.