Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

A holistic approach to improving safety for battery energy storage systems

The integration of battery energy storage systems(BESS)throughout our energy chain poses concerns regarding safety,especially since batteries have high energy density and numerous BESS failure events have occurred.Wider spread adoption will only increase the prevalence of these failure events unless there is a step change in the management and design of BESS.To understand the causes of failure,the main challenges of BESS safety are summarised.BESS consequences and failure events are discussed,including specific focus on the chain of events causing thermal runaway,and a case study of a BESS explosion in Surprise Arizona is analysed.Based on the technology and past events,a paradigm shift is required to improve BESS safety.In this review,a holistic approach is proposed.This combines currently adopted approaches including battery cell testing,lumped cell mathematical modelling,and calorimetry,alongside additional measures taken to ensure BESS safety including the requirement for computational fluid dynamics and kinetic modelling,assessment of installation level testing of the full BESS system and not simply a single cell battery test,hazard and layers of protection analysis,gas chromatography,and composition testing.The holistic approach proposed in this study aims to address challenges of BESS safety and form the basis of a paradigm shift in the safety management and design of these systems.

A perspective on the key factors of safety for rechargeable magnesium batteries

Rechargeable Mg batteries(RMBs)have become one of the best subsitutes for lithium-ion batteries due to the high volumetric capacity,abundant resources,and uniform plating behavior of Mg metal anode.However,the safety hazard induced by the formation of high-modulue Mg dendrites under a high current density(10 mA cm^(-1))was still revealed in recent years.It has forced researchers to re-examine the safety of RMBs.In this review,the intrinsic safety factors of key components in RMBs,such as uneven plating,pitting and flammability of Mg anode,heat release and crystalline water decomposition of cathode,strong corrosion,low oxidition stability and flammability of electrolytes,and soforth,are systematacially summarized.Their origins,formation mechanisms,and possible safety hazards are deeply discussed.To develop high-performance Mg anode,current strategies including designing artificial SEI,three-dimensional substrates,and Mg alloys are summarized.For practical electrolytes,the configurations of boron-centered anions and simple Mg salts and the functionalized solvent with high boiling point and low flammability are suggested to comprehensively design.In addition,the future study should more focus on the investigation on the thermal runaway and decomposition of cathode materials and separa-tors.This review aims to provide fundamental insights into the relationship between electrochemistry and safety,further promoting the sustainable development of RMBs.

Ganoderma lucidum:a comprehensive review of phytochemistry,efficacy,safety and clinical study

Ganoderma lucidum,one of the most well-known edible fungi,is believed to be very beneficial for longevity and vitality.A long usage history suggests that G.lucidum has various clinical therapeutic effects.And experimental studies have confirmed that G.lucidum has multiple pharmacological effects,including antitumor,anti-microbial,anti-HIV protease,and antidiabetic activity and so on.With the deepening of research,more than 300 compounds have been isolated from G.lucidum.There is an increasing population of G.lucidum-based products,and its international development is expanding.Currently,G.lucidum has drawn much attention to its chemical composition,therapeutic effect,clinical value,and safety.This paper provides a comprehensive review of these aspects to enhance the global promotion of G.lucidum.

Demonstration of safety characteristics and effects on gut microbiota of Lactobacillus gasseri HMV18

Human normal flora is a source of probiotics.The safety characteristics of a specific isolate determine its application in foods or drugs.The food-borne-pathogen antagonist strain Lactobacillus gasseri HMV18 is one of the isolates from normal human flora.In this work,we assessed the in vitro pH tolerance,bile tolerance,biogenic amine production,mucin utilization,and safety of in vivo administration to mice to evaluate general health,organ-body weight index,organ histopathological change,whether L.gasseri HMV18 can colonize in the gut or modulate the gut microbiota after oral administration.The results suggest that L.gasseri HMV18 can tolerate pH 3 for 2 h,3%bile for 3 h,biogenic amine negative,mucin usage negative,does not encode verified toxins,and cause no visible change in mice's organs.L.gasseri HMV18 might not colonize in mice's gut,but can significantly affect the structure of gut microbiota.A bibliographical survey suggested that there were as few as 8 opportunistic infection cases from 1984 to 2022 and that the possibility for L.gasseri to cause infection is relatively low.Therefore,this work provides a basis for the foods or drugs application of L.gasseri HMV18 and gives a map of experiments for the safety assessment of probiotics.

Toward Trustworthy Decision-Making for Autonomous Vehicles:A Robust Reinforcement Learning Approach with Safety Guarantees

While autonomous vehicles are vital components of intelligent transportation systems,ensuring the trustworthiness of decision-making remains a substantial challenge in realizing autonomous driving.Therefore,we present a novel robust reinforcement learning approach with safety guarantees to attain trustworthy decision-making for autonomous vehicles.The proposed technique ensures decision trustworthiness in terms of policy robustness and collision safety.Specifically,an adversary model is learned online to simulate the worst-case uncertainty by approximating the optimal adversarial perturbations on the observed states and environmental dynamics.In addition,an adversarial robust actor-critic algorithm is developed to enable the agent to learn robust policies against perturbations in observations and dynamics.Moreover,we devise a safety mask to guarantee the collision safety of the autonomous driving agent during both the training and testing processes using an interpretable knowledge model known as the Responsibility-Sensitive Safety Model.Finally,the proposed approach is evaluated through both simulations and experiments.These results indicate that the autonomous driving agent can make trustworthy decisions and drastically reduce the number of collisions through robust safety policies.

Research Progress of Agricultural Genetically Modified Crop Safety Evaluation

The commercial cultivation of genetically modified(GM)crops has eased the global food crisis and brought considerable economic and social benefits to countries.Because of the potential safety problems,it is necessary to make clear the molecular genetic characteristics,edible safety,planting,processing,and other aspects of the safety evaluation of GM crops.The safety problems existing in the cultivation of GM crops,safety evaluation and detection of GM crops were introduced in this paper,which provided the basis for safety evaluation and effective supervision of GM crops and their products.Commercial cultivation and reasonable supervision based on safety evaluation have far-reaching significance for ensuring consumer safety,enhancing the credibility of the national political system and enhancing citizens'confidence in the safety of GM crop products for consumption.

Evidence-based expert consensus on clinical management of safety of Bruton’s tyrosine kinase inhibitors(2024)

Bruton’s tyrosine kinase inhibitors(BTKis)have revolutionized the treatment of B-cell lymphomas.However,safety issues related to the use of BTKis may hinder treatment continuity and further affect clinical efficacy.A comprehensive and systematic expert consensus from a pharmacological perspective is lacking for safety issues associated with BTKi treatment.A multidisciplinary consensus working group was established,comprising 35 members from the fields of hematology,cardiovascular disease,cardio-oncology,clinical pharmacy,and evidencebased medicine.This evidence-based expert consensus was formulated using an evidence-based approach and the Delphi method.The Joanna Briggs Institute Critical Appraisal(JBI)tool and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)approach were used to rate the quality of evidence and grade the strength of recommendations,respectively.This consensus provides practical recommendations for BTKis medication based on nine aspects within three domains,including the management of common adverse drug events such as bleeding,cardiovascular events,and hematological toxicity,as well as the management of drug-drug interactions and guidance for special populations.This multidisciplinary expert consensus could contribute to promoting a multi-dimensional,comprehensive and standardized management of BTKis.

Influence of pier height on the safety of trains running on high-speed railway bridges during earthquakes

Sudden earthquakes pose a threat to the running safety of trains on high-speed railway bridges,and the stiffness of piers is one of the factors affecting the dynamic response of train-track-bridge system.In this paper,a experiment of a train running on a high-speed railway bridge is performed based on a dynamic experiment system,and the corresponding numerical model is established.The reliability of the numerical model is verified by experiments.Then,the experiment and numerical data are analyzed to reveal the pier height effects on the running safety of trains on bridges.The results show that when the pier height changes,the frequency of the bridge below the 30 m pier height changes greater;the increase of pier height causes the transverse fundamental frequency of the bridge close to that of the train,and the shaking angle and lateral displacement of the train are the largest for bridge with 50 m pier,which increases the risk of derailment;with the pier height increases from 8 m to 50 m,the derailment coefficient obtained by numerical simulations increases by 75% on average,and the spectral intensity obtained by experiments increases by 120% on average,two indicators exhibit logarithmic variation.

An Innovative Deep Architecture for Flight Safety Risk Assessment Based on Time Series Data

With the development of the integration of aviation safety and artificial intelligence,research on the combination of risk assessment and artificial intelligence is particularly important in the field of risk management,but searching for an efficient and accurate risk assessment algorithm has become a challenge for the civil aviation industry.Therefore,an improved risk assessment algorithm(PS-AE-LSTM)based on long short-term memory network(LSTM)with autoencoder(AE)is proposed for the various supervised deep learning algorithms in flight safety that cannot adequately address the problem of the quality on risk level labels.Firstly,based on the normal distribution characteristics of flight data,a probability severity(PS)model is established to enhance the quality of risk assessment labels.Secondly,autoencoder is introduced to reconstruct the flight parameter data to improve the data quality.Finally,utilizing the time-series nature of flight data,a long and short-termmemory network is used to classify the risk level and improve the accuracy of risk assessment.Thus,a risk assessment experimentwas conducted to analyze a fleet landing phase dataset using the PS-AE-LSTMalgorithm to assess the risk level associated with aircraft hard landing events.The results show that the proposed algorithm achieves an accuracy of 86.45%compared with seven baseline models and has excellent risk assessment capability.

Enhancing Patient Safety in the Operating Room: A Comprehensive Guide from a Nurse’s Perspective

Ensuring patient safety within the operating room is a paramount concern in contemporary healthcare, and this guide aims to provide an in-depth exploration of this crucial aspect from the perspective of nurses. Nurses play a pivotal role in supporting surgeons and maintaining a safe environment for patients undergoing various medical procedures.

Efficacy and Safety of Micropulse Trans-Scleral Cyclophotocoagulation in Cambodian Patients with Glaucoma

Objective: To evaluate the treatment outcomes of micropulse cyclophotocoagulation in Cambodian glaucoma patients. Materials and Methods: 14 patients were enrolled in this retrospective study that was conducted with the consent over a 14-month period. The medical records were analyzed for variables such as intra-ocular pressure, the number of anti-glaucoma drugs used, visual acuity, pain level, and complications during and after treatment. The main outcome was whether or not there was success or failure, with success being defined as a pressure level between 6 and 21 mmHg and a 30% decrease in IOP by week 24 (with/without drugs). Results: In our study, the mean age of patients was 52.36 ± 9.98 years old (42 to 75 years old). The mean intra-ocular pressure before treatment was 41.00 ± 12.26 mmHg, which decreased to 21.60 ± 8.11 mmHg (41.56% reduction) and 16.94 ± 5.46 mmHg (56.04% reduction) in the 12th and 24th weeks (p p Conclusion: Micro-pulse trans-scleral cyclophotocoagulation is a safe and effective method for lowering pressure in any stage of disease without the use of invasive surgeries.

Food Hygiene and Safety Practices amongst Food Vendors in the Western Area, Sierra Leone

Food safety and hygiene practices require a multisectoral approach including food, water, sanitation, waste management, transport, education, trade, policies and programs that enable safe food preparation, storage and service. Unsafe food can cause illness keeping people from achieving their full potential and death. This was a descriptive study that uses a mixed method approach to derive insights into the characteristics of food vendors related to demography, knowledge, practices, infrastructure, compliance and recommendation for a policymaking framework. Using the Lemeshows’ sample size formula, 473 vendors from formal (restaurants) and informal (cookri-baffa/table top) sites were interviewed and observed. We found from discussions that respondents had a good understanding on how to keep food safe. However, observed practices were poor 93% handled food with their bare hands, 83% did not cover their hair, and 76% did not wear an apron whilst handling, preparing or serving food, 61% did not keep their finger nails clean or short and 57% did not wash their hand before preparing or serving food. Over half (51%) had access to a toilet but 32% reported their use required payment and emphasized their poor condition/inadequate management. Nearly half (47%) of the vending sites did not have a handwashing facility, with soap and water available. Only 7% reported having any authority oversight of food safety. Food safety and hygiene practices in most cookri shops and restaurants was ‘poor’ with very limited surveillance system in place by competent authorities for compliance of food operators. Hand washing, clean surroundings, and covered food were the most common and emphasized practices to mitigate the risks associated with unsafe food.

Leveraging Augmented Reality,Semantic-Segmentation,and VANETs for Enhanced Driver’s Safety Assistance

Overtaking is a crucial maneuver in road transportation that requires a clear view of the road ahead.However,limited visibility of ahead vehicles can often make it challenging for drivers to assess the safety of overtaking maneuvers,leading to accidents and fatalities.In this paper,we consider atrous convolution,a powerful tool for explicitly adjusting the field-of-view of a filter as well as controlling the resolution of feature responses generated by Deep Convolutional Neural Networks in the context of semantic image segmentation.This article explores the potential of seeing-through vehicles as a solution to enhance overtaking safety.See-through vehicles leverage advanced technologies such as cameras,sensors,and displays to provide drivers with a real-time view of the vehicle ahead,including the areas hidden from their direct line of sight.To address the problems of safe passing and occlusion by huge vehicles,we designed a see-through vehicle system in this study,we employed a windshield display in the back car together with cameras in both cars.The server within the back car was used to segment the car,and the segmented portion of the car displayed the video from the front car.Our see-through system improves the driver’s field of vision and helps him change lanes,cross a large car that is blocking their view,and safely overtake other vehicles.Our network was trained and tested on the Cityscape dataset using semantic segmentation.This transparent technique will instruct the driver on the concealed traffic situation that the front vehicle has obscured.For our findings,we have achieved 97.1% F1-score.The article also discusses the challenges and opportunities of implementing see-through vehicles in real-world scenarios,including technical,regulatory,and user acceptance factors.

Thermal safety boundary of lithium-ion battery at different state of charge

Thermal runaway(TR)is a critical issue hindering the large-scale application of lithium-ion batteries(LIBs).Understanding the thermal safety behavior of LIBs at the cell and module level under different state of charges(SOCs)has significant implications for reinforcing the thermal safety design of the lithium-ion battery module.This study first investigates the thermal safety boundary(TSB)correspondence at the cells and modules level under the guidance of a newly proposed concept,safe electric quantity boundary(SEQB).A reasonable thermal runaway propagation(TRP)judgment indicator,peak heat transfer power(PHTP),is proposed to predict whether TRP occurs.Moreover,a validated 3D model is used to quantitatively clarify the TSB at different SOCs from the perspective of PHTP,TR trigger temperature,SOC,and the full cycle life.Besides,three different TRP transfer modes are discovered.The interconversion relationship of three different TRP modes is investigated from the perspective of PHTP.This paper explores the TSB of LIBs under different SOCs at both cell and module levels for the first time,which has great significance in guiding the thermal safety design of battery systems.

Safety assessment of a novel marine multi-stress-tolerant yeast Meyerozyma guilliermondii GXDK6 according to phenotype and whole genome-sequencing analysis

The application of microorganisms as probiotics is limited due to lack of safety evaluation.Here,a novel multi-stress-tolerant yeast Meyerozyma guilliermondii GXDK6 with aroma-producing properties was identified from marine mangrove microorganisms.Its safety and probiotic properties were assessed in accordance with phenotype and whole-genome sequencing analysis.Results showed that the genes and phenotypic expression of related virulence,antibiotic resistance and retroelement were rarely found.Hyphal morphogenesis genes(SIT4,HOG1,SPA2,ERK1,ICL1,CST20,HSP104,TPS1,and RHO1)and phospholipase secretion gene(VPS4)were annotated.True hyphae and phospholipase were absent.Only one retroelement(Tad1-65_BG)was found.Major biogenic amines(BAs)encoding genes were absent,except for spermidine synthase(JA9_002594),spermine synthase(JA9_004690),and tyrosine decarboxylase(inx).The production of single BAs and total BAs was far below the food-defined thresholds.GXDK6 had no resistance to common antifungal drugs.Virulence enzymes,such as gelatinase,DNase,hemolytic,lecithinase,and thrombin were absent.Acute toxicity test with mice demonstrated that GXDK6 is safe.GXDK6 has a good reproduction ability in the simulation gastrointestinal tract.GXDK6 also has a strong antioxidant ability,β-glucosidase,and inulinase activity.To sum up,GXDK6 is considered as a safe probiotic for human consumption and food fermentation.

Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.

A Survey on an Emerging Safety Challenge for Autonomous Vehicles:Safety of the Intended Functionality

As the complexity of autonomous vehicles(AVs)continues to increase and artificial intelligence algorithms are becoming increasingly ubiquitous,a novel safety concern known as the safety of the intended functionality(SOTIF)has emerged,presenting significant challenges to the widespread deployment of AVs.SOTIF focuses on issues arising from the functional insufficiencies of the AVs’intended functionality or its implementation,apart from conventional safety considerations.From the systems engineering standpoint,this study offers a comprehensive exploration of the SOTIF landscape by reviewing academic research,practical activities,challenges,and perspectives across the development,verification,validation,and operation phases.Academic research encompasses system-level SOTIF studies and algorithm-related SOTIF issues and solutions.Moreover,it encapsulates practical SOTIF activities undertaken by corporations,government entities,and academic institutions spanning international and Chinese contexts,focusing on the overarching methodologies and practices in different phases.Finally,the paper presents future challenges and outlook pertaining to the development,verification,validation,and operation phases,motivating stakeholders to address the remaining obstacles and challenges.

Deep learning approaches to recover the plasma current density profile from the safety factor based on Grad–Shafranov solutions across multiple tokamaks

Many magnetohydrodynamic stability analyses require generation of a set of equilibria with a fixed safety factor q-profile while varying other plasma parameters.A neural network(NN)-based approach is investigated that facilitates such a process.Both multilayer perceptron(MLP)-based NN and convolutional neural network(CNN)models are trained to map the q-profile to the plasma current density J-profile,and vice versa,while satisfying the Grad–Shafranov radial force balance constraint.When the initial target models are trained,using a database of semianalytically constructed numerical equilibria,an initial CNN with one convolutional layer is found to perform better than an initial MLP model.In particular,a trained initial CNN model can also predict the q-or J-profile for experimental tokamak equilibria.The performance of both initial target models is further improved by fine-tuning the training database,i.e.by adding realistic experimental equilibria with Gaussian noise.The fine-tuned target models,referred to as fine-tuned MLP and fine-tuned CNN,well reproduce the target q-or J-profile across multiple tokamak devices.As an important application,these NN-based equilibrium profile convertors can be utilized to provide a good initial guess for iterative equilibrium solvers,where the desired input quantity is the safety factor instead of the plasma current density.

Construction of core@double-shell structured energetic composites with simultaneously enhanced thermal stability and safety performance

The poor thermal stability and high sensitivity severely hinder the practical application of hexanitrohexaazaisowurtzitane(CL-20).Herein,a kind of novel core@double-shell CL-20 based energetic composites were fabricated to address the above issues.The coordination complexes which consist of natural polyphenol tannic acid(TA) and Fe~Ⅲ were chosen to construct the inner shell,while the graphene sheets were used to build the outer shell.The resulting CL-20/TA-Fe~Ⅲ/graphene composites exhibited simultaneously improved thermal stability and safety performance with only 1 wt% double-shell content,which should be ascribed to the intense physical encapsulation effect from inner shell combined with the desensitization effect of carbon nano-materials from outer shell.The phase transition(ε to γ) temperature increased from 173.70 ℃ of pure CL-20 to 191.87℃ of CL-20/TA-Fe~Ⅲ/graphene composites.Meanwhile,the characteristic drop height(H_(50)) dramatically increased from 14.7 cm of pure CL-20 to112.8 cm of CL-20/TA-Fe~Ⅲ/graphene composites,indicating much superior safety performance after the construction of the double-shell structure.In general,this work has provided an effective and versatile strategy to conquer the thermal stability and safety issues of CL-20 and contributes to the future application of high energy density energetic materials.