SUMMARY & CONCLUSIONSThe case study involves 25 deaths and near-death episodes of babies in a neonatal unit. A nurse in the unit has been convicted of murder and attempted murder; therefore, the dataset is an extreme example of recognizing causal system unreliability and describing the actual reliability of that system without any knowledge of what is inside the causal system. The presence of an unknown serial killer poses a challenge to traditional reliability approaches; however, the new data analysis method, Event Interval Probability (EIP), does not rely on knowledge of what is inside the system producing events.When attempted murder is combined with murders, the reliability of the neonatal unit drops from normal and acceptable to dangerously unreliable on the very first day of the 383-day-long dataset, with a 0.00683 false positive. The false positive is the probability of being wrong if we declare the neonatal unit unreliable. Without probabilities, the nurse was allowed to stay in the neonatal care unit for an additional year, which resulted in 23 more deaths and near-death events. The case study reveals that the system-generated events exhibit irrational time intervals, suggesting that the causes and effects behind these events are also irrational, perhaps a characteristic one could expect from a serial killer.Reliability engineers understand that the reliability of complex, steady-state, repairable systems, where repairs restore the system to a condition as good as new, can be expressed as e-λt, with λ representing the failure rate and t representing time. Importantly, understanding the causal basis of λ is unnecessary. This concept is used in EIP as the null hypothesis that λ remains constant, with its value based on a comparative population average, a goal, historical performance, or an acceptable standard. The concept of a null hypothesis is borrowed from statistics; however, it is either rejected or not based on probability values (p-values) calculated using probability theory, which assesses the likelihood that the null hypothesis could have produced the observed event intervals.EIP often detects a system change from reliable to unreliable with just a single data point; therefore, analysis must be performed at every event to ensure unreliability is identified and addressed immediately, preventing future events. The study also identifies a zero-point chaos theory attractor within the dataset (inside the neonatal unit), where the interval between events approaches zero. This neonatal unit dataset is contrasted with two social system precursor datasets, both involving individuals within the causal systems charged with murder.
Erzwiesite, ideally Ag8Pb12Bi16S40, Z= 1, is a new sulfosalt mineral discovered in the Erzwies mining area, Gastein Valley, Salzburg Province, Austria. The mineral occurs as small black, irregular needle-like crystals mixed with galena and heyrovsk & yacute;ite in a quartz matrix. In reflected light, erzwiesite is greyish white. Under crossed polars it is distinctly anisotropic, and the rotation tints change from pale brown to pale bluish grey to dark brown. Reflectance measurements in air yield the following R-min/R-max values based on the standard wavelengths (Commission on Ore Mineralogy, COM): 44.5/47.6 (470 nm), 41.9/45.0 (546 nm), 41.5/44.5 (589 nm), and 40.4/43.6 (650 nm). The Mohs' hardness is 3-3.5 (VHN50 ranges from 195 to 224, mean 210 kg mm(-2)). Averaged electron-microprobe analyses (n= 6) gave (in wt %) Ag 11.10(27), Cu 0.04(3), Pb 29.50(77), Cd 0.17(1), Bi 42.90(63), Te 0.21(14), Se 0.08(5), and S 16.08(11), with a total of 100.10(63). The empirical formula is Ag8.18Cu0.05Pb11.31Cd0.12Bi16.30Sb0.01S39.81Te0.13Se0.06 (based on 76 apfu). The calculated density is 7.075 g cm(-3) using the empirical formula. Erzwiesite crystallises in space group Cmcm (a= 4.085(5), b= 13.462(15), c= 33.92(4) & Aring;, and V= 1866(4) & Aring;3). The crystal structure was determined from single-crystal X-ray diffraction data (R-1= 5.24 % for 308 data with F-o > 4 sigma(F-o) and 51 variable parameters). The structural formula is Ag8.64Pb11.04Bi16.32S40. The seven strongest lines in the X-ray powder diagram are [d in & Aring; (intensity) hkl] 3.588 (64) 028, 3.387 (98) 115, 3.349 (37) 041, 3.288 (85) 029, 2.919 (100)133, 2.846 (99)134, and 2.039(43) 157. Erzwiesite is the first natural (8 : 8) homologue of the lillianite homologous series and is named after its type locality.
The digitalisation of the U.S. logistics market is transforming not only transportation technologies but also the job functions of dispatch personnel. The mandatory use of Electronic Logging Devices (ELDs), digital load boards, and Transportation Management Systems (TMS) has turned digital literacy into a basic requirement for effective work in the logistics sector. The article examines the transformation of dispatch personnel job functions and proposes a systematisation of five competency groups – digital, communication, cognitive, adaptive, and organizational – based on the distributed workforce model implemented by TAD. The results indicate that dispatchers increasingly perform the role of coordinators of digital logistics processes, while insufficient competency development may generate regulatory, operational, and HR-related risks.
Background Understanding variations in CHF-related hospitalization outcomes across racial and geographical groups can inform targeted interventions, improve equity in care delivery, and guide policy efforts to reduce healthcare disparities in heart failure management. Methods We performed a retrospective analysis of the 2018-2022 Nationwide Inpatient Sample to identify adult patients (>18 years) with a primary diagnosis of acute heart failure (ICD-10-CM codes). National estimates were calculated using survey weights, and all reported results represent weighted estimates. We constructed multivariable logistic regression models to evaluate regional differences in mortality adjusting for demographics, comorbidities, and hospital characteristics. Results More than 5.6 million acute heart failure admissions across U.S. regions were identified and revealed variations in demographics and outcomes. Patients averaged 72 years old, with 46.4% female and a racial distribution of 68.5% White, 18.0% Black, 8.3% Hispanic, and 2.3% Asian. In-hospital mortality ranged from 2.7% (West South Central) to 3.5% (New England, East South Central, Pacific). After risk adjustment, four regions—East North Central, South Atlantic, Mountain, and West South Central—showed significantly lower mortality odds (aOR 0.90-0.95), while East South Central and Pacific had higher odds (aOR 1.16-1.19). When grouped, regions with higher mortality (East South Central, Pacific) and those with lower mortality (East North Central, South Atlantic, West South Central, Mountain) showed similar age (70.4 vs. 70.9 years) and sex profiles (45.2% vs. 46.3% female). However, the higher-mortality group was slightly more racially diverse (64.5% White, 14.9% Black, 11.6% Hispanic, 6.0% Asian) compared to the lower-mortality group (66.1% White, 21.6% Black, 8.4% Hispanic, 1.1% Asian), highlighting potential disparities in outcomes linked to regional demographics. Conclusion Regional disparities in acute heart failure mortality persist after risk adjustment, with higher odds in East South Central and Pacific regions. Racial diversity in high-mortality areas suggests socio-structural influences on outcomes.
Introduction and Objective: Beginning in 2026, hospitals must report severe hyperglycemia as a quality measure to CMS. This study evaluated a pharmacy-led stewardship service to improve hyperglycemia management and glycemic control in an acute care facility, aiming to enhance outcomes and meet CMS standards. Methods: Outcomes were compared between November 2024 (pre) and November 2025 (post). Eligible patients had diabetes, received antihyperglycemic agents, or had ≥1 blood glucose ≥200 mg/dL. Patients were excluded if admitted <24 hours or initial glucose >600 mg/dL. A dedicated pharmacist worked 5 days/week, 8 hours/day, monitoring and intervening to maintain target glucose levels. The primary outcome was the difference in severe hyperglycemia hospital day ratio, defined as days with ≥1 blood glucose >300 mg/dL within 10 days of admission. Secondary outcomes included mean days of euglycemia (no events), hyperglycemia, severe hyperglycemia, and hypoglycemia (counting a full day if ≥1 event occurred), and provider acceptance rate. Chi-square tests analyzed the primary outcome and acceptance rate, while unpaired t-tests analyzed remaining secondary outcomes. Significance was set at p ≤ 0.05. Results: Of 382 patients screened, 212 were included with similar baseline characteristics. The post-intervention group had lower severe hyperglycemia days (6.95% vs. 9.41%, p = 0.18), more euglycemic days (2.82 ± 3.54 vs. 1.83 ± 2.68, p < 0.001), fewer hyperglycemic days (2.54 ± 4.20 vs. 6.64 ± 4.30, p < 0.0001), and no change in hypoglycemic days (p = 0.79). Provider acceptance for pharmacy interventions was lower post-intervention (83% vs. 92%, p = 0.26), but overall increased by 2.76-fold, from 25 to 69. Conclusion: The pharmacist-led glycemic stewardship service improved glycemic control and may enhance CMS quality measures. These findings support service expansion in acute care settings, with potential benefits to improve patient outcomes and CMS metrics. Further studies are needed to confirm long-term effects. Disclosure M. Watler: None. D.C. Beltran: None. C.J. Gonzalez Hernandez: None. L. Cabrera Ricabal: None.
