PurposePhysiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.ResultsA total of 2,558,760 unique alarms occurred in the 31-day study period: arrhythmia, 1,154,201; parameter, 612,927; technical, 791,632. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. 88.8% of the 12,671 annotated arrhythmia alarms were false positives. Conditions causing excessive alarms included inappropriate alarm settings, persistent atrial fibrillation, and non-actionable events such as PVC's and brief spikes in ST segments. Low amplitude QRS complexes in some, but not all available ECG leads caused undercounting and false arrhythmia alarms. Wide QRS complexes due to bundle branch block or ventricular pacemaker rhythm caused false alarms. 93% of the 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment.DiscussionThe excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.

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Topsoil (0-20 cm) samples were collected from the edge of roads to the locations about 200 m off the roads along the four roads with different transportation periods in October 2005. Total concentrations of As, Cd, Cr, Cu, Ni, Pb and Zn were determined using the inductively coupled plasma atomic absorption spectrometry in order to assess and compare road transportation pollution. Results showed that with the exception of As, Cu and Pb, the average concentrations of heavy metals were generally, higher than the regional elemental background values. Most soil samples were moderately or highly polluted by Cd or Ni, but the contamination index (P i ) values for As, Pb and Zn were lower than other heavy metals in all sites. Among the four roads, heavy metal pollution was heavier for Dali Road due to longer transportation periods, while low or no contamination could be observed for the other roads. However, the integrated contamination index (P c ) values showed a generally low contamination or no contamination level for all soil samples in this region, followed by the order of Dali Road [ Dabao Highway [ Road 320 [ Sixiao Highway. The same pollution source of these heavy metals was found using factor analysis.

Conventional electroencephalography with disc electrodes has major drawbacks including poor spatial resolution, selectivity and low signal-to-noise ratio that are critically limiting its use. Concentric ring electrodes, consisting of several elements including the central disc and a number of concentric rings, are a promising alternative with potential to improve all of the aforementioned aspects significantly. In our previous work, the tripolar concentric ring electrode was successfully used in a wide range of applications demonstrating its superiority to conventional disc electrode, in particular, in accuracy of Laplacian estimation. This paper takes the next step toward further improving the Laplacian estimation with novel multipolar concentric ring electrodes by completing and validating a general approach to estimation of the Laplacian for an (n + 1)-polar electrode with n rings using the (4n + 1)-point method for n ≥ 2 that allows cancellation of all the truncation terms up to the order of 2n. An explicit formula based on inversion of a square Vandermonde matrix is derived to make computation of multipolar Laplacian more efficient. To confirm the analytic result of the accuracy of Laplacian estimate increasing with the increase of n and to assess the significance of this gain in accuracy for practical applications finite element method model analysis has been performed. Multipolar concentric ring electrode configurations with n ranging from 1 ring (bipolar electrode configuration) to 6 rings (septapolar electrode configuration) were directly compared and obtained results suggest the significance of the increase in Laplacian accuracy caused by increase of n.