Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell...Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell proliferation and differentiation,thereby exerting neuroprotective effects.However,the beneficial effects of endogenous VEGFA/b FGF are limited as their expression is only transiently increased.In this study,we generated multilayered nanofiber membranes loaded with VEGFA/b FGF using layer-by-layer self-assembly and electrospinning techniques.We found that a membrane containing 10 layers had an ideal ultrastructure and could efficiently and stably release growth factors for more than 1 month.This 10-layered nanofiber membrane promoted brain microvascular endothelial cell tube formation and proliferation,inhibited neuronal apoptosis,upregulated the expression of tight junction proteins,and improved the viability of various cellular components of neurovascular units under conditions of oxygen/glucose deprivation.Furthermore,this nanofiber membrane decreased the expression of Janus kinase-2/signal transducer and activator of transcription-3(JAK2/STAT3),Bax/Bcl-2,and cleaved caspase-3.Therefore,this nanofiber membrane exhibits a neuroprotective effect on oxygen/glucose-deprived neurovascular units by inhibiting the JAK2/STAT3 pathway.展开更多
Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadr...Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadruped robots show great potential in unstructured environments due to their discrete landing positions and large payloads.As the most critical movement unit of a quadruped robot,the limb leg unit(LLU)directly affects movement speed and reliability,and requires a compact and lightweight design.Inspired by the dexterous skeleton–muscle systems of cheetahs and humans,this paper proposes a highly integrated bionic actuator system for a better dynamic performance of an LLU.We propose that a cylinder barrel with multiple element interfaces and internal smooth channels is realized using metal additive manufacturing,and hybrid lattice structures are introduced into the lightweight design of the piston rod.In addition,additive manufacturing and topology optimization are incorporated to reduce the redundant material of the structural parts of the LLU.The mechanical properties of the actuator system are verified by numerical simulation and experiments,and the power density of the actuators is far greater than that of cheetah muscle.The mass of the optimized LLU is reduced by 24.5%,and the optimized LLU shows better response time performance when given a step signal,and presents a good trajectory tracking ability with the increase in motion frequency.展开更多
Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, ac...Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.展开更多
Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patie...Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.展开更多
Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains un...Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains unprecise in a critical care context despite its frequent usage in nursing education and clinical practice.This study aimed to report a thorough concept analysis to clarify the meaning of facilitation in the critical care context by formulating attributes,antecedents,and consequences and providing model cases related to facilitation.Methods:This analysis was performed by searching online sources published from 1999 to 2023.EBSCOhost,CINAHL,PubMed,and Google Scholar databases were searched using online search engines.The analysis also included the manual search of books,thesaurus and dictionaries that showed relevance to facilitation.Walker and Avant’s eight-step approach was applied to explore and analyze the meaning of facilitation in critical care units.Results:A total of 68 articles were included in the analysis of this study.Eleven attributes,six antecedents,and seven consequences related to facilitation were formulated.The attributes included dynamic,interactive processes,creating a positive environment,mobilizing resources,assistance,studentcentered,shared goals,collaboration,engagement,participation,and feedback.Antecedents were facilitator qualities,motivation,a positive learning environment,student-facilitator relationship,time availability,and specified learning outcomes.The consequences of facilitation were identified as follows:change,professional development,competency,quality development,increased job satisfaction,staff retention,and self-confidence.Conclusions:The findings from the analysis indicated that effective facilitation results in nurses and critical care staff developing competency,caring,critical thinking,and independence.Therefore,clinical outcomes in critical care environments are improved through teamwork,decision-making,and problemsolving in life-threatening situations.展开更多
Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. Th...Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. This letter reports a dropout neuronal unit(1R1T-DNU) based on one memristor–one electrolyte-gated transistor with an ultralow energy consumption of 25 p J/spike. A dropout neural network is constructed based on such a device and has been verified by MNIST dataset, demonstrating high recognition accuracies(> 90%) within a large range of dropout probabilities up to40%. The running time can be reduced by increasing dropout probability without a significant loss in accuracy. Our results indicate the great potential of introducing such 1R1T-DNUs in full-hardware neural networks to enhance energy efficiency and to solve the overfitting problem.展开更多
BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognos...BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.展开更多
BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modi...BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.展开更多
In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden produc...In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden production. Today, the dynamics of the filao strip in the Dakar region tend to take on significant proportions under the impetus of natural and anthropogenic factors that threaten its sustainability. It is in this context that this study attempts to analyze the relationship between the dynamics of the land-use units of the filao strip and the natural and anthropogenic factors at the origin of its modification. The diachronic study of Landsat Multispectral Scanner System (1978), Thematic Mapper (1990), Enhance Thematic Mapper Plus (2006) and Operational Land Imager (2020) satellite images through the directed pixel-oriented classification method, cartographic information systems and qualitative surveys have been applied. The results based on the analysis of the data obtained show that both natural and anthropogenic factors are at the root of the profound changes observed in the filao strip. They reveal that the average annual progression rates of the open filao strip and the built-up area exceed 100%, and that the closed filao strip classes regressed by −16.2%, the sand dunes by −62.9% and the beach by −18.2% between 1978 and 2020. In short, the study shows that the landscape of the Niayes zone is marked by anthropization, leading to the degradation of the filao strip and natural ecosystems. The shrinking surface area of the increasingly anthropized closed filao strip represents a threat to its future.展开更多
Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the ...Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the Drâa Tafilalet region through a diagnostic study conducted by surveying 12 date-packing units. Interviews and surveys were conducted among 12 date packaging units provided by the State to Economic Interest Groups (EIG) in the Drâa-Tafilalet region. Data focused on general EIG information, unit identification, a four-year operational overview, and 2021 palm date processing activities. To streamline analysis, units were categorized into two groups based on packaging capacity: Group 1 (≥400 tons) and Group 2 (<400 tons). The assessment revealed that the packaging units had enhanced this crucial link in the dating industry and introduced a new dynamic in the date marketing chain. However, operational expertise and optimal equipment utilization often fall short, with over 50% of the EIG failing to use provided equipment, except for cold storage rooms. The chain involves a series of operations to preserve the stored product’s intrinsic and extrinsic quality. Evaluated practices include fumigation, meticulous sorting to eliminate visually anomalous dates, calibration during packaging, and storage at temperatures ranging from 0 to 4˚C with humidity levels between 50 and 80%, varying based on the date’s nature (soft, dry, or semi-dry). Expertise in this process mitigates the risk of desiccation or excessive rehydration, preventing date fermentation. Finally, to reduce their energy consumption and solve the balance sheet deficit issue, the government has equipped all the date packaging units from Group 1 and one from Group 2 in the Daraa Tafilalet region with photovoltaic energy. The date packaging infrastructure has boosted the value of Moroccan dates, benefiting small-scale agriculture. Despite improved packaging quality and job creation, suboptimal equipment usage by over 50% of EIGs emphasizes the need for enhanced operational efficiency.展开更多
BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-...BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.展开更多
There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore,...There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.展开更多
The SI system of units in rotational mechanics yields correct numerical results, but it produces physically incorrect units of measure in many cases. SI units also violate the principle of general covariance—the gene...The SI system of units in rotational mechanics yields correct numerical results, but it produces physically incorrect units of measure in many cases. SI units also violate the principle of general covariance—the general rule for defining continuous coordinates and units in mathematics and mathematical physics. After 30+ years of wrestling with these problems, the ultimate authority on units of measure has declared that Newton–meter and Joule are not equivalent in rotational mechanics, as they are in the rest of physics. This article proposes a simple modification to SI units called “Nonstandard International units” (“NI units”) until a better name is agreed upon. NI units yield correct numerical results and physically correct units of measure, and they satisfy the principle of general covariance. The main obstacle to the adoption of NI units is the consensus among users that the radius of rotation should have the unit meter because the radius can be measured with a ruler. NI units assigned to radius should have units meter/radian because the radius is a conversion factor between angular size and circumferential length, as in arclength = rθ. To manage the social consensus behind SI units, the author recommends retaining SI units as they are, and informing users who want correct units that NI units solve the technical problems of SI units.展开更多
Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(M...Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(MFSM)method.Methods This study established the MFSM method.To demonstrate its effectiveness,we applied this novel approach to analyze Danxi Granules(丹膝颗粒,DXG)and its constituent herbal materials.To begin with,the ultra-performance liquid chromatography(UPLC)was applied to obtain the chromatographic fingerprints of DXG and its constituent herbal materi-als.Next,the MFSM was leveraged to compress and integrate them into a new fingerprint with fewer analytical units.Then,we characterized the properties and variability of both the original and integrated fingerprints by calculating total quantum statistical moment(TQSM)parameters,information entropy and information amount,along with their relative standard deviation(RSD).Finally,we compared the TQSM parameters,information entropy and infor-mation amount,and their RSD between the traditional and novel fingerprints to validate the new analytical method.Results The chromatographic peaks of DXG and its 12 raw herbal materials were divided and integrated into peak families by the MFSM method.Before integration,the ranges of the peak number,three TQSM parameters,information entropy and information amount for each peak or peak family of UPLC fingerprints of DXG and its 12 raw herbal materials were 95.07−209.73,9390−183064μv·s,5.928−21.33 min,22.62−106.69 min^(2),4.230−6.539,and 50530−974186μv·s,respectively.After integration,the ranges of these parameters were 10.00−88.00,9390−183064μv·s,5.951−22.02 min,22.27−104.73 min^(2),2.223−5.277,and 38159−807200μv·s,respectively.Correspondingly,the RSD of all the aforementioned pa-rameters before integration were 2.12%−9.15%,6.04%−49.78%,1.15%−23.10%,3.97%−25.79%,1.49%−19.86%,and 6.64%−51.20%,respectively.However,after integration,they changed to 0.00%,6.04%−49.87%,1.73%−23.02%,3.84%−26.85%,1.17%−16.54%,and 6.40%−48.59%,respectively.The results demonstrated that in the newly integrated fingerprint,the analytical units of constituent herbal materials,information entropy and information amount were significantly reduced(P<0.05),while the TQSM parameters remained unchanged(P>0.05).Additionally,the RSD of the TQSM parameters,information entropy,and information amount didn’t show significant difference before and after integration(P>0.05),but the RSD of the number and area of the integrated analytical units significantly decreased(P<0.05).Conclusion The MFSM method could reduce the analytical units of constituent herbal mate-rials while maintain the properties and variability from their original fingerprint.Thus,it could serve as a feasible and reliable tool to reduce difficulties in analyzing multi-compo-nents within CMMs and facilitating the evaluation of their quality.展开更多
Objective:To investigate the impact of a family participatory management model in the critical care wards of the Department of Obstetrics and Gynecology.Methods:Space resources in the obstetrics and gynecology intensi...Objective:To investigate the impact of a family participatory management model in the critical care wards of the Department of Obstetrics and Gynecology.Methods:Space resources in the obstetrics and gynecology intensive care unit were reorganized and optimally allocated.Nurses received training and assessment on family-integrated management knowledge specific to the obstetrics and gynecology ICU.Management rules and regulations for family-integrated care were established.Primary caregivers were encouraged and supported to participate in specialized education and caregiving during the hospitalization of pregnant women.Results:Key outcomes such as labor duration,delivery outcomes,neonatal nursing skills,length of hospital stay,and psychological parameters(measured using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale)were compared between groups before and after the intervention.Patient and family satisfaction were also evaluated.Conclusion:Family-integrated ward management effectively shortened the labor process,reduced patient anxiety,decreased hospitalization duration,and enhanced family satisfaction.展开更多
The traditional teaching methods of one-way cultivation of students can no longer meet the requirements of talent cultivation at this stage.The issue of how to promote students from passive acceptance to the independe...The traditional teaching methods of one-way cultivation of students can no longer meet the requirements of talent cultivation at this stage.The issue of how to promote students from passive acceptance to the independent cognitive understanding stage(i.e.deep learning)has become the focus of geography teaching.Therefore,under the guidance of deep learning theory,this paper takes the“landforms”knowledge unit of the Humanistic Education Edition as an example,improves the classroom teaching means through the unit teaching mode,reconstructs the“landforms”teaching unit,and explores the specific teaching of high school geography unit based on deep learning.This study provides a good example and guidelines for high school geography teaching and learning.展开更多
The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,...The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.展开更多
Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medicati...Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medication reconciliation in healthcare facilities to reduce them and ensure patients a safe, high-quality healthcare pathway. Objective: This study aimed to detect medication errors by reconciling drug treatments and assess the relevance and feasibility of this standardized practice within the Medical Emergency Unit of the Teaching Pediatric Hospital of Ouagadougou (Burkina Faso). Methods: Patients whose parents gave their consent at their entrance were enrolled. For each patient, the pharmacy team completed a reconciliation form that included the patient’s usual treatment, which was taken and in progress and received upon admission to the medical emergency unit. Patients’ treatments were reviewed to detect and characterize discrepancies. The data of each form were reported and analyzed using KoboCollect, an Android application. Results: 135 records and 412 medication lines were captured over six weeks. The average time of treatment reconciliation per patient was 57 minutes. One thousand one hundred ninety-eight (1198) intentional discrepancies were detected, of which 6.09% were documented. Seventy-one (71) unintentional discrepancies were collected, including 39 omissions, 24 regimen dosing errors, and 8 pharmaceutical form dosage errors. Forty-nine (49) unintentional discrepancies, or 69.01%, were corrected by formulated pharmaceutical interventions toward physicians. Conclusion: Medical treatment reconciliation during hospital admission is critical because discrepancies can compromise the efficacy and/or safety of the patient’s hospital medication.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
基金supported by the National Natural Science Foundation of China,Nos.81974207(to JH),82001383(to DW)the Special Clinical Research Project of Health Profession of Shanghai Municipal Health Commission,No.20204Y0076(to DW)。
文摘Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell proliferation and differentiation,thereby exerting neuroprotective effects.However,the beneficial effects of endogenous VEGFA/b FGF are limited as their expression is only transiently increased.In this study,we generated multilayered nanofiber membranes loaded with VEGFA/b FGF using layer-by-layer self-assembly and electrospinning techniques.We found that a membrane containing 10 layers had an ideal ultrastructure and could efficiently and stably release growth factors for more than 1 month.This 10-layered nanofiber membrane promoted brain microvascular endothelial cell tube formation and proliferation,inhibited neuronal apoptosis,upregulated the expression of tight junction proteins,and improved the viability of various cellular components of neurovascular units under conditions of oxygen/glucose deprivation.Furthermore,this nanofiber membrane decreased the expression of Janus kinase-2/signal transducer and activator of transcription-3(JAK2/STAT3),Bax/Bcl-2,and cleaved caspase-3.Therefore,this nanofiber membrane exhibits a neuroprotective effect on oxygen/glucose-deprived neurovascular units by inhibiting the JAK2/STAT3 pathway.
基金The work is supported by the National Natural Science Foundation of China(Nos.U21A20124 and 52205059)the Key Research and Development Program of Zhejiang Province(No.2022C01039)。
文摘Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadruped robots show great potential in unstructured environments due to their discrete landing positions and large payloads.As the most critical movement unit of a quadruped robot,the limb leg unit(LLU)directly affects movement speed and reliability,and requires a compact and lightweight design.Inspired by the dexterous skeleton–muscle systems of cheetahs and humans,this paper proposes a highly integrated bionic actuator system for a better dynamic performance of an LLU.We propose that a cylinder barrel with multiple element interfaces and internal smooth channels is realized using metal additive manufacturing,and hybrid lattice structures are introduced into the lightweight design of the piston rod.In addition,additive manufacturing and topology optimization are incorporated to reduce the redundant material of the structural parts of the LLU.The mechanical properties of the actuator system are verified by numerical simulation and experiments,and the power density of the actuators is far greater than that of cheetah muscle.The mass of the optimized LLU is reduced by 24.5%,and the optimized LLU shows better response time performance when given a step signal,and presents a good trajectory tracking ability with the increase in motion frequency.
文摘Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.
文摘Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.
文摘Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains unprecise in a critical care context despite its frequent usage in nursing education and clinical practice.This study aimed to report a thorough concept analysis to clarify the meaning of facilitation in the critical care context by formulating attributes,antecedents,and consequences and providing model cases related to facilitation.Methods:This analysis was performed by searching online sources published from 1999 to 2023.EBSCOhost,CINAHL,PubMed,and Google Scholar databases were searched using online search engines.The analysis also included the manual search of books,thesaurus and dictionaries that showed relevance to facilitation.Walker and Avant’s eight-step approach was applied to explore and analyze the meaning of facilitation in critical care units.Results:A total of 68 articles were included in the analysis of this study.Eleven attributes,six antecedents,and seven consequences related to facilitation were formulated.The attributes included dynamic,interactive processes,creating a positive environment,mobilizing resources,assistance,studentcentered,shared goals,collaboration,engagement,participation,and feedback.Antecedents were facilitator qualities,motivation,a positive learning environment,student-facilitator relationship,time availability,and specified learning outcomes.The consequences of facilitation were identified as follows:change,professional development,competency,quality development,increased job satisfaction,staff retention,and self-confidence.Conclusions:The findings from the analysis indicated that effective facilitation results in nurses and critical care staff developing competency,caring,critical thinking,and independence.Therefore,clinical outcomes in critical care environments are improved through teamwork,decision-making,and problemsolving in life-threatening situations.
基金Project supported by the National Key Research and Development Program of China (Grant Nos. 2021YFA1202600 and 2023YFE0208600)in part by the National Natural Science Foundation of China (Grant Nos. 62174082, 92364106, 61921005, 92364204, and 62074075)。
文摘Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. This letter reports a dropout neuronal unit(1R1T-DNU) based on one memristor–one electrolyte-gated transistor with an ultralow energy consumption of 25 p J/spike. A dropout neural network is constructed based on such a device and has been verified by MNIST dataset, demonstrating high recognition accuracies(> 90%) within a large range of dropout probabilities up to40%. The running time can be reduced by increasing dropout probability without a significant loss in accuracy. Our results indicate the great potential of introducing such 1R1T-DNUs in full-hardware neural networks to enhance energy efficiency and to solve the overfitting problem.
文摘BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.
基金Supported by Research Project of Zhejiang Provincial Department of Education,No.Y202045115.
文摘BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.
文摘In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden production. Today, the dynamics of the filao strip in the Dakar region tend to take on significant proportions under the impetus of natural and anthropogenic factors that threaten its sustainability. It is in this context that this study attempts to analyze the relationship between the dynamics of the land-use units of the filao strip and the natural and anthropogenic factors at the origin of its modification. The diachronic study of Landsat Multispectral Scanner System (1978), Thematic Mapper (1990), Enhance Thematic Mapper Plus (2006) and Operational Land Imager (2020) satellite images through the directed pixel-oriented classification method, cartographic information systems and qualitative surveys have been applied. The results based on the analysis of the data obtained show that both natural and anthropogenic factors are at the root of the profound changes observed in the filao strip. They reveal that the average annual progression rates of the open filao strip and the built-up area exceed 100%, and that the closed filao strip classes regressed by −16.2%, the sand dunes by −62.9% and the beach by −18.2% between 1978 and 2020. In short, the study shows that the landscape of the Niayes zone is marked by anthropization, leading to the degradation of the filao strip and natural ecosystems. The shrinking surface area of the increasingly anthropized closed filao strip represents a threat to its future.
文摘Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the Drâa Tafilalet region through a diagnostic study conducted by surveying 12 date-packing units. Interviews and surveys were conducted among 12 date packaging units provided by the State to Economic Interest Groups (EIG) in the Drâa-Tafilalet region. Data focused on general EIG information, unit identification, a four-year operational overview, and 2021 palm date processing activities. To streamline analysis, units were categorized into two groups based on packaging capacity: Group 1 (≥400 tons) and Group 2 (<400 tons). The assessment revealed that the packaging units had enhanced this crucial link in the dating industry and introduced a new dynamic in the date marketing chain. However, operational expertise and optimal equipment utilization often fall short, with over 50% of the EIG failing to use provided equipment, except for cold storage rooms. The chain involves a series of operations to preserve the stored product’s intrinsic and extrinsic quality. Evaluated practices include fumigation, meticulous sorting to eliminate visually anomalous dates, calibration during packaging, and storage at temperatures ranging from 0 to 4˚C with humidity levels between 50 and 80%, varying based on the date’s nature (soft, dry, or semi-dry). Expertise in this process mitigates the risk of desiccation or excessive rehydration, preventing date fermentation. Finally, to reduce their energy consumption and solve the balance sheet deficit issue, the government has equipped all the date packaging units from Group 1 and one from Group 2 in the Daraa Tafilalet region with photovoltaic energy. The date packaging infrastructure has boosted the value of Moroccan dates, benefiting small-scale agriculture. Despite improved packaging quality and job creation, suboptimal equipment usage by over 50% of EIGs emphasizes the need for enhanced operational efficiency.
文摘BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.
文摘There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.
文摘The SI system of units in rotational mechanics yields correct numerical results, but it produces physically incorrect units of measure in many cases. SI units also violate the principle of general covariance—the general rule for defining continuous coordinates and units in mathematics and mathematical physics. After 30+ years of wrestling with these problems, the ultimate authority on units of measure has declared that Newton–meter and Joule are not equivalent in rotational mechanics, as they are in the rest of physics. This article proposes a simple modification to SI units called “Nonstandard International units” (“NI units”) until a better name is agreed upon. NI units yield correct numerical results and physically correct units of measure, and they satisfy the principle of general covariance. The main obstacle to the adoption of NI units is the consensus among users that the radius of rotation should have the unit meter because the radius can be measured with a ruler. NI units assigned to radius should have units meter/radian because the radius is a conversion factor between angular size and circumferential length, as in arclength = rθ. To manage the social consensus behind SI units, the author recommends retaining SI units as they are, and informing users who want correct units that NI units solve the technical problems of SI units.
基金Natural Science Foundation of Hunan province(2022JJ30453 and 2024JJ6362)the Key Research and Development Program of Hunan Province(2022SK2014).
文摘Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(MFSM)method.Methods This study established the MFSM method.To demonstrate its effectiveness,we applied this novel approach to analyze Danxi Granules(丹膝颗粒,DXG)and its constituent herbal materials.To begin with,the ultra-performance liquid chromatography(UPLC)was applied to obtain the chromatographic fingerprints of DXG and its constituent herbal materi-als.Next,the MFSM was leveraged to compress and integrate them into a new fingerprint with fewer analytical units.Then,we characterized the properties and variability of both the original and integrated fingerprints by calculating total quantum statistical moment(TQSM)parameters,information entropy and information amount,along with their relative standard deviation(RSD).Finally,we compared the TQSM parameters,information entropy and infor-mation amount,and their RSD between the traditional and novel fingerprints to validate the new analytical method.Results The chromatographic peaks of DXG and its 12 raw herbal materials were divided and integrated into peak families by the MFSM method.Before integration,the ranges of the peak number,three TQSM parameters,information entropy and information amount for each peak or peak family of UPLC fingerprints of DXG and its 12 raw herbal materials were 95.07−209.73,9390−183064μv·s,5.928−21.33 min,22.62−106.69 min^(2),4.230−6.539,and 50530−974186μv·s,respectively.After integration,the ranges of these parameters were 10.00−88.00,9390−183064μv·s,5.951−22.02 min,22.27−104.73 min^(2),2.223−5.277,and 38159−807200μv·s,respectively.Correspondingly,the RSD of all the aforementioned pa-rameters before integration were 2.12%−9.15%,6.04%−49.78%,1.15%−23.10%,3.97%−25.79%,1.49%−19.86%,and 6.64%−51.20%,respectively.However,after integration,they changed to 0.00%,6.04%−49.87%,1.73%−23.02%,3.84%−26.85%,1.17%−16.54%,and 6.40%−48.59%,respectively.The results demonstrated that in the newly integrated fingerprint,the analytical units of constituent herbal materials,information entropy and information amount were significantly reduced(P<0.05),while the TQSM parameters remained unchanged(P>0.05).Additionally,the RSD of the TQSM parameters,information entropy,and information amount didn’t show significant difference before and after integration(P>0.05),but the RSD of the number and area of the integrated analytical units significantly decreased(P<0.05).Conclusion The MFSM method could reduce the analytical units of constituent herbal mate-rials while maintain the properties and variability from their original fingerprint.Thus,it could serve as a feasible and reliable tool to reduce difficulties in analyzing multi-compo-nents within CMMs and facilitating the evaluation of their quality.
基金supported by a grant from the project of Wenzhou Science and Technology Bureau(Grant No.Y2023597).
文摘Objective:To investigate the impact of a family participatory management model in the critical care wards of the Department of Obstetrics and Gynecology.Methods:Space resources in the obstetrics and gynecology intensive care unit were reorganized and optimally allocated.Nurses received training and assessment on family-integrated management knowledge specific to the obstetrics and gynecology ICU.Management rules and regulations for family-integrated care were established.Primary caregivers were encouraged and supported to participate in specialized education and caregiving during the hospitalization of pregnant women.Results:Key outcomes such as labor duration,delivery outcomes,neonatal nursing skills,length of hospital stay,and psychological parameters(measured using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale)were compared between groups before and after the intervention.Patient and family satisfaction were also evaluated.Conclusion:Family-integrated ward management effectively shortened the labor process,reduced patient anxiety,decreased hospitalization duration,and enhanced family satisfaction.
文摘The traditional teaching methods of one-way cultivation of students can no longer meet the requirements of talent cultivation at this stage.The issue of how to promote students from passive acceptance to the independent cognitive understanding stage(i.e.deep learning)has become the focus of geography teaching.Therefore,under the guidance of deep learning theory,this paper takes the“landforms”knowledge unit of the Humanistic Education Edition as an example,improves the classroom teaching means through the unit teaching mode,reconstructs the“landforms”teaching unit,and explores the specific teaching of high school geography unit based on deep learning.This study provides a good example and guidelines for high school geography teaching and learning.
基金supported by the State Grid Corporation of China Science and Technology Project,grant number 52270723000900K.
文摘The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.
文摘Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medication reconciliation in healthcare facilities to reduce them and ensure patients a safe, high-quality healthcare pathway. Objective: This study aimed to detect medication errors by reconciling drug treatments and assess the relevance and feasibility of this standardized practice within the Medical Emergency Unit of the Teaching Pediatric Hospital of Ouagadougou (Burkina Faso). Methods: Patients whose parents gave their consent at their entrance were enrolled. For each patient, the pharmacy team completed a reconciliation form that included the patient’s usual treatment, which was taken and in progress and received upon admission to the medical emergency unit. Patients’ treatments were reviewed to detect and characterize discrepancies. The data of each form were reported and analyzed using KoboCollect, an Android application. Results: 135 records and 412 medication lines were captured over six weeks. The average time of treatment reconciliation per patient was 57 minutes. One thousand one hundred ninety-eight (1198) intentional discrepancies were detected, of which 6.09% were documented. Seventy-one (71) unintentional discrepancies were collected, including 39 omissions, 24 regimen dosing errors, and 8 pharmaceutical form dosage errors. Forty-nine (49) unintentional discrepancies, or 69.01%, were corrected by formulated pharmaceutical interventions toward physicians. Conclusion: Medical treatment reconciliation during hospital admission is critical because discrepancies can compromise the efficacy and/or safety of the patient’s hospital medication.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
