Elliptic curve(EC)based cryptosystems gained more attention due to enhanced security than the existing public key cryptosystems.A substitution box(S-box)plays a vital role in securing modern symmetric key cryptosystem...Elliptic curve(EC)based cryptosystems gained more attention due to enhanced security than the existing public key cryptosystems.A substitution box(S-box)plays a vital role in securing modern symmetric key cryptosystems.However,the recently developed EC based algorithms usually trade off between computational efficiency and security,necessitating the design of a new algorithm with the desired cryptographic strength.To address these shortcomings,this paper proposes a new scheme based onMordell elliptic curve(MEC)over the complex field for generating distinct,dynamic,and highly uncorrelated S-boxes.Furthermore,we count the exact number of the obtained S-boxes,and demonstrate that the permuted version of the presented S-box is statistically optimal.The nonsingularity of the presented algorithm and the injectivity of the resultant output are explored.Rigorous theoretical analysis and experimental results demonstrate that the proposedmethod is highly effective in generating a large number of dynamic S-boxes with adequate cryptographic properties,surpassing current state-of-the-art S-box generation algorithms in terms of security.Apart fromthis,the generated S-box is benchmarked using side-channel attacks,and its performance is compared with highly nonlinear S-boxes,demonstrating comparable results.In addition,we present an application of our proposed S-box generator by incorporating it into an image encryption technique.The encrypted and decrypted images are tested by employing extensive standard security metrics,including the Number of Pixel Change Rate,the Unified Average Changing Intensity,information entropy,correlation coefficient,and histogram analysis.Moreover,the analysis is extended beyond conventional metrics to validate the new method using advanced tests,such as the NIST statistical test suite,robustness analysis,and noise and cropping attacks.Experimental outcomes show that the presented algorithm strengthens the existing encryption scheme against various well-known cryptographic attacks.展开更多
Violet phosphorus,a recently explored layered elemental semiconductor,has attracted much attention due to its unique photoelectric,mechanical properties,and high hole mobility.Herein,violet arsenic phosphorus has for ...Violet phosphorus,a recently explored layered elemental semiconductor,has attracted much attention due to its unique photoelectric,mechanical properties,and high hole mobility.Herein,violet arsenic phosphorus has for the first time been synthesized by a molten lead method.The crystal structure of violet arsenic phosphorus(P^(83.4)As_(0.6),CSD-2408761)was determined by single crystal X-ray diffraction to have similar structure as that of violet phosphorus,where P12 is occupied by arsenic/phosphorus(As/P)atoms as mixed occupancy sites As1/P12.The arsenic substitution has been demonstrated to tune the band structure of violet phosphorus,switching p-type of violet phosphorus to high-performance n-type violet arsenic phosphorus.The effective electron mass along the<010>direction is significantly reduced from 1.792 to 0.515 m_(0)by arsenic substitution,resulting in an extremely high electron mobility of 2622.503 cm^(2)V^(-1)s^(-1).The field effect transistor built with P_(83.4)As_(0.6)nanosheets was measured to have a high electron mobility(137.06 cm^(2)V^(-1)s^(-1),61.2 nm),even under ambient conditions for 5 h,much higher than the hole mobility of violet phosphorene nanosheets(4.07 cm^(2)V^(-1)s^(-1),73.3 nm).This work provides a new idea for designing phosphorus-based materials for field effect transistors,giving significant potential in complementary metal-oxide-semiconductor applications.展开更多
Thinopyrum ponticum(2n=10×=70),a wild relative of common wheat(Triticum aestivum L.),is considered an invaluable genetic resource for wheat improvement due to its abundance of genes conferring resistance to bioti...Thinopyrum ponticum(2n=10×=70),a wild relative of common wheat(Triticum aestivum L.),is considered an invaluable genetic resource for wheat improvement due to its abundance of genes conferring resistance to biotic and abiotic stresses.This study focused on the CH97 line,derived from the BC1F7 progeny of a cross between wheat cv.7182 and Th.ponticum.Cytological evidence showed that CH97 has 42 chromosomes,forming 21 bivalents at meiotic metaphase I,with the bivalents subsequently separating and moving to opposite poles during meiotic anaphase I.Through a combination of fluorescence in situ hybridization(FISH),genomic in situ hybridization(GISH),multicolor GISH(mc-GISH),and liquid array analysis,it was determined that CH97 comprises 40 wheat chromosomes and two alien chromosomes from the Ee genome of Th.ponticum,featuring the absence of a pair of 5D chromosomes and variations in 1B,6B,and 7B chromosomes.These findings confirm that CH97 is a stable wheat-Th.ponticum 5E(5D)alien disomic substitution line.Inoculation experiments revealed that CH97 exhibits high resistance to wheat powdery mildew and stripe rust throughout the growth period,in contrast to the highly susceptible common wheat parent 7182.Compared to 7182,CH97 displayed improvements in thousand-kernel weight and kernel length.Additionally,utilizing specific-locus amplified fragment sequencing(SLAF-seq)technology,chromosome 5E-specific molecular markers were developed and validated,achieving a 33.3% success rate,facilitating marker-assisted selection for disease resistance in wheat.Overall,the CH97 substitution line,with its resistance to diseases and improved agronomic traits,represents valuable new germplasm for wheat chromosome engineering and breeding.展开更多
Background:The phenomenon of multimorbidity in chronic diseases among the elderly is prevalent,and its significant association with depression poses a serious threat to the physical and mental health of older adults.C...Background:The phenomenon of multimorbidity in chronic diseases among the elderly is prevalent,and its significant association with depression poses a serious threat to the physical and mental health of older adults.Current research on the associations between 24-hour movement behaviors(including physical activity,sedentary behavior,and sleep)and depression has largely been confined to examining the effects of single behaviors,overlooking the intrinsic compositional nature and interrelationships among these behaviors.Therefore,it is necessary to investigate the integrated effects of 24-hour movement behaviors on depression in older adults with multimorbidity from a holistic,compositional perspective.Methods:From November 2024 to April 2025,a total of 226 older adult patients with multimorbidity were recruited from a tertiary hospital in Changzhou City.Data were collected using a general information questionnaire,the International Physical Activity Questionnaire–Short Form(IPAQ-SF),the Pittsburgh Sleep Quality Index(PSQI),and the Patient Health Questionnaire-9(PHQ-9).Compositional data analysis and isotemporal substitution models were employed for statistical analysis.Results:The mean daily durations of Light-Intensity Physical Activity(LPA),Moderate-to-Vigorous Physical Activity(MVPA),Sedentary Behavior(SB),and Sleep(SLP)in older adults with multimorbidity were 402.48 min,12.04 min,511.52 min,and 458.68 min,respectively.The prevalence of depressive symptoms was 37.6%.Compositional data analysis revealed that SB was positively associated with depression(βSB=1.005,P=0.006),while SLP was negatively associated with depression(βSLP=−1.736,P<0.001).No statistically significant associations were found between MVPA or LPA and depression(P>0.05).In the 10-minute isotemporal substitution model,replacing SB with any other behavioral component was associated with a decrease in depression scores.Conversely,substituting SLP with either LPA or SB resulted in an increase in depression scores,while substituting SLP with MVPA led to a decrease in depression scores.The dose-response analysis revealed that,among the isotemporal substitution effects,replacing SB with SLP and replacing SLP with MVPA were the substitution pathways associated with the most rapid decline in depression scores,representing the greatest beneficial health effects.Conclusion:The prevalence of depression is notably high among older adults with multimorbidity.Reducing daily sedentary behavior(SB),maintaining adequate sleep(SLP),and increasing moderate-to-vigorous physical activity(MVPA)can improve depressive symptoms and enhance overall health in this population.展开更多
Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorp...Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorptiometry assessed percent body fat(%BF).Ultrasonography determined muscle cross-sectional area(CSA),echo intensity(EI),and subcutaneous fat(s FAT).MU behavior was assessed during isometric muscle actions at 50%of maximal voluntary contraction(MVC)by analyzing the y-intercepts and slopes for the MU action potential amplitude(MUAPAMP)vs.recruitment threshold(RT)relationships,the A and B terms for the mean firing rate(MFR)vs.RT relationships,and normalized electromyographic amplitude(N-EMGRMS).MU firing times and waveforms were validated with reconstruct-and-test and spike trigger average procedures.Results:%BF was greater for OF(25.70%±5.40%)than NF(16.50%±2.20%;p<0.001).MVC was greater for NF(27.13±7.16)N than OF([19.89±4.96]N;p=0.014).CSA was greater for NF(2.48±0.39)cm^(2)than OF([1.95±0.47]cm^(2);p=0.011).The y-intercepts for the MUAPAMPvs.RT relationships were greater for NF(0.283±0.254)m V than OF([-0.221±0.659]m V;p=0.004).The B terms for the MFR vs.RT relationships were greater for NF(-0.024±0.003)pps/%MVC than OF([-0.031±0.009]pps/%MVC;p=0.038).N-EMGRMSwas similar between groups(p=0.463).Conclusion:Maximal strength,muscle size,and MU recruitment and firing rate patterns for a non-weight bearing muscle differed between normal-fat and over-fat males.展开更多
Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automaticall...Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automatically and manually corrected hydrological slope unit division,the Longhua District,Shenzhen City,Guangdong Province,was selected as the study area.A total of 15 influencing factors,namely Fluctuation,slope,slope aspect,curvature,topographic witness index(TWI),stream power index(SPI),topographic roughness index(TRI),annual average rainfall,distance to water system,engineering rock group,distance to fault,land use,normalized difference vegetation index(NDVI),nighttime light,and distance to road,were selected as evaluation indicators.The information volume model(IV)and random points were used to select non-geological disaster units,and then the random forest model(RF)was used to evaluate the susceptibility to geological disasters.The automatic slope unit and the hydrological slope unit were compared and analyzed in the random forest and information volume random forest models.The results show that the area under the curve(AUC)values of the automatic slope unit evaluation results are 0.931 for the IV-RF model and 0.716 for the RF model,which are 0.6%(IV-RF model)and 1.9%(RF model)higher than those for the hydrological slope unit.Based on a comparison of the evaluation methods based on the two types of slope units,the hydrological slope unit evaluation method based on manual correction is highly subjective,is complicated to operate,and has a low evaluation accuracy,whereas the evaluation method based on automatic slope unit division is efficient and accurate,is suitable for large-scale efficient geological disaster evaluation,and can better deal with the problem of geological disaster susceptibility evaluation.展开更多
1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconn...1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. Th...The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.展开更多
本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―...本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―内容整合―标准研制―实践实施”四步策略,以重构层级化、主题化的单元目标体系。同时,本研究以“人教版”七年级上册Unit 3 My School为例进行实证检验,结果显示,上述策略能有效提升学生的语言、文化、思维、学习能力,实现核心素养的课堂转化,为教师提供可操作的单元整体教学设计指南。展开更多
Partial substitution of chemical fertilizers by organic amendments is adopted widely for promoting the availability of soil phosphorus(P)in agricultural production.However,few studies have comprehensively evaluated th...Partial substitution of chemical fertilizers by organic amendments is adopted widely for promoting the availability of soil phosphorus(P)in agricultural production.However,few studies have comprehensively evaluated the effects of longterm organic substitution on soil P availability and microbial activity in greenhouse vegetable fields.A 10-year(2009–2019)field experiment was carried out to investigate the impacts of organic fertilizer substitution on soil P pools,phosphatase activities and the microbial community,and identify factors that regulate these soil P transformation characteristics.Four treatments included 100%chemical N fertilizer(4 CN),50%substitution of chemical N by manure(2 CN+2 MN),straw(2 CN+2 SN),and combined manure with straw(2 CN+1 MN+1 SN).Compared with the 4 CN treatment,organic substitution treatments increased celery and tomato yields by 6.9-13.8%and 8.6-18.1%,respectively,with the highest yields being in the 2 CN+1 MN+1 SN treatment.After 10 years of fertilization,organic substitution treatments reduced total P and inorganic P accumulation,increased the concentrations of available P,organic P,and microbial biomass P,and promoted phosphatase activities(alkaline and acid phosphomonoesterase,phosphodiesterase,and phytase)and microbial growth in comparison with the 4 CN treatment.Further,organic substitution treatments significantly increased soil C/P,and the partial least squares path model(PLS-PM)revealed that the soil C/P ratio directly and significantly affected phosphatase activities and the microbial biomass and positively influenced soil P pools and vegetable yield.Partial least squares(PLS)regression demonstrated that arbuscular mycorrhizal fungi positively affected phosphatase activities.Our results suggest that organic fertilizer substitution can promote soil P transformation and availability.Combining manure with straw was more effective than applying these materials separately for developing sustainable P management practices.展开更多
Synthetic nitrogen(N)fertilizer has made a great contribution to the improvement of soil fertility and productivity,but excessive application of synthetic N fertilizer may cause agroecosystem risks,such as soil acidif...Synthetic nitrogen(N)fertilizer has made a great contribution to the improvement of soil fertility and productivity,but excessive application of synthetic N fertilizer may cause agroecosystem risks,such as soil acidification,groundwater contamination and biodiversity reduction.Meanwhile,organic substitution has received increasing attention for its ecologically and environmentally friendly and productivity benefits.However,the linkages between manure substitution,crop yield and the underlying microbial mechanisms remain uncertain.To bridge this gap,a three-year field experiment was conducted with five fertilization regimes:i)Control,non-fertilization;CF,conventional synthetic fertilizer application;CF_(1/2)M_(1/2),1/2 N input via synthetic fertilizer and 1/2 N input via manure;CF_(1/4)M_(3/4),1/4 N input synthetic fertilizer and 3/4 N input via manure;M,manure application.All fertilization treatments were designed to have equal N input.Our results showed that all manure substituted treatments achieved high soil fertility indexes(SFI)and productivities by increasing the soil organic carbon(SOC),total N(TN)and available phosphorus(AP)concentrations,and by altering the bacterial community diversity and composition compared with CF.SOC,AP,and the soil C:N ratio were mainly responsible for microbial community variations.The co-occurrence network revealed that SOC and AP had strong positive associations with Rhodospirillales and Burkholderiales,while TN and C:N ratio had positive and negative associations with Micromonosporaceae,respectively.These specific taxa are implicated in soil macroelement turnover.Random Forest analysis predicted that both biotic(bacterial composition and Micromonosporaceae)and abiotic(AP,SOC,SFI,and TN)factors had significant effects on crop yield.The present work strengthens our understanding of the effects of manure substitution on crop yield and provides theoretical support for optimizing fertilization strategies.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
Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluct...Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilit...Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.展开更多
BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA...BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.展开更多
BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’...BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.展开更多
文摘Elliptic curve(EC)based cryptosystems gained more attention due to enhanced security than the existing public key cryptosystems.A substitution box(S-box)plays a vital role in securing modern symmetric key cryptosystems.However,the recently developed EC based algorithms usually trade off between computational efficiency and security,necessitating the design of a new algorithm with the desired cryptographic strength.To address these shortcomings,this paper proposes a new scheme based onMordell elliptic curve(MEC)over the complex field for generating distinct,dynamic,and highly uncorrelated S-boxes.Furthermore,we count the exact number of the obtained S-boxes,and demonstrate that the permuted version of the presented S-box is statistically optimal.The nonsingularity of the presented algorithm and the injectivity of the resultant output are explored.Rigorous theoretical analysis and experimental results demonstrate that the proposedmethod is highly effective in generating a large number of dynamic S-boxes with adequate cryptographic properties,surpassing current state-of-the-art S-box generation algorithms in terms of security.Apart fromthis,the generated S-box is benchmarked using side-channel attacks,and its performance is compared with highly nonlinear S-boxes,demonstrating comparable results.In addition,we present an application of our proposed S-box generator by incorporating it into an image encryption technique.The encrypted and decrypted images are tested by employing extensive standard security metrics,including the Number of Pixel Change Rate,the Unified Average Changing Intensity,information entropy,correlation coefficient,and histogram analysis.Moreover,the analysis is extended beyond conventional metrics to validate the new method using advanced tests,such as the NIST statistical test suite,robustness analysis,and noise and cropping attacks.Experimental outcomes show that the presented algorithm strengthens the existing encryption scheme against various well-known cryptographic attacks.
基金supported by the National Natural Science Foundation of China(Grant No.22175136)the State Key Laboratory of Electrical Insulation and Power Equipment(Grant No.EIPE23127)the Fundamental Research Funds for the Central Universities(xtr052024009,xtr052025002).
文摘Violet phosphorus,a recently explored layered elemental semiconductor,has attracted much attention due to its unique photoelectric,mechanical properties,and high hole mobility.Herein,violet arsenic phosphorus has for the first time been synthesized by a molten lead method.The crystal structure of violet arsenic phosphorus(P^(83.4)As_(0.6),CSD-2408761)was determined by single crystal X-ray diffraction to have similar structure as that of violet phosphorus,where P12 is occupied by arsenic/phosphorus(As/P)atoms as mixed occupancy sites As1/P12.The arsenic substitution has been demonstrated to tune the band structure of violet phosphorus,switching p-type of violet phosphorus to high-performance n-type violet arsenic phosphorus.The effective electron mass along the<010>direction is significantly reduced from 1.792 to 0.515 m_(0)by arsenic substitution,resulting in an extremely high electron mobility of 2622.503 cm^(2)V^(-1)s^(-1).The field effect transistor built with P_(83.4)As_(0.6)nanosheets was measured to have a high electron mobility(137.06 cm^(2)V^(-1)s^(-1),61.2 nm),even under ambient conditions for 5 h,much higher than the hole mobility of violet phosphorene nanosheets(4.07 cm^(2)V^(-1)s^(-1),73.3 nm).This work provides a new idea for designing phosphorus-based materials for field effect transistors,giving significant potential in complementary metal-oxide-semiconductor applications.
基金funded by the Key R&D Program of Yangling Seed Industry Innovation,China(Ylzy-xm-02)the Young Elite Scientists Sponsorship Program by China Association for Science and Technology(2021QNRC001)。
文摘Thinopyrum ponticum(2n=10×=70),a wild relative of common wheat(Triticum aestivum L.),is considered an invaluable genetic resource for wheat improvement due to its abundance of genes conferring resistance to biotic and abiotic stresses.This study focused on the CH97 line,derived from the BC1F7 progeny of a cross between wheat cv.7182 and Th.ponticum.Cytological evidence showed that CH97 has 42 chromosomes,forming 21 bivalents at meiotic metaphase I,with the bivalents subsequently separating and moving to opposite poles during meiotic anaphase I.Through a combination of fluorescence in situ hybridization(FISH),genomic in situ hybridization(GISH),multicolor GISH(mc-GISH),and liquid array analysis,it was determined that CH97 comprises 40 wheat chromosomes and two alien chromosomes from the Ee genome of Th.ponticum,featuring the absence of a pair of 5D chromosomes and variations in 1B,6B,and 7B chromosomes.These findings confirm that CH97 is a stable wheat-Th.ponticum 5E(5D)alien disomic substitution line.Inoculation experiments revealed that CH97 exhibits high resistance to wheat powdery mildew and stripe rust throughout the growth period,in contrast to the highly susceptible common wheat parent 7182.Compared to 7182,CH97 displayed improvements in thousand-kernel weight and kernel length.Additionally,utilizing specific-locus amplified fragment sequencing(SLAF-seq)technology,chromosome 5E-specific molecular markers were developed and validated,achieving a 33.3% success rate,facilitating marker-assisted selection for disease resistance in wheat.Overall,the CH97 substitution line,with its resistance to diseases and improved agronomic traits,represents valuable new germplasm for wheat chromosome engineering and breeding.
基金supported by the 2025 Jiangsu Province Graduate Student Practice Innovation Program(No.SJCX25_1696)the 2024 Changzhou University Educational Research Project(No.GJY2024009).
文摘Background:The phenomenon of multimorbidity in chronic diseases among the elderly is prevalent,and its significant association with depression poses a serious threat to the physical and mental health of older adults.Current research on the associations between 24-hour movement behaviors(including physical activity,sedentary behavior,and sleep)and depression has largely been confined to examining the effects of single behaviors,overlooking the intrinsic compositional nature and interrelationships among these behaviors.Therefore,it is necessary to investigate the integrated effects of 24-hour movement behaviors on depression in older adults with multimorbidity from a holistic,compositional perspective.Methods:From November 2024 to April 2025,a total of 226 older adult patients with multimorbidity were recruited from a tertiary hospital in Changzhou City.Data were collected using a general information questionnaire,the International Physical Activity Questionnaire–Short Form(IPAQ-SF),the Pittsburgh Sleep Quality Index(PSQI),and the Patient Health Questionnaire-9(PHQ-9).Compositional data analysis and isotemporal substitution models were employed for statistical analysis.Results:The mean daily durations of Light-Intensity Physical Activity(LPA),Moderate-to-Vigorous Physical Activity(MVPA),Sedentary Behavior(SB),and Sleep(SLP)in older adults with multimorbidity were 402.48 min,12.04 min,511.52 min,and 458.68 min,respectively.The prevalence of depressive symptoms was 37.6%.Compositional data analysis revealed that SB was positively associated with depression(βSB=1.005,P=0.006),while SLP was negatively associated with depression(βSLP=−1.736,P<0.001).No statistically significant associations were found between MVPA or LPA and depression(P>0.05).In the 10-minute isotemporal substitution model,replacing SB with any other behavioral component was associated with a decrease in depression scores.Conversely,substituting SLP with either LPA or SB resulted in an increase in depression scores,while substituting SLP with MVPA led to a decrease in depression scores.The dose-response analysis revealed that,among the isotemporal substitution effects,replacing SB with SLP and replacing SLP with MVPA were the substitution pathways associated with the most rapid decline in depression scores,representing the greatest beneficial health effects.Conclusion:The prevalence of depression is notably high among older adults with multimorbidity.Reducing daily sedentary behavior(SB),maintaining adequate sleep(SLP),and increasing moderate-to-vigorous physical activity(MVPA)can improve depressive symptoms and enhance overall health in this population.
文摘Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorptiometry assessed percent body fat(%BF).Ultrasonography determined muscle cross-sectional area(CSA),echo intensity(EI),and subcutaneous fat(s FAT).MU behavior was assessed during isometric muscle actions at 50%of maximal voluntary contraction(MVC)by analyzing the y-intercepts and slopes for the MU action potential amplitude(MUAPAMP)vs.recruitment threshold(RT)relationships,the A and B terms for the mean firing rate(MFR)vs.RT relationships,and normalized electromyographic amplitude(N-EMGRMS).MU firing times and waveforms were validated with reconstruct-and-test and spike trigger average procedures.Results:%BF was greater for OF(25.70%±5.40%)than NF(16.50%±2.20%;p<0.001).MVC was greater for NF(27.13±7.16)N than OF([19.89±4.96]N;p=0.014).CSA was greater for NF(2.48±0.39)cm^(2)than OF([1.95±0.47]cm^(2);p=0.011).The y-intercepts for the MUAPAMPvs.RT relationships were greater for NF(0.283±0.254)m V than OF([-0.221±0.659]m V;p=0.004).The B terms for the MFR vs.RT relationships were greater for NF(-0.024±0.003)pps/%MVC than OF([-0.031±0.009]pps/%MVC;p=0.038).N-EMGRMSwas similar between groups(p=0.463).Conclusion:Maximal strength,muscle size,and MU recruitment and firing rate patterns for a non-weight bearing muscle differed between normal-fat and over-fat males.
文摘Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automatically and manually corrected hydrological slope unit division,the Longhua District,Shenzhen City,Guangdong Province,was selected as the study area.A total of 15 influencing factors,namely Fluctuation,slope,slope aspect,curvature,topographic witness index(TWI),stream power index(SPI),topographic roughness index(TRI),annual average rainfall,distance to water system,engineering rock group,distance to fault,land use,normalized difference vegetation index(NDVI),nighttime light,and distance to road,were selected as evaluation indicators.The information volume model(IV)and random points were used to select non-geological disaster units,and then the random forest model(RF)was used to evaluate the susceptibility to geological disasters.The automatic slope unit and the hydrological slope unit were compared and analyzed in the random forest and information volume random forest models.The results show that the area under the curve(AUC)values of the automatic slope unit evaluation results are 0.931 for the IV-RF model and 0.716 for the RF model,which are 0.6%(IV-RF model)and 1.9%(RF model)higher than those for the hydrological slope unit.Based on a comparison of the evaluation methods based on the two types of slope units,the hydrological slope unit evaluation method based on manual correction is highly subjective,is complicated to operate,and has a low evaluation accuracy,whereas the evaluation method based on automatic slope unit division is efficient and accurate,is suitable for large-scale efficient geological disaster evaluation,and can better deal with the problem of geological disaster susceptibility evaluation.
文摘1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.
文摘本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―内容整合―标准研制―实践实施”四步策略,以重构层级化、主题化的单元目标体系。同时,本研究以“人教版”七年级上册Unit 3 My School为例进行实证检验,结果显示,上述策略能有效提升学生的语言、文化、思维、学习能力,实现核心素养的课堂转化,为教师提供可操作的单元整体教学设计指南。
基金supported by the China Agriculture Research System of MOF and MARA(CARS-23-B04)the National Key Research and Development Program of China(2016YFD0201001)。
文摘Partial substitution of chemical fertilizers by organic amendments is adopted widely for promoting the availability of soil phosphorus(P)in agricultural production.However,few studies have comprehensively evaluated the effects of longterm organic substitution on soil P availability and microbial activity in greenhouse vegetable fields.A 10-year(2009–2019)field experiment was carried out to investigate the impacts of organic fertilizer substitution on soil P pools,phosphatase activities and the microbial community,and identify factors that regulate these soil P transformation characteristics.Four treatments included 100%chemical N fertilizer(4 CN),50%substitution of chemical N by manure(2 CN+2 MN),straw(2 CN+2 SN),and combined manure with straw(2 CN+1 MN+1 SN).Compared with the 4 CN treatment,organic substitution treatments increased celery and tomato yields by 6.9-13.8%and 8.6-18.1%,respectively,with the highest yields being in the 2 CN+1 MN+1 SN treatment.After 10 years of fertilization,organic substitution treatments reduced total P and inorganic P accumulation,increased the concentrations of available P,organic P,and microbial biomass P,and promoted phosphatase activities(alkaline and acid phosphomonoesterase,phosphodiesterase,and phytase)and microbial growth in comparison with the 4 CN treatment.Further,organic substitution treatments significantly increased soil C/P,and the partial least squares path model(PLS-PM)revealed that the soil C/P ratio directly and significantly affected phosphatase activities and the microbial biomass and positively influenced soil P pools and vegetable yield.Partial least squares(PLS)regression demonstrated that arbuscular mycorrhizal fungi positively affected phosphatase activities.Our results suggest that organic fertilizer substitution can promote soil P transformation and availability.Combining manure with straw was more effective than applying these materials separately for developing sustainable P management practices.
基金supported by the National Key Research and Development Program of China(2022YFD2301403-2)the Major Special Project of Anhui Province,China(2021d06050003)+2 种基金the Postdoctoral Foundation of Anhui Province,China(2022B638)the Special Project of Zhongke Bengbu Technology Transfer Center,China(ZKBB202103)the Grant of the President Foundation of Hefei Institutes of Physical Science of Chinese Academy of Sciences(YZJJ2023QN37)。
文摘Synthetic nitrogen(N)fertilizer has made a great contribution to the improvement of soil fertility and productivity,but excessive application of synthetic N fertilizer may cause agroecosystem risks,such as soil acidification,groundwater contamination and biodiversity reduction.Meanwhile,organic substitution has received increasing attention for its ecologically and environmentally friendly and productivity benefits.However,the linkages between manure substitution,crop yield and the underlying microbial mechanisms remain uncertain.To bridge this gap,a three-year field experiment was conducted with five fertilization regimes:i)Control,non-fertilization;CF,conventional synthetic fertilizer application;CF_(1/2)M_(1/2),1/2 N input via synthetic fertilizer and 1/2 N input via manure;CF_(1/4)M_(3/4),1/4 N input synthetic fertilizer and 3/4 N input via manure;M,manure application.All fertilization treatments were designed to have equal N input.Our results showed that all manure substituted treatments achieved high soil fertility indexes(SFI)and productivities by increasing the soil organic carbon(SOC),total N(TN)and available phosphorus(AP)concentrations,and by altering the bacterial community diversity and composition compared with CF.SOC,AP,and the soil C:N ratio were mainly responsible for microbial community variations.The co-occurrence network revealed that SOC and AP had strong positive associations with Rhodospirillales and Burkholderiales,while TN and C:N ratio had positive and negative associations with Micromonosporaceae,respectively.These specific taxa are implicated in soil macroelement turnover.Random Forest analysis predicted that both biotic(bacterial composition and Micromonosporaceae)and abiotic(AP,SOC,SFI,and TN)factors had significant effects on crop yield.The present work strengthens our understanding of the effects of manure substitution on crop yield and provides theoretical support for optimizing fertilization strategies.
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.
基金supported by the National Natural Science Foundation of China(Project No.52377082)the Scientific Research Program of Jilin Provincial Department of Education(Project No.JJKH20230123KJ).
文摘Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.
文摘BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.
文摘BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.
