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
Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophy...Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophysiological processes in which heat triggers a cascade of dysregulated inflammatory responses,endothelial dysfunction,coagulation abnormalities,and muscle damage.These processes can lead to multiorgan failure,significantly increasing the risk of mortality.^([2])Given the severity of EHS,early identification and timely intervention are crucial.However,there are no specific diagnostic markers for EHS,^([1])highlighting the need to identify reliable clinical parameters that can assist early decision-making.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 Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery ...BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.展开更多
Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study...Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHEⅡ,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.展开更多
Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU S...Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU SO. No epidemiological data is available on the subject. Objective: Determine the epidemiological and etiological profiles of a pregnant, parturient, or woman who has given birth dead before or within 10 minutes of her admission. Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: In total, 654 maternal deaths, including 153 maternal deaths before admission, were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum, 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel;46.3% were referred without a reference form, 94.3% were referred without venous access. In 10.7%, the reason for evacuation was bleeding from the delivery, with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes, including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: Deaths before admission constitute an increasingly growing problem at CHU SO. A late referral is a determining factor in maternal deaths before admission.展开更多
In this paper, a novel admission scheme is proposed which provides high degrees of quality of service (QoS) guarantees for multimedia traffic carried in mobile networks. The proposed scheme combines the admission cont...In this paper, a novel admission scheme is proposed which provides high degrees of quality of service (QoS) guarantees for multimedia traffic carried in mobile networks. The proposed scheme combines the admission control and bandwidth reservation to guarantee QoS requirements. It considers both local information and remote information to determine whether to accept or reject a connection. In order to embody the characteristics of the algorithms proposed in the article, two traditional algorithms of admission control are used for comparison. In the end of the paper the simulation analyses are given and the results show that the proposed algorithm can adjust the bandwidth according to the current status of networks and decrease the probability of connections forcibly dropped. The most important thing is that the algorithm is based on the multimedia communications and can guarantee the QoS of real time connections through decreasing the bandwidth of non real time connections.展开更多
This study mainly uses the move and step analysis to conduct a contrastive genre analysis on the selected 20 Chinese ad-mission brochures(CABs) and 20 American admission brochures(AABs).Differences in moves,move seque...This study mainly uses the move and step analysis to conduct a contrastive genre analysis on the selected 20 Chinese ad-mission brochures(CABs) and 20 American admission brochures(AABs).Differences in moves,move sequences and step arrange-ments have revealed themselves in this comparison.Firstly,Chinese university admission brochures cast more focus on basic infor-mation about the university,the application procedure and admission criteria,while American universities,besides offering such in-formation,also emphasize the promotional function of the admission brochures.They use appealing and creative moves to commer-cially‘sell'advantages of the university to the potential applicants.Secondly,based on Kress & van Leeuwen's visual grammarsymbolic meaning,images and colors in admission brochures are also explored and analyzed as language.For one thing,after count-ing the frequency of the four categories of images,namely portrait,campus scenery,campus life pictures and graphs,it is foundthat,compared with CABs,AABs have a highly more obvious tendency in using images.The images are used as an effective tool toincrease the sense of credibility,identity-recognition,attract reader's attention,and help understanding,making the facts and in-formation more intuitive.For another thing,the main colors used in the brochures are yet another noticeable feature.Especially inAmerican brochures,universities tend to use their‘traditional colors' in the brochure to achieve a sense of consistency.Some Chi-nese brochures also follow this promotional strategy,yet a large percentage of them do not use any recognizable colors other thanthe printed black and white.Based on these differences,suggestions are put forward from perspectives including choice of movesand steps to improve the quality of CABs,hopefully raising their acceptance in the international level.展开更多
BACKGROUND:The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients.However,most studies only focus on the timing of surgery when patients have alread...BACKGROUND:The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients.However,most studies only focus on the timing of surgery when patients have already been hospitalized,without considering pre-admission waiting time.Therefore,the present study aims to explore the infl uence of admission delay on surgical outcomes.METHODS:In this retrospective study,we recorded admission timing and interval from admission to surgery for included patient.Other covariates were also collected to control confounding.The primary outcome was 1-year mortality.The secondary outcomes were 1-month mortality,3-month mortality,ICU admission and postoperative pneumonia.We mainly used multivariate logistic regression to determine the effect of admission timing on postoperative outcomes.An additional survival analysis was also performed to assess the impact of admission delay on survival status in the fi rst year after operation.RESULTS:The proportion of patients hospitalized on day 0,day 1,day 2 after injury was 25.4%,54.7%and 66.3%,respectively.And 12.6%patients visited hospital one week later after injury.Mean time from admission to surgery was 5.2 days(standard deviation 2.8 days).Hospitalization at one week after injury was a risk factor for 1-year mortality(OR 1.762,95%CI 1.026–3.379,P=0.041).CONCLUSION:Admission delay of more than one week is signifi cantly associated with higher 1-year mortality.As a supplement to the current guidelines which emphasizes early surgery after admission,we also advocate early admission once patients get injured.展开更多
Objective To investigate the association between ambient air pollution and hospital emergency admissions in Beijing. Methods In this study, a semi-parametric generalized additive model （GAM） was used to evaluate the...Objective To investigate the association between ambient air pollution and hospital emergency admissions in Beijing. Methods In this study, a semi-parametric generalized additive model （GAM） was used to evaluate the specific influences of air pollutants （PM10, SO2, and NO2） on hospital emergency admissions with different lag structures from 2009 to 2011, the sex and age specific influences of air pollution and the modifying effect of seasons on air pollution to analyze the possible interaction. Results It was found that a 10μg/m3 increase in concentration of PMlo at lag 03 day, SO2 and NO2 at lag 0 day were associated with an increase of 0.88%, 0.76%, and 1.82% respectively in overall emergency admissions. A 10 lag/m3 increase in concentration of PM10, SO2 and NO2 at lag 5 day were associated with an increase of 1.39%, 1.56%, and 1.18% respectively in cardiovascular disease emergency admissions. For lag 02, a 10 μg/m3 increase in concentration of PM10, SO2 and NO2 were associated with 1.72%, 1.34%, and 2.57% increases respectively in respiratory disease emergency admissions. Conclusion This study further confirmed that short-term exposure to ambient air pollution was associated with increased risk of hospital emergency admissions in Beijing.展开更多
Objective The study is to investigate the associations between visibility, major air pollutants and daily counts of hospital admission in Shanghai, China. Methods Daily data on hospital admission, visibility, and air ...Objective The study is to investigate the associations between visibility, major air pollutants and daily counts of hospital admission in Shanghai, China. Methods Daily data on hospital admission, visibility, and air pollution during 2005‐2008 were obtained from the Shanghai Insurance Bureau （SHIB）, Shanghai Meteorological Bureau, and Shanghai Environmental Monitoring Center, respectively. The generalized additive model （GAM） with penalized splines was used to examine the associations between daily visibility and hospital admission. Results Among various pollutants, PM 2.5 showed strongest correlation with visibility. Decreased visibility was significantly associated with increased risk of hospital admission in Shanghai. An inter‐quartile range decrease in the 2‐day （L01） moving average of visibility corresponded to 3.66% （95%CI： 1.02%, 6.31%）, 4.06% （95%CI： 0.84%, 7.27%）, and 4.32% （95%CI： 1.67%, 6.97%） increase of total, cardiovascular, and respiratory hospitalizations, respectively. Conclusion Our analyses provide the first piece of evidence in China, demonstrating that decreased visibility has an effect on hospital admission, and this finding strengthens the rationale for further limiting air pollution levels in Shanghai.展开更多
As device-to-device(D2D) communications usually reuses the resource of cellular networks, call admission control(CAC) and power control are crucial problems. However in most power control schemes, total data rates or ...As device-to-device(D2D) communications usually reuses the resource of cellular networks, call admission control(CAC) and power control are crucial problems. However in most power control schemes, total data rates or throughput are regarded as optimization criterion. In this paper, a combining call admission control(CAC) and power control scheme under guaranteeing QoS of every user equipment(UE) is proposed. First, a simple CAC scheme is introduced. Then based on the CAC scheme, a combining call admission control and power control scheme is proposed. Next, the performance of the proposed scheme is evaluated. Finally, maximum DUE pair number and average transmitting power is calculated. Simulation results show that D2 D communications with the proposed combining call admission control and power control scheme can effectively improve the maximum DUE pair number under the premise of meeting necessary QoS.展开更多
OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemi...OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。展开更多
The turbine in an LH2/LOX rocket engine is designed as a two-stage supersonic partialadmission turbine. Three-dimensional steady and unsteady simulations were conducted to analyze turbine performance and aerodynamic f...The turbine in an LH2/LOX rocket engine is designed as a two-stage supersonic partialadmission turbine. Three-dimensional steady and unsteady simulations were conducted to analyze turbine performance and aerodynamic forces on rotor blades. Different configurations were employed to investigate the effects of the axial gap and nozzle distribution on the predicted performance and aerodynamic forces. Rotor blades experience unsteady aerodynamic forces because of the partial admission. Aerodynamic forces show periodicity in the admission region, and are close to zero after leaving the admission region. The unsteady forces in frequency domain indicate that components exist in a wide frequency region, and the admission passing frequency is dominant.Those multiples of the rotational frequency which are multiples of the nozzle number in a fulladmission turbine are notable components. Results show that the turbine efficiency decreases as the axial gap between nozzles and the 1 st stage rotor（rotor 1） increases. Fluctuation of the circumferential aerodynamic force on rotor 1 blades decreases with the axial gap increasing. The turbine efficiency decreases as the circumferential spacing between nozzles increases. Fluctuations of the circumferential and axial aerodynamic forces increase as the circumferential spacing increases. As for the non-equidistant nozzle distribution, it produces similar turbine performance and amplitudefrequency characteristics of forces to those of the normal configuration, when the mean spacing is equal to that of the normal case.展开更多
Avionics full duplex switched ethernet（AFDX） is a switched interconnection technology developed to provide reliable data exchange with strong data transmission time guarantees in internal communication of the spacec...Avionics full duplex switched ethernet（AFDX） is a switched interconnection technology developed to provide reliable data exchange with strong data transmission time guarantees in internal communication of the spacecraft or aircraft.Virtual link（VL） is an important concept of AFDX to meet quality of service（QoS） requirements in terms of end-to-end message deadlines.A VL admission control algorithm in AFDX network under hard real-time（HRT） constraints is studied.Based on the scheduling prin-ciple of AFDX protocol,a packet scheduling scheme under HRT constraints is proposed,and after that an efficient VL admission control algorithm is presented.Analytical proof that the algorithm can effectively determine whether VL should be admitted is given.Finally simulative examples are presented to promote the conclusion.展开更多
In network service systems, satisfying quality of service (QoS) is one of the main objectives. Admission control and resource allocation strategy can be used to guarantee the QoS requirement. Based on partially observ...In network service systems, satisfying quality of service (QoS) is one of the main objectives. Admission control and resource allocation strategy can be used to guarantee the QoS requirement. Based on partially observable Markov decision processes (POMDPs), this paper proposes a novel admission control model for video on demand (VOD) service systems with elastic QoS. Elastic QoS is also considered in resource allocation strategy. Policy gradient algorithm is often available to find the solution of POMDP problems, with a satisfactory convergence rate. Through numerical examples, it can be shown that the proposed admission control strategy has better performance than complete admission control strategy.展开更多
Network slicing based fog radio access network(F-RAN) has emerged as a promising architecture to support various novel applications in 5 G-and-beyond wireless networks. However, the co-existence of multiple network sl...Network slicing based fog radio access network(F-RAN) has emerged as a promising architecture to support various novel applications in 5 G-and-beyond wireless networks. However, the co-existence of multiple network slices in F-RANs may lead to significant performance degradation due to the resource competitions among different network slices. In this paper, the downlink F-RANs with a hotspot slice and an Internet of Things(Io T) slice are considered, in which the user equipments(UEs) of different slices share the same spectrum. A novel joint resource allocation and admission control scheme is developed to maximize the number of UEs in the hotspot slice that can be supported with desired quality-of-service, while satisfying the interference constraint of the UEs in the Io T slice. Specifically, the admission control and beamforming vector optimization are performed in the hotspot slice to maximize the number of admitted UEs, while the joint sub-channel and power allocation is performed in the Io T slice to maximize the capability of the UEs in the Io T slice tolerating the interference from the hotspot slice. Numerical results show that our proposed scheme can effectively boost the number of UEs in the hotspot slice compared to the existing baselines.展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
Power efficiency and link reliability are of great impor- tance in hierarchical wireless sensor networks （HWSNs）, espe- cially at the key level, which consists of sensor nodes located only one hop away from the sink...Power efficiency and link reliability are of great impor- tance in hierarchical wireless sensor networks （HWSNs）, espe- cially at the key level, which consists of sensor nodes located only one hop away from the sink node called OHS. The power and admission control problem in HWSNs is comsidered to improve its power efficiency and link reliability. This problem is modeled as a non-cooperative game in which the active OHSs are con- sidered as players. By applying a double-pricing scheme in the definition of OHSs＇ utility function, a Nash Equilibrium solution with network properties is derived. Besides, a distributed algorithm is also proposed to show the dynamic processes to achieve Nash Equilibrium. Finally, the simulation results demonstrate the effec- tiveness of the proposed algorithm.展开更多
Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP p...Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.展开更多
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.
基金funded by Research Fund of Zhejiang Provincial Health Commission (2025KY8662025)。
文摘Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophysiological processes in which heat triggers a cascade of dysregulated inflammatory responses,endothelial dysfunction,coagulation abnormalities,and muscle damage.These processes can lead to multiorgan failure,significantly increasing the risk of mortality.^([2])Given the severity of EHS,early identification and timely intervention are crucial.However,there are no specific diagnostic markers for EHS,^([1])highlighting the need to identify reliable clinical parameters that can assist early decision-making.
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 Nature Science Foundation of China(No.82370336&No.82330014)the Key Research and Development Plan of Heilongjiang Province(2022ZX06C23&JD2023SJ44)the Research Project of the First Affiliated Hospital of Harbin Medical University(No.2021M19).
文摘BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.
文摘Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHEⅡ,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.
文摘Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU SO. No epidemiological data is available on the subject. Objective: Determine the epidemiological and etiological profiles of a pregnant, parturient, or woman who has given birth dead before or within 10 minutes of her admission. Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: In total, 654 maternal deaths, including 153 maternal deaths before admission, were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum, 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel;46.3% were referred without a reference form, 94.3% were referred without venous access. In 10.7%, the reason for evacuation was bleeding from the delivery, with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes, including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: Deaths before admission constitute an increasingly growing problem at CHU SO. A late referral is a determining factor in maternal deaths before admission.
文摘In this paper, a novel admission scheme is proposed which provides high degrees of quality of service (QoS) guarantees for multimedia traffic carried in mobile networks. The proposed scheme combines the admission control and bandwidth reservation to guarantee QoS requirements. It considers both local information and remote information to determine whether to accept or reject a connection. In order to embody the characteristics of the algorithms proposed in the article, two traditional algorithms of admission control are used for comparison. In the end of the paper the simulation analyses are given and the results show that the proposed algorithm can adjust the bandwidth according to the current status of networks and decrease the probability of connections forcibly dropped. The most important thing is that the algorithm is based on the multimedia communications and can guarantee the QoS of real time connections through decreasing the bandwidth of non real time connections.
文摘This study mainly uses the move and step analysis to conduct a contrastive genre analysis on the selected 20 Chinese ad-mission brochures(CABs) and 20 American admission brochures(AABs).Differences in moves,move sequences and step arrange-ments have revealed themselves in this comparison.Firstly,Chinese university admission brochures cast more focus on basic infor-mation about the university,the application procedure and admission criteria,while American universities,besides offering such in-formation,also emphasize the promotional function of the admission brochures.They use appealing and creative moves to commer-cially‘sell'advantages of the university to the potential applicants.Secondly,based on Kress & van Leeuwen's visual grammarsymbolic meaning,images and colors in admission brochures are also explored and analyzed as language.For one thing,after count-ing the frequency of the four categories of images,namely portrait,campus scenery,campus life pictures and graphs,it is foundthat,compared with CABs,AABs have a highly more obvious tendency in using images.The images are used as an effective tool toincrease the sense of credibility,identity-recognition,attract reader's attention,and help understanding,making the facts and in-formation more intuitive.For another thing,the main colors used in the brochures are yet another noticeable feature.Especially inAmerican brochures,universities tend to use their‘traditional colors' in the brochure to achieve a sense of consistency.Some Chi-nese brochures also follow this promotional strategy,yet a large percentage of them do not use any recognizable colors other thanthe printed black and white.Based on these differences,suggestions are put forward from perspectives including choice of movesand steps to improve the quality of CABs,hopefully raising their acceptance in the international level.
文摘BACKGROUND:The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients.However,most studies only focus on the timing of surgery when patients have already been hospitalized,without considering pre-admission waiting time.Therefore,the present study aims to explore the infl uence of admission delay on surgical outcomes.METHODS:In this retrospective study,we recorded admission timing and interval from admission to surgery for included patient.Other covariates were also collected to control confounding.The primary outcome was 1-year mortality.The secondary outcomes were 1-month mortality,3-month mortality,ICU admission and postoperative pneumonia.We mainly used multivariate logistic regression to determine the effect of admission timing on postoperative outcomes.An additional survival analysis was also performed to assess the impact of admission delay on survival status in the fi rst year after operation.RESULTS:The proportion of patients hospitalized on day 0,day 1,day 2 after injury was 25.4%,54.7%and 66.3%,respectively.And 12.6%patients visited hospital one week later after injury.Mean time from admission to surgery was 5.2 days(standard deviation 2.8 days).Hospitalization at one week after injury was a risk factor for 1-year mortality(OR 1.762,95%CI 1.026–3.379,P=0.041).CONCLUSION:Admission delay of more than one week is signifi cantly associated with higher 1-year mortality.As a supplement to the current guidelines which emphasizes early surgery after admission,we also advocate early admission once patients get injured.
基金supported by the Gong-Yi Program of China Meteorological Administration(GYHY201106034)the Fundamental Research Funds for the Central Universities(lzuibky-2013-m03)+2 种基金National Natural Science Foundation of China(41075103)National Natural Science Foundation of China(41075102)National Natural Science Foundation of China(41305105)
文摘Objective To investigate the association between ambient air pollution and hospital emergency admissions in Beijing. Methods In this study, a semi-parametric generalized additive model （GAM） was used to evaluate the specific influences of air pollutants （PM10, SO2, and NO2） on hospital emergency admissions with different lag structures from 2009 to 2011, the sex and age specific influences of air pollution and the modifying effect of seasons on air pollution to analyze the possible interaction. Results It was found that a 10μg/m3 increase in concentration of PMlo at lag 03 day, SO2 and NO2 at lag 0 day were associated with an increase of 0.88%, 0.76%, and 1.82% respectively in overall emergency admissions. A 10 lag/m3 increase in concentration of PM10, SO2 and NO2 at lag 5 day were associated with an increase of 1.39%, 1.56%, and 1.18% respectively in cardiovascular disease emergency admissions. For lag 02, a 10 μg/m3 increase in concentration of PM10, SO2 and NO2 were associated with 1.72%, 1.34%, and 2.57% increases respectively in respiratory disease emergency admissions. Conclusion This study further confirmed that short-term exposure to ambient air pollution was associated with increased risk of hospital emergency admissions in Beijing.
基金funded by the National Basic Research Program (973 program) of China (2011CB503802)Gong‐Yi Program of China Ministry of Environmental Protection (200809109)+3 种基金National Natural Science Foundation of China (30800892)Shanghai Pu Jiang Program (09PJ1401700)Program for New Century Excellent Talents in University (NCET‐09‐0314)and National High Technology Research and Development Program of China (863 Program) (2007AA06Z409)
文摘Objective The study is to investigate the associations between visibility, major air pollutants and daily counts of hospital admission in Shanghai, China. Methods Daily data on hospital admission, visibility, and air pollution during 2005‐2008 were obtained from the Shanghai Insurance Bureau （SHIB）, Shanghai Meteorological Bureau, and Shanghai Environmental Monitoring Center, respectively. The generalized additive model （GAM） with penalized splines was used to examine the associations between daily visibility and hospital admission. Results Among various pollutants, PM 2.5 showed strongest correlation with visibility. Decreased visibility was significantly associated with increased risk of hospital admission in Shanghai. An inter‐quartile range decrease in the 2‐day （L01） moving average of visibility corresponded to 3.66% （95%CI： 1.02%, 6.31%）, 4.06% （95%CI： 0.84%, 7.27%）, and 4.32% （95%CI： 1.67%, 6.97%） increase of total, cardiovascular, and respiratory hospitalizations, respectively. Conclusion Our analyses provide the first piece of evidence in China, demonstrating that decreased visibility has an effect on hospital admission, and this finding strengthens the rationale for further limiting air pollution levels in Shanghai.
基金supported in part by the Project of National Natural Science Foundation of China (61301110)Project of Shanghai Key Laboratory of Intelligent Information Processing, China [grant number IIPL-2014-005]+1 种基金the Project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutionsthe Project of Jiangsu Overseas Research & Training Program for University Prominent Young & Middle-Aged Teachers and Presidents
文摘As device-to-device(D2D) communications usually reuses the resource of cellular networks, call admission control(CAC) and power control are crucial problems. However in most power control schemes, total data rates or throughput are regarded as optimization criterion. In this paper, a combining call admission control(CAC) and power control scheme under guaranteeing QoS of every user equipment(UE) is proposed. First, a simple CAC scheme is introduced. Then based on the CAC scheme, a combining call admission control and power control scheme is proposed. Next, the performance of the proposed scheme is evaluated. Finally, maximum DUE pair number and average transmitting power is calculated. Simulation results show that D2 D communications with the proposed combining call admission control and power control scheme can effectively improve the maximum DUE pair number under the premise of meeting necessary QoS.
文摘OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。
文摘The turbine in an LH2/LOX rocket engine is designed as a two-stage supersonic partialadmission turbine. Three-dimensional steady and unsteady simulations were conducted to analyze turbine performance and aerodynamic forces on rotor blades. Different configurations were employed to investigate the effects of the axial gap and nozzle distribution on the predicted performance and aerodynamic forces. Rotor blades experience unsteady aerodynamic forces because of the partial admission. Aerodynamic forces show periodicity in the admission region, and are close to zero after leaving the admission region. The unsteady forces in frequency domain indicate that components exist in a wide frequency region, and the admission passing frequency is dominant.Those multiples of the rotational frequency which are multiples of the nozzle number in a fulladmission turbine are notable components. Results show that the turbine efficiency decreases as the axial gap between nozzles and the 1 st stage rotor（rotor 1） increases. Fluctuation of the circumferential aerodynamic force on rotor 1 blades decreases with the axial gap increasing. The turbine efficiency decreases as the circumferential spacing between nozzles increases. Fluctuations of the circumferential and axial aerodynamic forces increase as the circumferential spacing increases. As for the non-equidistant nozzle distribution, it produces similar turbine performance and amplitudefrequency characteristics of forces to those of the normal configuration, when the mean spacing is equal to that of the normal case.
基金National Natural Science Foundation of China (60879024)
文摘Avionics full duplex switched ethernet（AFDX） is a switched interconnection technology developed to provide reliable data exchange with strong data transmission time guarantees in internal communication of the spacecraft or aircraft.Virtual link（VL） is an important concept of AFDX to meet quality of service（QoS） requirements in terms of end-to-end message deadlines.A VL admission control algorithm in AFDX network under hard real-time（HRT） constraints is studied.Based on the scheduling prin-ciple of AFDX protocol,a packet scheduling scheme under HRT constraints is proposed,and after that an efficient VL admission control algorithm is presented.Analytical proof that the algorithm can effectively determine whether VL should be admitted is given.Finally simulative examples are presented to promote the conclusion.
基金supported by National Natural Science Foundation of China (Nos. 61174124, 61233003 and 60935001)National High Technology Research and Development Program of China (863 Program) (No. 2011AA01A102)
文摘In network service systems, satisfying quality of service (QoS) is one of the main objectives. Admission control and resource allocation strategy can be used to guarantee the QoS requirement. Based on partially observable Markov decision processes (POMDPs), this paper proposes a novel admission control model for video on demand (VOD) service systems with elastic QoS. Elastic QoS is also considered in resource allocation strategy. Policy gradient algorithm is often available to find the solution of POMDP problems, with a satisfactory convergence rate. Through numerical examples, it can be shown that the proposed admission control strategy has better performance than complete admission control strategy.
基金supported in part by the State Major Science and Technology Special Project(Grant No.2018ZX03001002)the National Natural Science Foundation of China under Grant No.61925101 and No.61831002+2 种基金the Beijing Natural Science Foundation under Grant No.JQ18016the National Program for Special Support of Eminent Professionalsthe Fundamental Research Funds for the Central Universities under Grant No.24820202020RC09 and Grant No.24820202020RC11。
文摘Network slicing based fog radio access network(F-RAN) has emerged as a promising architecture to support various novel applications in 5 G-and-beyond wireless networks. However, the co-existence of multiple network slices in F-RANs may lead to significant performance degradation due to the resource competitions among different network slices. In this paper, the downlink F-RANs with a hotspot slice and an Internet of Things(Io T) slice are considered, in which the user equipments(UEs) of different slices share the same spectrum. A novel joint resource allocation and admission control scheme is developed to maximize the number of UEs in the hotspot slice that can be supported with desired quality-of-service, while satisfying the interference constraint of the UEs in the Io T slice. Specifically, the admission control and beamforming vector optimization are performed in the hotspot slice to maximize the number of admitted UEs, while the joint sub-channel and power allocation is performed in the Io T slice to maximize the capability of the UEs in the Io T slice tolerating the interference from the hotspot slice. Numerical results show that our proposed scheme can effectively boost the number of UEs in the hotspot slice compared to the existing baselines.
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
基金supported by the National Natural Science Foundation of China (7070102571071105)+2 种基金the Program for New Century Excellent Talents in Universities of China (NCET-08-0396)the National Science Fund for Distinguished Young Scholars of China (70925005)the Program for Changjiang Scholars and Innovative Research Team in University (IRT/028)
文摘Power efficiency and link reliability are of great impor- tance in hierarchical wireless sensor networks （HWSNs）, espe- cially at the key level, which consists of sensor nodes located only one hop away from the sink node called OHS. The power and admission control problem in HWSNs is comsidered to improve its power efficiency and link reliability. This problem is modeled as a non-cooperative game in which the active OHSs are con- sidered as players. By applying a double-pricing scheme in the definition of OHSs＇ utility function, a Nash Equilibrium solution with network properties is derived. Besides, a distributed algorithm is also proposed to show the dynamic processes to achieve Nash Equilibrium. Finally, the simulation results demonstrate the effec- tiveness of the proposed algorithm.
基金supported by the National Natural Science Foundation of China,Research on Brain Magnetic Resonance Image Segmentation Based on Particle Computation(No.61672386).
文摘Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.
