BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
Pediatric emergency care(PEC)encompasses the specialized medical care delivered to infants,children,and adolescents facing urgent medical situations,addressing critical conditions such as infections,allergic responses...Pediatric emergency care(PEC)encompasses the specialized medical care delivered to infants,children,and adolescents facing urgent medical situations,addressing critical conditions such as infections,allergic responses,seizures,respiratory distress,and trauma.PEC calls for prompt,focused interventions to address each child's developmental and physiological needs.The literature was searched using Google Scholar,PubMed,and the Cochrane Library to retrieve studies assessing quality indicators and outcomes in pediatric emergencies.The search was limited to papers published in peer-reviewed journals between 01 Jan 2000 and 15 Dec 2024.This review evaluates current PEC standards such as patient safety,diagnostic precision,timeliness,and patient and family satisfaction.Patient safety is vital because children are particularly vulnerable to medical errors,such as inappropriate doses of medication.The provision of high-quality PEC is hampered by systemic issues such as inadequate training,a lack of re-sources,and restricted access to treatment.Telemedicine,pediatric transport units,artificial intelligence applications for diagnostics,and simulation-based training are suggested approaches to overcome these challenges.Research net-works and quality improvement initiatives are important steps to improve PEC care.展开更多
There is increasing research into the potential benefits of incorporating artificial intelligence(AI)and machine learning algorithms into emergency medical services.AI is finding new applications across a wide range o...There is increasing research into the potential benefits of incorporating artificial intelligence(AI)and machine learning algorithms into emergency medical services.AI is finding new applications across a wide range of sectors,one of which is healthcare,where it is being used to enhance clinical diagnostics.AI solutions have enormous untapped potential to improve healthcare efficiency and quality,thus researchers have focused heavily on emergency medicine(EM).Many individuals without prior experience with any physician often receive their initial medical care in the emergency room.Two areas that could benefit from the implementation of AI are reducing waiting times and enhancing diagnostic capabilities.This study provides further explanation of how AI is used in emergency rooms.Several machine learning‐based algorithms are also addressed.In this research,we summarise recent developments in the use of AI in EM.This research tries to summarise the usefulness of AI in EM by looking at recent developments in emergency department operations and clinical patient management.展开更多
Objective:To analyze the effect of optimizing the emergency nursing process on the nursing effect of patients with acute upper gastrointestinal bleeding(AUGB)in the emergency department.Methods:100 cases(Group A)were ...Objective:To analyze the effect of optimizing the emergency nursing process on the nursing effect of patients with acute upper gastrointestinal bleeding(AUGB)in the emergency department.Methods:100 cases(Group A)were randomly selected from AUGB patients who had undergone the routine emergency care process in the emergency department from January 2022 to December 2022,and 100 cases(Group B)were randomly selected from AUGB patients who had undergone the optimized emergency care process in the emergency department from January 2023 to December 2023.The nursing effects of the two groups were compared.Results:clinical indicators that include the emergency response time,time to open the infusion channel,time from diagnosis to specialty treatment,hospitalization time,resuscitation success rate,rebleeding rate,nursing satisfaction score,post-care SAS score,and SF-36 score in Group B were better than those in Group A(P<0.05).Conclusion:Optimization of the emergency care process for AUGB patients in the emergency department can improve the efficiency and success rate of resuscitation,reduce the risk of rebleeding,improve the mood and quality of life of patients,and make the patients more satisfied with the nursing service.展开更多
Accessible communication based on sign language recognition(SLR)is the key to emergency medical assistance for the hearing-impaired community.Balancing the capture of both local and global information in SLR for emerg...Accessible communication based on sign language recognition(SLR)is the key to emergency medical assistance for the hearing-impaired community.Balancing the capture of both local and global information in SLR for emergency medicine poses a significant challenge.To address this,we propose a novel approach based on the inter-learning of visual features between global and local information.Specifically,our method enhances the perception capabilities of the visual feature extractor by strategically leveraging the strengths of convolutional neural network(CNN),which are adept at capturing local features,and visual transformers which perform well at perceiving global features.Furthermore,to mitigate the issue of overfitting caused by the limited availability of sign language data for emergency medical applications,we introduce an enhanced short temporal module for data augmentation through additional subsequences.Experimental results on three publicly available sign language datasets demonstrate the efficacy of the proposed approach.展开更多
Meteor Burst Communication(MBC),a niche yet revolutionary wireless communication paradigm,exploits the transient ionized trails generated by meteors ablating in Earth’s atmosphere to enable sporadic yet resilient lon...Meteor Burst Communication(MBC),a niche yet revolutionary wireless communication paradigm,exploits the transient ionized trails generated by meteors ablating in Earth’s atmosphere to enable sporadic yet resilient long-distance radio links.Known for its exceptional resilience,robustness,and sustained connectivity,MBC holds significant promise for applications in emergency communications,remote area connectivity,military/defense systems,and environmental monitoring.However,the scientific exploration and application of MBC have long been highly challenging.In particular,under the combined influence of multiple physical field factors,the channel experiences superimposed multiple random fading effects,exhibiting bursty,highly time-varying,and strongly random characteristics.This persistent technical challenge has resulted in the absence of a practical statistical channel model for MBC to date.展开更多
BACKGROUND Acute upper gastrointestinal bleeding(AUGIB)is a common emergency critical illness that requires prompt assessment upon admission to prevent disease deterioration.As a resuscitation mode,the fast track for ...BACKGROUND Acute upper gastrointestinal bleeding(AUGIB)is a common emergency critical illness that requires prompt assessment upon admission to prevent disease deterioration.As a resuscitation mode,the fast track for emergency treatment increases the success rate and improves patient outcomes.However,misuse will consume resources.The Glasgow-Blatchford score(GBS)is considered to predict the clinical intervention needs for AUGIB patients,guiding diagnosis and treatment.Therefore,clinical research is needed to identify the recommended GBS thresholds that support effective use in AUGIB patients.AIM To validate the effectiveness of the GBS in establishing a fast track to reduce the time and cost of treatment for patients with AUGIB.METHODS A retrospective analysis was performed using the data of 124 cases of AUGIB patients with GBS≥6 treated at the University-Town Hospital of Chongqing Medical University from August 2020 to April 2023.Based on GBS risk stratification,patients were divided into moderate-risk(12>GBS≥6)and high-risk(GBS≥12)groups.Furthermore,depending on whether a fast track was established after the patients arrived in the emergency department,the patients were categorized into control and fast-track groups.The changes in various indicators,such as length of time in the emergency resuscitation room,door-to-endoscopy time,total blood transfusion volume,hospitalization duration,and hospitalization costs,were compared between the control and fast-track groups under each risk stratification level.RESULTS In the comparison of the aforementioned indicators,the moderate-risk fast-track group did not show any significant differences from the control group(P>0.05).However,in the high-risk fast-track group,the door-toendoscopy time,total blood transfusion volume,and hospitalization costs were significantly lower than those in the control group(P<0.05).CONCLUSION Establishing a fast track for emergency treatment based on GBS risk stratification has assessment value in reducing door-to-endoscopy time,decreasing total blood transfusion volume,and lowering hospitalization costs in patients with AUGIB.GBS≥12 is recommended as the threshold for implementing the fast track for emergency treatment,and its clinical promotion is advised.展开更多
Emergency resources play a vital role in the emergency rescue process.The adequate and timely supply of emergency resources can effectively control the development of accidents and reduce accident losses.However,the c...Emergency resources play a vital role in the emergency rescue process.The adequate and timely supply of emergency resources can effectively control the development of accidents and reduce accident losses.However,the current emergency resource allocation of chemical enterprises lacks scientific analysis of accident scenarios,and the individual allocation method of enterprises increases the cost of emergency resource allocation.Given the above problems,this paper proposes a regional collaborative allocation method of emergency resources for enterprises within the chemical industry park(CIP)based on the worst credible accident scenario(WCAS).Firstly,the concept and analysis method of the WCAS is proposed.Then,based on the characteristics and consequences of the accident,the mapping relationship between accident scenarios and emergency resources is established.Finally,an optimization model for regional collaborative allocation of emergency resources is constructed to determine the amount of emergency resource allocation for each enterprise.Through the case study,the emergency resource allocation method based on the WCAS analysis can better meet the demands of accident emergency rescue.Simultaneously,the regional collaborative allocation optimization model can strengthen the cooperation ability among enterprises,greatly reducing the cost of emergency resource allocation for each enterprise.展开更多
The consultation intention of emergency decision-makers in urban rail transit(URT)is input into the emergency knowledge base in the form of domain questions to obtain emergency decision support services.This approach ...The consultation intention of emergency decision-makers in urban rail transit(URT)is input into the emergency knowledge base in the form of domain questions to obtain emergency decision support services.This approach facilitates the rapid collection of complete knowledge and rules to form effective decisions.However,the current structured degree of the URT emergency knowledge base remains low,and the domain questions lack labeled datasets,resulting in a large deviation between the consultation outcomes and the intended objectives.To address this issue,this paper proposes a question intention recognition model for the URT emergency domain,leveraging knowledge graph(KG)and data enhancement technology.First,a structured storage of emergency cases and emergency plans is realized based on KG.Subsequently,a comprehensive question template is developed,and the labeled dataset of emergency domain questions in URT is generated through the KG.Lastly,data enhancement is applied by prompt learning and the NLP Chinese Data Augmentation(NLPCDA)tool,and the intention recognition model combining Generalized Auto-regression Pre-training for Language Understanding(XLNet)and Recurrent Convolutional Neural Network for Text Classification(TextRCNN)is constructed.Word embeddings are generated by XLNet,context information is further captured using Bidirectional Long Short-Term Memory Neural Network(BiLSTM),and salient features are extracted with Convolutional Neural Network(CNN).Experimental results demonstrate that the proposed model can enhance the clarity of classification and the identification of domain questions,thereby providing supportive knowledge for emergency decision-making in URT.展开更多
Frequent flood disasters caused by climate change may lead to tremendous economic and human losses along inland waterways.Emergency response and rescue vessels(ERRVs)play an essential role in minimizing losses and pro...Frequent flood disasters caused by climate change may lead to tremendous economic and human losses along inland waterways.Emergency response and rescue vessels(ERRVs)play an essential role in minimizing losses and protecting lives and property.However,the path planning of ERRVs has mainly depended on expert experiences instead of rational decision making.This paper proposes an improved artificial potential field(APF)algorithm to optimize the shortest path for ERRVs in the rescue process.To verify the feasibility of the proposed model,eight tests were carried out in two water areas of the Yangtze River.The results showed that the improved APF algorithm was efficient with fewer iterations and that the response time of path planning was reduced to around eight seconds.The improved APF algorithm performed better in the ERRV’s goal achievement,compared with the traditional algorithm.The path planning method for ERRVs proposed in this paper has theoretical and practical value in flood relief.It can be applied in the emergency management of ERRVs to accelerate flood management efficiency and improve capacity to prevent,mitigate,and relieve flood disasters.展开更多
Objective:To explore the application effect of emergency rescue capability intervention among students in a university in Beijing.Methods:A total of 900 students from a university in Beijing in 2023 were selected as t...Objective:To explore the application effect of emergency rescue capability intervention among students in a university in Beijing.Methods:A total of 900 students from a university in Beijing in 2023 were selected as the research objects.Emergency rescue capability training was conducted from March 2023 to June 2023,once a month.The students’mastery of emergency rescue before and after the intervention was analyzed.Survey questionnaires were distributed to all college students to understand their channels and willingness to acquire emergency rescue knowledge.Results:A total of 886 valid questionnaires were collected in this study.The highest proportion of knowledge about China’s general emergency telephone number and how to dial the emergency rescue hotline was 100.00%.Among the strategies for dealing with cardiac arrest in CPR,the highest proportion was 336.34%.Among the four major first aid techniques of hemostasis,bandaging,fixation,transportation,the highest proportion of knowledge about the use of rubber band signs was 31.71%.Among the first aid techniques for heatstroke,poisoning,fire,and sharp instrument injuries,the principle of emergency treatment for severe gas poisoning had the highest proportion of 41.42%,showing significant differences.College students mainly acquire knowledge of emergency rescue capability through TV programs,health education lectures,and the internet.Around 61.40%of college students hope to learn more about prevention and control knowledge.Conclusion:After the intervention of emergency rescue capability,the emergency rescue capability of college students in this university has been significantly improved,showing a strong training effect,which is worthy of promotion.展开更多
BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practi...BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.展开更多
This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement ...This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement of intelligent emergency,further improving the effectiveness of intelligent emergency management.First,approximately 3,900 documents from the intelligent emergency field are analyzed to determine the future research trend in intelligent emergency management.The socio-technical theory concerning technical and social systems is introduced.The emergency management system concepts of“technology enabling”and“enabling value creation”are defined according to bibliometric analysis and socio-technical theory.Second,a research framework that includes technology enabling and enabling value creation for the decision-making paradigm in emergency management according to the big data environment is constructed.A detailed analysis approach from intelligent emergency technology enabling to enabling value creation in emergency management is proposed.Finally,earthquake disasters are taken as examples,and specific analyses of the intelligent emergency enabling and enabling value creation are explored;enabling value creation is discussed based on measurable indicators.The clear concept of emergency management system technology enabling and enabling value creation,as well as the detailed analysis approach from intelligent emergency technology enabling to enabling value creation,provide a theoretical bases for scholars and practitioners to evaluate the value(performance)of intelligent emergency for the first time.展开更多
Shotcrete is one of the common solutions for shallow sliding.It works by forming a protective layer with high strength and cementing the loose soil particles on the slope surface to prevent shallow sliding.However,the...Shotcrete is one of the common solutions for shallow sliding.It works by forming a protective layer with high strength and cementing the loose soil particles on the slope surface to prevent shallow sliding.However,the solidification time of conventional cement paste is long when shotcrete is used to treat cohesionless soil landslide.The idea of reinforcing slope with polyurethane solidified soil(i.e.,mixture of polyurethane and sand)was proposed.Model tests and finite element analysis were carried out to study the effectiveness of the proposed new method on the emergency treatment of cohesionless soil landslide.Surcharge loading on the crest of the slope was applied step by step until landslide was triggered so as to test and compare the stability and bearing capacity of slope models with different conditions.The simulated slope displacements were relatively close to the measured results,and the simulated slope deformation characteristics were in good agreement with the observed phenomena,which verifies the accuracy of the numerical method.Under the condition of surcharge loading on the crest of the slope,the unreinforced slope slid when the surcharge loading exceeded 30 k Pa,which presented a failure mode of local instability and collapse at the shallow layer of slope top.The reinforced slope remained stable even when the surcharge loading reached 48 k Pa.The displacement of the reinforced slope was reduced by more than 95%.Overall,this study verifies the effectiveness of polyurethane in the emergency treatment of cohesionless soil landslide and should have broad application prospects in the field of geological disasters concerning the safety of people's live.展开更多
Emergency department nurses face severe occupational stress leading to anxiety,depression,and burnout,which significantly impair their well-being and patientcare quality.This narrative review examined the role of mind...Emergency department nurses face severe occupational stress leading to anxiety,depression,and burnout,which significantly impair their well-being and patientcare quality.This narrative review examined the role of mindfulness-based stress reduction(MBSR)in addressing these challenges.Rooted in nonjudgmental present-moment awareness,MBSR enhances emotional regulation and reduces psychological distress by fostering adaptive coping strategies.Studies have demonstrated its efficacy in lowering anxiety,depressive symptoms,and emotional exhaustion,while improving workplace well-being,empathy,and job satisfaction.Mechanistically,MBSR improves interoceptive awareness and autonomic balance,as evidenced by physiological markers such as heart rate variability.However,gaps remain in long-term efficacy assessments,personalized interventions,and integration with multidisciplinary approaches.Future research should prioritize tailored biomarker-driven programs,longitudinal studies,and scalable implementation strategies in high-stress clinical settings.This review underscores MBSR’s potential as a sustainable,evidence-based tool to enhance emergency department nurses’mental health and professional performance,advocating for broader adoption and further refinement of its practical applications.展开更多
Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribu...Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribution network emergency recovery framework.A phase-space reconstruction and stacked integrated model for predicting wind and photovoltaic generation during typhoon disasters is proposed in the first stage.This provides guidance for second-stage post-disaster emergency recovery scheduling.The emergency recovery scheduling model is established in the second stage,and this model is supported by a thermal power-generating unit,mobile emergency generators,and distributed generators.Distributed generation includes wind power generation,photovoltaics,fuel cells,etc.Simultaneously,we con-sider the gray-start based on the pumped storage unit to be an important first step in the emergency recovery strategy.This model is val-idated on the improved IEEE 33 node system,which utilizes data from the 2022 super typhoon“Muifa”in Zhoushan,Zhejiang,China.Simulations indicate the superiority of a gray start with a pumped storage unit and the proposed emergency recovery strategy.展开更多
On November 26,2021,a novel lineage (B.1.1.529) was categorized as the fifth virus of concern (VOC) and named Omicron by World Health Organization (WHO).Patients infected with COVID-19 Omicron variant are reported to ...On November 26,2021,a novel lineage (B.1.1.529) was categorized as the fifth virus of concern (VOC) and named Omicron by World Health Organization (WHO).Patients infected with COVID-19 Omicron variant are reported to have higher transmissibility,lower severity and mortality than those with previous subvariants.In terms of virulence,the Omicron subvariant is weaker than previous strains,with symptoms mostly being fever,running nose and other symptoms mainly seen in upper respiratory tract infections.However,the clinical characteristics of medical staff infected with Omicron variants have rarely been reported before.We conducted a survey in five centers and summarized these profiles to explore the clinical characteristics.展开更多
Climate change exacerbates tourism emergencies, making it increasingly critical to enhance mitigation and adaptation capacity to alleviate extreme climate's impacts during tourism. Climate-induced impacts and thre...Climate change exacerbates tourism emergencies, making it increasingly critical to enhance mitigation and adaptation capacity to alleviate extreme climate's impacts during tourism. Climate-induced impacts and threats in mountainous tourism areas are more challenging given complex terrains and multiple risk sources. Prior studies have focused on assessing climate-related impacts in mountainous tourism areas, while limited studies have investigated the emergency rescue capacity of mountainous tourism areas. This largely constrains decision makers to adopt proper solutions to enhance emergency rescue capacity. To address this research challenges, this study aims to assess emergency rescue capability through an empirical study of the Wulong Karst Tourism Destination(WKTD) area in Chongqing, China. In particular, based on road network and emergency response facility data, the accessibility of road network was delineated by the Spatial Design Network Analysis(s DNA) model. The results indicate that fire and medical rescue facilities were extremely limited and their service coverage was irregular. Valleys significantly narrowed rescue facilities' service area and weakened their functional connection. With the vital 60-minute timeframe, the closeness and betweenness analyses revealed the low accessibility of global rescue roads, while relatively high accessibility of small-scale vehicle and pedestrian rescue roads. The Mean Crow Flight(MCF) and Diversion Ratio(DR) analyses verified that the accessibility of road rescue services was impeded by mountainous terrain. Overall, this study informs solutions pertaining to rescue and disaster mitigation in mountainous tourism areas.展开更多
BACKGROUND Artificial intelligence(AI)is increasingly being explored in radiology,including its potential role in emergency imaging settings.However,global perspectives on AI adoption,usefulness,and limitations among ...BACKGROUND Artificial intelligence(AI)is increasingly being explored in radiology,including its potential role in emergency imaging settings.However,global perspectives on AI adoption,usefulness,and limitations among emergency radiologists remain underexplored.AIM To assess awareness,usage,perceived benefits,and limitations of AI tools among radiologists practicing emergency radiology worldwide.METHODS A 16-question survey was distributed globally between October 24,2024,and August 4,2025,targeting radiologists working in academic,community,and private settings who practice emergency radiology as a primary or secondary subspecialty.The survey was disseminated via direct emails extracted using automated and manual methods from recent publications in major radiology journals.A total of 57 responses were collected.RESULTS AI awareness was high(93%),but frequent clinical use was reported by only 28%.Daily use of AI in emergent imaging was limited to 23%of respondents.The majority anticipated AI becoming essential within five years(68%),and 51%believed AI would replace certain radiological tasks.Image interpretation and acquisition were the most common AI applications.Key perceived benefits included improved diagnostic accuracy and increased efficiency,while concerns included limited accuracy,integration difficulties,and cost.Trust in AI varied by experience,with less experienced radiologists viewed as more trusting.CONCLUSION While emergency radiologists globally recognize AI’s potential,significant barriers to its routine adoption remain.Addressing issues of trust,cost,accuracy,and workflow integration is essential to unlock AI's full utility in emergency radiology.展开更多
BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’...BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.展开更多
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
文摘Pediatric emergency care(PEC)encompasses the specialized medical care delivered to infants,children,and adolescents facing urgent medical situations,addressing critical conditions such as infections,allergic responses,seizures,respiratory distress,and trauma.PEC calls for prompt,focused interventions to address each child's developmental and physiological needs.The literature was searched using Google Scholar,PubMed,and the Cochrane Library to retrieve studies assessing quality indicators and outcomes in pediatric emergencies.The search was limited to papers published in peer-reviewed journals between 01 Jan 2000 and 15 Dec 2024.This review evaluates current PEC standards such as patient safety,diagnostic precision,timeliness,and patient and family satisfaction.Patient safety is vital because children are particularly vulnerable to medical errors,such as inappropriate doses of medication.The provision of high-quality PEC is hampered by systemic issues such as inadequate training,a lack of re-sources,and restricted access to treatment.Telemedicine,pediatric transport units,artificial intelligence applications for diagnostics,and simulation-based training are suggested approaches to overcome these challenges.Research net-works and quality improvement initiatives are important steps to improve PEC care.
文摘There is increasing research into the potential benefits of incorporating artificial intelligence(AI)and machine learning algorithms into emergency medical services.AI is finding new applications across a wide range of sectors,one of which is healthcare,where it is being used to enhance clinical diagnostics.AI solutions have enormous untapped potential to improve healthcare efficiency and quality,thus researchers have focused heavily on emergency medicine(EM).Many individuals without prior experience with any physician often receive their initial medical care in the emergency room.Two areas that could benefit from the implementation of AI are reducing waiting times and enhancing diagnostic capabilities.This study provides further explanation of how AI is used in emergency rooms.Several machine learning‐based algorithms are also addressed.In this research,we summarise recent developments in the use of AI in EM.This research tries to summarise the usefulness of AI in EM by looking at recent developments in emergency department operations and clinical patient management.
文摘Objective:To analyze the effect of optimizing the emergency nursing process on the nursing effect of patients with acute upper gastrointestinal bleeding(AUGB)in the emergency department.Methods:100 cases(Group A)were randomly selected from AUGB patients who had undergone the routine emergency care process in the emergency department from January 2022 to December 2022,and 100 cases(Group B)were randomly selected from AUGB patients who had undergone the optimized emergency care process in the emergency department from January 2023 to December 2023.The nursing effects of the two groups were compared.Results:clinical indicators that include the emergency response time,time to open the infusion channel,time from diagnosis to specialty treatment,hospitalization time,resuscitation success rate,rebleeding rate,nursing satisfaction score,post-care SAS score,and SF-36 score in Group B were better than those in Group A(P<0.05).Conclusion:Optimization of the emergency care process for AUGB patients in the emergency department can improve the efficiency and success rate of resuscitation,reduce the risk of rebleeding,improve the mood and quality of life of patients,and make the patients more satisfied with the nursing service.
基金supported by the National Natural Science Foundation of China(No.62376197)the Tianjin Science and Technology Program(No.23JCYBJC00360)the Tianjin Health Research Project(No.TJWJ2025MS045).
文摘Accessible communication based on sign language recognition(SLR)is the key to emergency medical assistance for the hearing-impaired community.Balancing the capture of both local and global information in SLR for emergency medicine poses a significant challenge.To address this,we propose a novel approach based on the inter-learning of visual features between global and local information.Specifically,our method enhances the perception capabilities of the visual feature extractor by strategically leveraging the strengths of convolutional neural network(CNN),which are adept at capturing local features,and visual transformers which perform well at perceiving global features.Furthermore,to mitigate the issue of overfitting caused by the limited availability of sign language data for emergency medical applications,we introduce an enhanced short temporal module for data augmentation through additional subsequences.Experimental results on three publicly available sign language datasets demonstrate the efficacy of the proposed approach.
文摘Meteor Burst Communication(MBC),a niche yet revolutionary wireless communication paradigm,exploits the transient ionized trails generated by meteors ablating in Earth’s atmosphere to enable sporadic yet resilient long-distance radio links.Known for its exceptional resilience,robustness,and sustained connectivity,MBC holds significant promise for applications in emergency communications,remote area connectivity,military/defense systems,and environmental monitoring.However,the scientific exploration and application of MBC have long been highly challenging.In particular,under the combined influence of multiple physical field factors,the channel experiences superimposed multiple random fading effects,exhibiting bursty,highly time-varying,and strongly random characteristics.This persistent technical challenge has resulted in the absence of a practical statistical channel model for MBC to date.
基金Supported by the Key Discipline of Pathology at Chongqing Medical and Pharmaceutical College,No.ygz2021303.
文摘BACKGROUND Acute upper gastrointestinal bleeding(AUGIB)is a common emergency critical illness that requires prompt assessment upon admission to prevent disease deterioration.As a resuscitation mode,the fast track for emergency treatment increases the success rate and improves patient outcomes.However,misuse will consume resources.The Glasgow-Blatchford score(GBS)is considered to predict the clinical intervention needs for AUGIB patients,guiding diagnosis and treatment.Therefore,clinical research is needed to identify the recommended GBS thresholds that support effective use in AUGIB patients.AIM To validate the effectiveness of the GBS in establishing a fast track to reduce the time and cost of treatment for patients with AUGIB.METHODS A retrospective analysis was performed using the data of 124 cases of AUGIB patients with GBS≥6 treated at the University-Town Hospital of Chongqing Medical University from August 2020 to April 2023.Based on GBS risk stratification,patients were divided into moderate-risk(12>GBS≥6)and high-risk(GBS≥12)groups.Furthermore,depending on whether a fast track was established after the patients arrived in the emergency department,the patients were categorized into control and fast-track groups.The changes in various indicators,such as length of time in the emergency resuscitation room,door-to-endoscopy time,total blood transfusion volume,hospitalization duration,and hospitalization costs,were compared between the control and fast-track groups under each risk stratification level.RESULTS In the comparison of the aforementioned indicators,the moderate-risk fast-track group did not show any significant differences from the control group(P>0.05).However,in the high-risk fast-track group,the door-toendoscopy time,total blood transfusion volume,and hospitalization costs were significantly lower than those in the control group(P<0.05).CONCLUSION Establishing a fast track for emergency treatment based on GBS risk stratification has assessment value in reducing door-to-endoscopy time,decreasing total blood transfusion volume,and lowering hospitalization costs in patients with AUGIB.GBS≥12 is recommended as the threshold for implementing the fast track for emergency treatment,and its clinical promotion is advised.
基金support provided by the Qingdao Science and Technology Benefits People Demonstration and Guidance Project(21-1-4-sf-4-nsh).
文摘Emergency resources play a vital role in the emergency rescue process.The adequate and timely supply of emergency resources can effectively control the development of accidents and reduce accident losses.However,the current emergency resource allocation of chemical enterprises lacks scientific analysis of accident scenarios,and the individual allocation method of enterprises increases the cost of emergency resource allocation.Given the above problems,this paper proposes a regional collaborative allocation method of emergency resources for enterprises within the chemical industry park(CIP)based on the worst credible accident scenario(WCAS).Firstly,the concept and analysis method of the WCAS is proposed.Then,based on the characteristics and consequences of the accident,the mapping relationship between accident scenarios and emergency resources is established.Finally,an optimization model for regional collaborative allocation of emergency resources is constructed to determine the amount of emergency resource allocation for each enterprise.Through the case study,the emergency resource allocation method based on the WCAS analysis can better meet the demands of accident emergency rescue.Simultaneously,the regional collaborative allocation optimization model can strengthen the cooperation ability among enterprises,greatly reducing the cost of emergency resource allocation for each enterprise.
基金supported in part by the National Natural Science Foundation of China.The funding numbers 62433005,62272036,62132003,and 62173167.
文摘The consultation intention of emergency decision-makers in urban rail transit(URT)is input into the emergency knowledge base in the form of domain questions to obtain emergency decision support services.This approach facilitates the rapid collection of complete knowledge and rules to form effective decisions.However,the current structured degree of the URT emergency knowledge base remains low,and the domain questions lack labeled datasets,resulting in a large deviation between the consultation outcomes and the intended objectives.To address this issue,this paper proposes a question intention recognition model for the URT emergency domain,leveraging knowledge graph(KG)and data enhancement technology.First,a structured storage of emergency cases and emergency plans is realized based on KG.Subsequently,a comprehensive question template is developed,and the labeled dataset of emergency domain questions in URT is generated through the KG.Lastly,data enhancement is applied by prompt learning and the NLP Chinese Data Augmentation(NLPCDA)tool,and the intention recognition model combining Generalized Auto-regression Pre-training for Language Understanding(XLNet)and Recurrent Convolutional Neural Network for Text Classification(TextRCNN)is constructed.Word embeddings are generated by XLNet,context information is further captured using Bidirectional Long Short-Term Memory Neural Network(BiLSTM),and salient features are extracted with Convolutional Neural Network(CNN).Experimental results demonstrate that the proposed model can enhance the clarity of classification and the identification of domain questions,thereby providing supportive knowledge for emergency decision-making in URT.
基金The National Natural Science Foundation of China(Grant No.72274052)the National Natural Science Foundation of China(Grant No.72174173).
文摘Frequent flood disasters caused by climate change may lead to tremendous economic and human losses along inland waterways.Emergency response and rescue vessels(ERRVs)play an essential role in minimizing losses and protecting lives and property.However,the path planning of ERRVs has mainly depended on expert experiences instead of rational decision making.This paper proposes an improved artificial potential field(APF)algorithm to optimize the shortest path for ERRVs in the rescue process.To verify the feasibility of the proposed model,eight tests were carried out in two water areas of the Yangtze River.The results showed that the improved APF algorithm was efficient with fewer iterations and that the response time of path planning was reduced to around eight seconds.The improved APF algorithm performed better in the ERRV’s goal achievement,compared with the traditional algorithm.The path planning method for ERRVs proposed in this paper has theoretical and practical value in flood relief.It can be applied in the emergency management of ERRVs to accelerate flood management efficiency and improve capacity to prevent,mitigate,and relieve flood disasters.
文摘Objective:To explore the application effect of emergency rescue capability intervention among students in a university in Beijing.Methods:A total of 900 students from a university in Beijing in 2023 were selected as the research objects.Emergency rescue capability training was conducted from March 2023 to June 2023,once a month.The students’mastery of emergency rescue before and after the intervention was analyzed.Survey questionnaires were distributed to all college students to understand their channels and willingness to acquire emergency rescue knowledge.Results:A total of 886 valid questionnaires were collected in this study.The highest proportion of knowledge about China’s general emergency telephone number and how to dial the emergency rescue hotline was 100.00%.Among the strategies for dealing with cardiac arrest in CPR,the highest proportion was 336.34%.Among the four major first aid techniques of hemostasis,bandaging,fixation,transportation,the highest proportion of knowledge about the use of rubber band signs was 31.71%.Among the first aid techniques for heatstroke,poisoning,fire,and sharp instrument injuries,the principle of emergency treatment for severe gas poisoning had the highest proportion of 41.42%,showing significant differences.College students mainly acquire knowledge of emergency rescue capability through TV programs,health education lectures,and the internet.Around 61.40%of college students hope to learn more about prevention and control knowledge.Conclusion:After the intervention of emergency rescue capability,the emergency rescue capability of college students in this university has been significantly improved,showing a strong training effect,which is worthy of promotion.
基金National Natural Science Foundation of China(U24A20714 to XMF and 82102238 to PC)。
文摘BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.
基金the National Natural Science Foundation of China(Grant No.:71771061).
文摘This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement of intelligent emergency,further improving the effectiveness of intelligent emergency management.First,approximately 3,900 documents from the intelligent emergency field are analyzed to determine the future research trend in intelligent emergency management.The socio-technical theory concerning technical and social systems is introduced.The emergency management system concepts of“technology enabling”and“enabling value creation”are defined according to bibliometric analysis and socio-technical theory.Second,a research framework that includes technology enabling and enabling value creation for the decision-making paradigm in emergency management according to the big data environment is constructed.A detailed analysis approach from intelligent emergency technology enabling to enabling value creation in emergency management is proposed.Finally,earthquake disasters are taken as examples,and specific analyses of the intelligent emergency enabling and enabling value creation are explored;enabling value creation is discussed based on measurable indicators.The clear concept of emergency management system technology enabling and enabling value creation,as well as the detailed analysis approach from intelligent emergency technology enabling to enabling value creation,provide a theoretical bases for scholars and practitioners to evaluate the value(performance)of intelligent emergency for the first time.
基金the financial support from the Fujian Science Foundation for Outstanding Youth(2023J06039)the National Natural Science Foundation of China(Grant No.41977259,U2005205,41972268)the Independent Research Project of Technology Innovation Center for Monitoring and Restoration Engineering of Ecological Fragile Zone in Southeast China(KY-090000-04-2022-019)。
文摘Shotcrete is one of the common solutions for shallow sliding.It works by forming a protective layer with high strength and cementing the loose soil particles on the slope surface to prevent shallow sliding.However,the solidification time of conventional cement paste is long when shotcrete is used to treat cohesionless soil landslide.The idea of reinforcing slope with polyurethane solidified soil(i.e.,mixture of polyurethane and sand)was proposed.Model tests and finite element analysis were carried out to study the effectiveness of the proposed new method on the emergency treatment of cohesionless soil landslide.Surcharge loading on the crest of the slope was applied step by step until landslide was triggered so as to test and compare the stability and bearing capacity of slope models with different conditions.The simulated slope displacements were relatively close to the measured results,and the simulated slope deformation characteristics were in good agreement with the observed phenomena,which verifies the accuracy of the numerical method.Under the condition of surcharge loading on the crest of the slope,the unreinforced slope slid when the surcharge loading exceeded 30 k Pa,which presented a failure mode of local instability and collapse at the shallow layer of slope top.The reinforced slope remained stable even when the surcharge loading reached 48 k Pa.The displacement of the reinforced slope was reduced by more than 95%.Overall,this study verifies the effectiveness of polyurethane in the emergency treatment of cohesionless soil landslide and should have broad application prospects in the field of geological disasters concerning the safety of people's live.
文摘Emergency department nurses face severe occupational stress leading to anxiety,depression,and burnout,which significantly impair their well-being and patientcare quality.This narrative review examined the role of mindfulness-based stress reduction(MBSR)in addressing these challenges.Rooted in nonjudgmental present-moment awareness,MBSR enhances emotional regulation and reduces psychological distress by fostering adaptive coping strategies.Studies have demonstrated its efficacy in lowering anxiety,depressive symptoms,and emotional exhaustion,while improving workplace well-being,empathy,and job satisfaction.Mechanistically,MBSR improves interoceptive awareness and autonomic balance,as evidenced by physiological markers such as heart rate variability.However,gaps remain in long-term efficacy assessments,personalized interventions,and integration with multidisciplinary approaches.Future research should prioritize tailored biomarker-driven programs,longitudinal studies,and scalable implementation strategies in high-stress clinical settings.This review underscores MBSR’s potential as a sustainable,evidence-based tool to enhance emergency department nurses’mental health and professional performance,advocating for broader adoption and further refinement of its practical applications.
基金supported in part by the National Nat-ural Science Foundation of China(52177110)Key Pro-gram of the National Natural Science Foundation of China(U22B20106,U2142206)+2 种基金Shenzhen Science and Technology Program(JCYJ20210324131409026)the Science and Technology Project of the State Grid Corpo-ration of China(5200-202319382A-2-3-XG)State Grid Zhejiang Elctric Power Co.,Ltd.Science and Tech-nology Project(B311DS24001A).
文摘Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribution network emergency recovery framework.A phase-space reconstruction and stacked integrated model for predicting wind and photovoltaic generation during typhoon disasters is proposed in the first stage.This provides guidance for second-stage post-disaster emergency recovery scheduling.The emergency recovery scheduling model is established in the second stage,and this model is supported by a thermal power-generating unit,mobile emergency generators,and distributed generators.Distributed generation includes wind power generation,photovoltaics,fuel cells,etc.Simultaneously,we con-sider the gray-start based on the pumped storage unit to be an important first step in the emergency recovery strategy.This model is val-idated on the improved IEEE 33 node system,which utilizes data from the 2022 super typhoon“Muifa”in Zhoushan,Zhejiang,China.Simulations indicate the superiority of a gray start with a pumped storage unit and the proposed emergency recovery strategy.
文摘On November 26,2021,a novel lineage (B.1.1.529) was categorized as the fifth virus of concern (VOC) and named Omicron by World Health Organization (WHO).Patients infected with COVID-19 Omicron variant are reported to have higher transmissibility,lower severity and mortality than those with previous subvariants.In terms of virulence,the Omicron subvariant is weaker than previous strains,with symptoms mostly being fever,running nose and other symptoms mainly seen in upper respiratory tract infections.However,the clinical characteristics of medical staff infected with Omicron variants have rarely been reported before.We conducted a survey in five centers and summarized these profiles to explore the clinical characteristics.
基金supported by the State Key Laboratory of Subtropical Building and Urban Science (No.2024KA03)Southwest University Graduate Research Innovation Project (Grant No.SWUB23043)+1 种基金the China Meteorological Administration “Research on value realization of climate ecological products” Youth Innovation Team Project (No.CMA2024QN15)Chongqing Natural Science(No.CSTB2024NSCQ-MSX0670)。
文摘Climate change exacerbates tourism emergencies, making it increasingly critical to enhance mitigation and adaptation capacity to alleviate extreme climate's impacts during tourism. Climate-induced impacts and threats in mountainous tourism areas are more challenging given complex terrains and multiple risk sources. Prior studies have focused on assessing climate-related impacts in mountainous tourism areas, while limited studies have investigated the emergency rescue capacity of mountainous tourism areas. This largely constrains decision makers to adopt proper solutions to enhance emergency rescue capacity. To address this research challenges, this study aims to assess emergency rescue capability through an empirical study of the Wulong Karst Tourism Destination(WKTD) area in Chongqing, China. In particular, based on road network and emergency response facility data, the accessibility of road network was delineated by the Spatial Design Network Analysis(s DNA) model. The results indicate that fire and medical rescue facilities were extremely limited and their service coverage was irregular. Valleys significantly narrowed rescue facilities' service area and weakened their functional connection. With the vital 60-minute timeframe, the closeness and betweenness analyses revealed the low accessibility of global rescue roads, while relatively high accessibility of small-scale vehicle and pedestrian rescue roads. The Mean Crow Flight(MCF) and Diversion Ratio(DR) analyses verified that the accessibility of road rescue services was impeded by mountainous terrain. Overall, this study informs solutions pertaining to rescue and disaster mitigation in mountainous tourism areas.
文摘BACKGROUND Artificial intelligence(AI)is increasingly being explored in radiology,including its potential role in emergency imaging settings.However,global perspectives on AI adoption,usefulness,and limitations among emergency radiologists remain underexplored.AIM To assess awareness,usage,perceived benefits,and limitations of AI tools among radiologists practicing emergency radiology worldwide.METHODS A 16-question survey was distributed globally between October 24,2024,and August 4,2025,targeting radiologists working in academic,community,and private settings who practice emergency radiology as a primary or secondary subspecialty.The survey was disseminated via direct emails extracted using automated and manual methods from recent publications in major radiology journals.A total of 57 responses were collected.RESULTS AI awareness was high(93%),but frequent clinical use was reported by only 28%.Daily use of AI in emergent imaging was limited to 23%of respondents.The majority anticipated AI becoming essential within five years(68%),and 51%believed AI would replace certain radiological tasks.Image interpretation and acquisition were the most common AI applications.Key perceived benefits included improved diagnostic accuracy and increased efficiency,while concerns included limited accuracy,integration difficulties,and cost.Trust in AI varied by experience,with less experienced radiologists viewed as more trusting.CONCLUSION While emergency radiologists globally recognize AI’s potential,significant barriers to its routine adoption remain.Addressing issues of trust,cost,accuracy,and workflow integration is essential to unlock AI's full utility in emergency radiology.
文摘BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.
