In this paper an intensional concept theory based on an intensional containment relation is presented, which, in turn, is then generalized in order to define the complete concept of God. We are following Leibniz＇s de...In this paper an intensional concept theory based on an intensional containment relation is presented, which, in turn, is then generalized in order to define the complete concept of God. We are following Leibniz＇s definition of God as a most perfect Being, by which he meant a subject of all perfections. As a consequence of this definition of God, two different complete concepts of the Devil（s） can be defined. However, these two complete concepts of the Devil（s） are not only incoherent with Leibniz＇s philosophy, but they introduce the problem of the Devil（s） as well, which seems to originate from a problem of an adequate definition of the concept of God on one hand, and the logical problem of the intensional negation of a concept on the other hand.展开更多
Trademark is developing rapidly nowadays,it has direct effects on people’s daily life in many aspects.Translation of trademark plays a very important role in this highly competitive society.This paper tries to approa...Trademark is developing rapidly nowadays,it has direct effects on people’s daily life in many aspects.Translation of trademark plays a very important role in this highly competitive society.This paper tries to approach the the translation of the descriptions of import and export goods and the trademarks from the angle of cultural differences.Translation of trademarks can transmit plentiful information from the commodities effectively.Here is the summary of some important principles and six methods on how to translate the trademarks.展开更多
This study presents a comprehensive evaluation of tropical cyclone(TC)forecast performance in the western North Pacific from 2013 to 2022,based on operational forecasts issued by the China Meteorological Administratio...This study presents a comprehensive evaluation of tropical cyclone(TC)forecast performance in the western North Pacific from 2013 to 2022,based on operational forecasts issued by the China Meteorological Administration.The analysis reveals systematic improvements in both track and intensity forecasts over the decade,with distinct error characteristics observed across various forecast parameters.Track forecast errors have steadily decreased,particularly for longer lead times,while error magnitudes have increased with longer forecast lead times.Intensity forecasts show similar progressive enhancements,with maximum sustained wind speed errors decreasing by 0.26 m/s per year for 120 h forecasts.The study also identifies several key patterns in forecast performance:typhoon-grade or stronger TCs exhibit smaller track errors than week or weaker systems;intensity forecasts systematically overestimate weaker TCs while underestimating stronger systems;and spatial error distributions show greater track inaccuracies near landmasses and regional intensity biases.These findings highlight both the significant advances in TC forecasting capability achieved through improved modeling and observational systems,and the remaining challenges in predicting TC changes and landfall behavior,providing valuable benchmarks for future forecast system development.展开更多
BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
Dispatched by the Chinese government,a multidisciplinary team of 30 researchers collaborated with a team from Myanmar to conduct a 14-day on-site investigation.The work encompassed seismic intensity assessments,field ...Dispatched by the Chinese government,a multidisciplinary team of 30 researchers collaborated with a team from Myanmar to conduct a 14-day on-site investigation.The work encompassed seismic intensity assessments,field surveys,and loss evaluations.The paper focuses on the intensity distribution and structural damage characteristics of the 2025 M7.9 Myanmar earthquake,yielding the following key findings.(1)The seismogenic fault rupture propagated in a nearly N-S direction,with a surface rupture length of approximately 450 km.The seismic impact zone exhibited an elongated N-S distribution and a shorter E-W span,distributed like a belt around the seismogenic fault.(2)Within the seismic impact zones,existing buildings comprised five primary structural types,with timber(bamboo)structures constituting the largest proportion(≈80%in rural areas,≈50%in urban areas).The relatively low disaster losses and casualties were primarily attributable to the good seismic performance and low damage ratio of timber(bamboo)structures across varying intensity zones.(3)An anomalous zone of intensityⅨwas located at the boundary between intensityⅥandⅦregions in Nay Pyi Taw.Here,ridge topography combined with soft soil layers significantly amplified ground motion,exacerbating structural damage.(4)Directional effects of ground motion were observed,with the structural damage phenomena and peak ground acceleration(PGA)values in the N-S direction exceeding those in the E-W direction.This validates that the maximum PGA distribution of strike-slip fault earthquakes aligns with the fault strike.The research is expected to provide technical support for post-disaster reconstruction planning,site selection,and disaster mitigation strategies in Myanmar.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Energy poverty in developing countries is a critical issue characterized by the lack of access to modern energy services,such as electricity and clean cooking facilities,as marked in SDG 7.This study explores the corr...Energy poverty in developing countries is a critical issue characterized by the lack of access to modern energy services,such as electricity and clean cooking facilities,as marked in SDG 7.This study explores the correlations between energy poverty,energy intensity,resource abundance,and income inequality,as these factors have been theorized to play important roles in influencing energy poverty in developing countries.By observing that the dataset is heterogeneous across the countries and over the time frame,we use the Method of Moments Quantile Regression(MMQR)to analyze our developing countries’data from 2000 to 2019.Our findings indicate that energy intensity is a significant factor influencing energy poverty,suggesting that higher energy consumption relative to the sample countries can exacerbate this issue.Additionally,we observe that income inequality within the sample countries is a critical determinant of energy poverty levels,highlighting the dynamics between economic disparity and access to energy resources.Interestingly,our study reveals that resource abundance acts as a blessing rather than a curse in terms of energy poverty,implying that countries rich in natural resources may have better opportunities to combat energy deprivation.Finally,we emphasize the vital role of financial markets in addressing energy poverty on a global scale,suggesting that robust financial systems can facilitate investments and innovations aimed at improving energy access for vulnerable populations.The results from the robustness analysis support the empirical results obtained from the main estimation.The empirical findings of the present study advance important comprehensions for policymakers to adopt energy policies that address the complex challenges of energy poverty and promote inclusive energy access.展开更多
This study examines the evolving use of synthetic chemicals in intensive agriculture over the past decade.It highlights the negative impacts of chemical inputs on soil health and ecosystem integrity and recommends kno...This study examines the evolving use of synthetic chemicals in intensive agriculture over the past decade.It highlights the negative impacts of chemical inputs on soil health and ecosystem integrity and recommends knowledge-sharing platforms,soil protection laws,and collaborative efforts between regulatory agencies and agricultural experts.The study emphasizes the need for a balanced approach that includes natural methods alongside synthetic chemicals,particularly herbicides.Ten years ago,farmers primarily used urea,DAP,and potassium for nutrients.However,increased awareness,market forces,and government subsidies have led to a significant rise in herbicide use as a cost-effective weed management strategy.Over the past decade,synthetic fertilizer use for cotton cultivation has increased by 80%,leading to deteriorating soil quality.Paddy cultivation has decreased by 23%,while cotton cultivation has increased by 20.4%due to higher economic incentives.Currently,89.1%of farmers use herbicides,compared to 97.2%who did not a decade ago.Insecticide use has also surged,with 97.8%of farmers applying 1.5 liters or more per acre.The excessive use of chemicals threatens soil fertility and disrupts the ecosystem’s balance.This article explores the reasons behind the adoption of chemical-intensive farming practices and offers insights into farmers’decision-making processes.The careful use of synthetic chemicals is essential to safeguard soil health and maintain ecological balance.展开更多
Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood require...Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.展开更多
Urban environments offer a wealth of opportunities for residents to respite from their hectic life.Outdoor running or jogging becomes increasingly popular of an option.Impacts of urban environments on outdoor running,...Urban environments offer a wealth of opportunities for residents to respite from their hectic life.Outdoor running or jogging becomes increasingly popular of an option.Impacts of urban environments on outdoor running,despite some initial studies,remain underexplored.This study aims to establish an analytical framework that can holistically assess the urban environment on the healthy vitality of running.The proposed framework is applied to two modern Chinese cities,i.e.,Guangzhou and Shenzhen.We construct three interpretable random forest models to explore the non-linear relationship between environmental variables and running intensity(RI)through analyzing the runners'trajectories and integrating with multi-source urban big data(e.g.,street view imagery,remote sensing,and socio-economic data)across the built,natural,and social dimensions,The findings uncover that road density has the greatest impact on RI,and social variables(e.g.,population density and housing price)and natural variables(e.g.,slope and humidity)all make notable impact on outdoor running.Despite these findings,the impact of environmental variables likely change across different regions due to disparate regional construction and micro-environments,and those specific impacts as well as optimal thresholds also alter.Therefore,construction of healthy cities should take the whole urban environment into account and adapt to local conditions.This study provides a comprehensive evaluation on the influencing variables of healthy vitality and guides sustainable urban planning for creating running-friendly cities.展开更多
The 2025 M_(w)7.7 Myanmar earthquake highlighted the challenge of near-fault seismic intensity field reconstruction due to sparse seismic networks.To address this limitation,a framework was proposed integrating seismi...The 2025 M_(w)7.7 Myanmar earthquake highlighted the challenge of near-fault seismic intensity field reconstruction due to sparse seismic networks.To address this limitation,a framework was proposed integrating seismic wave simulation with a data-constrained finite-fault rupture model.The constraint is implemented by identifying the optimal ground motion models(GMMs)through a scoring system that selects the best-fit GMMs to mid-and far-field China Earthquake Networks Center(CENC)seismic network data;and applying the optimal GMMs to refine the rupture model parameters for near-fault intensity field simulation.The simulated near-fault seismic intensity field reproduces seismic intensities collected from Myanmar’s sparse seismic network and concentrated in≥Ⅷintensity zones within 50 km of the projected fault plane;and identifies abnormal intensity regions exhibiting≥Ⅹintensity along the Meiktila-Naypyidaw corridor and near Shwebo that are attributed to soft soil amplification effects and near-fault directivity.This framework can also be applied to post-earthquake assessments in other similar regions.展开更多
BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effec...BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.展开更多
This study primarily investigates the rock fracture mechanism of bottom cushion layer blasting and explores the effects of the bottom cushion layer on rock fragmentation.It involves analyses of the evolution patterns ...This study primarily investigates the rock fracture mechanism of bottom cushion layer blasting and explores the effects of the bottom cushion layer on rock fragmentation.It involves analyses of the evolution patterns of blasting stress,characteristics of crack distribution,and rock fracture features in the specimens.First,blasting model experiments were carried out using the dynamic caustics principle to investigate the influence of bottom cushion layers and initiation methods on the integrity of the bottom rock mass.The experimental results indicate that the combined use of bottom cushion layers and inverse initiation effectively protects the integrity of the bottom rock mass.Subsequently,the process of stress wave propagation and dynamic crack propagation in rocks was simulated using the continuum-discontinuum element method(CDEM)and the Landau explosion source model,with varying thicknesses of bottom cushion layers.The numerical simulation results indicate that with increasing cushion thickness,the absorption of energy generated by the explosion becomes more pronounced,resulting in fewer cracks in the bottom rock mass.This illustrates the positive role of the cushion layer in protecting the integrity of the bottom rock mass.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This ...The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.展开更多
文摘In this paper an intensional concept theory based on an intensional containment relation is presented, which, in turn, is then generalized in order to define the complete concept of God. We are following Leibniz＇s definition of God as a most perfect Being, by which he meant a subject of all perfections. As a consequence of this definition of God, two different complete concepts of the Devil（s） can be defined. However, these two complete concepts of the Devil（s） are not only incoherent with Leibniz＇s philosophy, but they introduce the problem of the Devil（s） as well, which seems to originate from a problem of an adequate definition of the concept of God on one hand, and the logical problem of the intensional negation of a concept on the other hand.
文摘Trademark is developing rapidly nowadays,it has direct effects on people’s daily life in many aspects.Translation of trademark plays a very important role in this highly competitive society.This paper tries to approach the the translation of the descriptions of import and export goods and the trademarks from the angle of cultural differences.Translation of trademarks can transmit plentiful information from the commodities effectively.Here is the summary of some important principles and six methods on how to translate the trademarks.
基金supported by the National Key R&D Program of China [grant number 2023YFC3008004]。
文摘This study presents a comprehensive evaluation of tropical cyclone(TC)forecast performance in the western North Pacific from 2013 to 2022,based on operational forecasts issued by the China Meteorological Administration.The analysis reveals systematic improvements in both track and intensity forecasts over the decade,with distinct error characteristics observed across various forecast parameters.Track forecast errors have steadily decreased,particularly for longer lead times,while error magnitudes have increased with longer forecast lead times.Intensity forecasts show similar progressive enhancements,with maximum sustained wind speed errors decreasing by 0.26 m/s per year for 120 h forecasts.The study also identifies several key patterns in forecast performance:typhoon-grade or stronger TCs exhibit smaller track errors than week or weaker systems;intensity forecasts systematically overestimate weaker TCs while underestimating stronger systems;and spatial error distributions show greater track inaccuracies near landmasses and regional intensity biases.These findings highlight both the significant advances in TC forecasting capability achieved through improved modeling and observational systems,and the remaining challenges in predicting TC changes and landfall behavior,providing valuable benchmarks for future forecast system development.
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
基金National Natural Science Foundation of China under Grant No.U2239252National Natural Science Foundation of China under Grant No.52279128Natural Science Foundation of Heilongjiang Province of China under Grant No.YQ2022E013。
文摘Dispatched by the Chinese government,a multidisciplinary team of 30 researchers collaborated with a team from Myanmar to conduct a 14-day on-site investigation.The work encompassed seismic intensity assessments,field surveys,and loss evaluations.The paper focuses on the intensity distribution and structural damage characteristics of the 2025 M7.9 Myanmar earthquake,yielding the following key findings.(1)The seismogenic fault rupture propagated in a nearly N-S direction,with a surface rupture length of approximately 450 km.The seismic impact zone exhibited an elongated N-S distribution and a shorter E-W span,distributed like a belt around the seismogenic fault.(2)Within the seismic impact zones,existing buildings comprised five primary structural types,with timber(bamboo)structures constituting the largest proportion(≈80%in rural areas,≈50%in urban areas).The relatively low disaster losses and casualties were primarily attributable to the good seismic performance and low damage ratio of timber(bamboo)structures across varying intensity zones.(3)An anomalous zone of intensityⅨwas located at the boundary between intensityⅥandⅦregions in Nay Pyi Taw.Here,ridge topography combined with soft soil layers significantly amplified ground motion,exacerbating structural damage.(4)Directional effects of ground motion were observed,with the structural damage phenomena and peak ground acceleration(PGA)values in the N-S direction exceeding those in the E-W direction.This validates that the maximum PGA distribution of strike-slip fault earthquakes aligns with the fault strike.The research is expected to provide technical support for post-disaster reconstruction planning,site selection,and disaster mitigation strategies in Myanmar.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘Energy poverty in developing countries is a critical issue characterized by the lack of access to modern energy services,such as electricity and clean cooking facilities,as marked in SDG 7.This study explores the correlations between energy poverty,energy intensity,resource abundance,and income inequality,as these factors have been theorized to play important roles in influencing energy poverty in developing countries.By observing that the dataset is heterogeneous across the countries and over the time frame,we use the Method of Moments Quantile Regression(MMQR)to analyze our developing countries’data from 2000 to 2019.Our findings indicate that energy intensity is a significant factor influencing energy poverty,suggesting that higher energy consumption relative to the sample countries can exacerbate this issue.Additionally,we observe that income inequality within the sample countries is a critical determinant of energy poverty levels,highlighting the dynamics between economic disparity and access to energy resources.Interestingly,our study reveals that resource abundance acts as a blessing rather than a curse in terms of energy poverty,implying that countries rich in natural resources may have better opportunities to combat energy deprivation.Finally,we emphasize the vital role of financial markets in addressing energy poverty on a global scale,suggesting that robust financial systems can facilitate investments and innovations aimed at improving energy access for vulnerable populations.The results from the robustness analysis support the empirical results obtained from the main estimation.The empirical findings of the present study advance important comprehensions for policymakers to adopt energy policies that address the complex challenges of energy poverty and promote inclusive energy access.
文摘This study examines the evolving use of synthetic chemicals in intensive agriculture over the past decade.It highlights the negative impacts of chemical inputs on soil health and ecosystem integrity and recommends knowledge-sharing platforms,soil protection laws,and collaborative efforts between regulatory agencies and agricultural experts.The study emphasizes the need for a balanced approach that includes natural methods alongside synthetic chemicals,particularly herbicides.Ten years ago,farmers primarily used urea,DAP,and potassium for nutrients.However,increased awareness,market forces,and government subsidies have led to a significant rise in herbicide use as a cost-effective weed management strategy.Over the past decade,synthetic fertilizer use for cotton cultivation has increased by 80%,leading to deteriorating soil quality.Paddy cultivation has decreased by 23%,while cotton cultivation has increased by 20.4%due to higher economic incentives.Currently,89.1%of farmers use herbicides,compared to 97.2%who did not a decade ago.Insecticide use has also surged,with 97.8%of farmers applying 1.5 liters or more per acre.The excessive use of chemicals threatens soil fertility and disrupts the ecosystem’s balance.This article explores the reasons behind the adoption of chemical-intensive farming practices and offers insights into farmers’decision-making processes.The careful use of synthetic chemicals is essential to safeguard soil health and maintain ecological balance.
文摘Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.
基金National Natural Science Foundation of China,No.42171455The Hong Kong RGC Research Impact Fund,No.R5011-23The Hong Kong General Research Fund,No.15204121。
文摘Urban environments offer a wealth of opportunities for residents to respite from their hectic life.Outdoor running or jogging becomes increasingly popular of an option.Impacts of urban environments on outdoor running,despite some initial studies,remain underexplored.This study aims to establish an analytical framework that can holistically assess the urban environment on the healthy vitality of running.The proposed framework is applied to two modern Chinese cities,i.e.,Guangzhou and Shenzhen.We construct three interpretable random forest models to explore the non-linear relationship between environmental variables and running intensity(RI)through analyzing the runners'trajectories and integrating with multi-source urban big data(e.g.,street view imagery,remote sensing,and socio-economic data)across the built,natural,and social dimensions,The findings uncover that road density has the greatest impact on RI,and social variables(e.g.,population density and housing price)and natural variables(e.g.,slope and humidity)all make notable impact on outdoor running.Despite these findings,the impact of environmental variables likely change across different regions due to disparate regional construction and micro-environments,and those specific impacts as well as optimal thresholds also alter.Therefore,construction of healthy cities should take the whole urban environment into account and adapt to local conditions.This study provides a comprehensive evaluation on the influencing variables of healthy vitality and guides sustainable urban planning for creating running-friendly cities.
基金Scientific Research Fund of Institute of Engineering Mechanics,China Earthquake Administration under Grant No.2023C01National Natural Science Foundation of China under Grant No.52478570Distinguished Young Scholars Program of the Natural Science Foundation of Heilongjiang Province,China under Grant No.JQ2024E002。
文摘The 2025 M_(w)7.7 Myanmar earthquake highlighted the challenge of near-fault seismic intensity field reconstruction due to sparse seismic networks.To address this limitation,a framework was proposed integrating seismic wave simulation with a data-constrained finite-fault rupture model.The constraint is implemented by identifying the optimal ground motion models(GMMs)through a scoring system that selects the best-fit GMMs to mid-and far-field China Earthquake Networks Center(CENC)seismic network data;and applying the optimal GMMs to refine the rupture model parameters for near-fault intensity field simulation.The simulated near-fault seismic intensity field reproduces seismic intensities collected from Myanmar’s sparse seismic network and concentrated in≥Ⅷintensity zones within 50 km of the projected fault plane;and identifies abnormal intensity regions exhibiting≥Ⅹintensity along the Meiktila-Naypyidaw corridor and near Shwebo that are attributed to soft soil amplification effects and near-fault directivity.This framework can also be applied to post-earthquake assessments in other similar regions.
文摘BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
基金financially supported by the National Natural Science Foundation of China(Nos.52204085 and 52104074)the Youth Science and Technology Foundation Key Laboratory for Mechanics in Fluid Solid Coupling System,Institute of Mechanics(No.E0XM040401)。
文摘This study primarily investigates the rock fracture mechanism of bottom cushion layer blasting and explores the effects of the bottom cushion layer on rock fragmentation.It involves analyses of the evolution patterns of blasting stress,characteristics of crack distribution,and rock fracture features in the specimens.First,blasting model experiments were carried out using the dynamic caustics principle to investigate the influence of bottom cushion layers and initiation methods on the integrity of the bottom rock mass.The experimental results indicate that the combined use of bottom cushion layers and inverse initiation effectively protects the integrity of the bottom rock mass.Subsequently,the process of stress wave propagation and dynamic crack propagation in rocks was simulated using the continuum-discontinuum element method(CDEM)and the Landau explosion source model,with varying thicknesses of bottom cushion layers.The numerical simulation results indicate that with increasing cushion thickness,the absorption of energy generated by the explosion becomes more pronounced,resulting in fewer cracks in the bottom rock mass.This illustrates the positive role of the cushion layer in protecting the integrity of the bottom rock mass.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
文摘The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.
