Physical restraint is one of the most controversial methods in managing aggressive behaviors and maintaining patients' safety. This manuscript purposed to convince stockholders and policymakers of the negative imp...Physical restraint is one of the most controversial methods in managing aggressive behaviors and maintaining patients' safety. This manuscript purposed to convince stockholders and policymakers of the negative impact of physical restraint on patients' psychological and physical health. The current authors review the ethical and legal underpinnings of the opponents' and proponents' views. On one hand, there is a clear violation of the main principles of the code of ethics. Autonomy and justice;as the patients are tied against their will and without obtaining their consent, non-maleficent;as physical restraints are reported in many cases of physical and psychological traumas, thus many agencies prohibited the use of physical restraints as a safety method to be replaced with other deescalating techniques. On the other hand, physical restraints are a precious method in controlling aggressive behaviors and maintaining patients' safety, which is the selective beneficence in providing patient care. Also, most of the same agencies who prohibited the use of restraints, agreed the use of physical restraint as the last resor t.Summary statement What is already known about this topic?· Currently, physical restraint is used as the first accessible method to manage patients' behaviors, without considering the negative aura that surrounds the way of treatment. The usage of physical restraint has gone beyond the purpose of maintaining patient safety and managing aggressive behaviors to be a punishment method.· The Ethical and Legal context of using physical restraints is still vague and needs more clarification.What does this paper add?· This manuscript illustrates the Ethical and Legal points of view of the opponents and proponents of using physical restraints.· The current manuscript clearly justifies the authors' point of view to oppose physical restraints usage and how physical restraints violate the core principles of the code of ethics. In addition, it illustrates the legal agencies that suppor t/oppose the usage of physical restraint and the rationale beyond that position.· This manuscript provides alternatives to manage patients' aggressive behaviors and other ways to protect patients' safety as well as patient's dignity and code of ethics.The implications of this paper This argumentative essay provides an accessible, relevant exploration of public health policy, and its impact on nursing practice, mental health services, and patient health. Moreover, it provides a forum for mental health services to evaluate the current implications of physical restraints. The manuscript creates a paradigm for future studies and projects on physical restraints usage.展开更多
Factors that influence the development of China's modern flower arrangement art are analyzed in this study,countermeasures and suggestions are proposed for the future development.
Coupled-plate structures are widely used in the practical engineering such as aeronautical,civil and naval engineering etc.Limited works can be found on the vibration of the coupled-plate structure due to the increase...Coupled-plate structures are widely used in the practical engineering such as aeronautical,civil and naval engineering etc.Limited works can be found on the vibration of the coupled-plate structure due to the increased mathematical complexity compared with the single plate structure.In order to study analytically the vibration characteristics and power transmission of the coupled-plate structure,an analytical model consisting of three coupled plates elastically restrained along boundary edges and elastically coupled with arbitrary angle is considered,in which four groups of springs are distributed consistently along each edge of the model to simulate the transverse shearing forces,bending moments,in-plane longitudinal forces and in-plane shearing forces separately.With elastic coupling condition and general boundary condition of both flexural and in-plane vibrations taken into account by setting the stiffness of corresponding springs,the double Fourier series solution to the dynamic response of the structure was obtained by employing the Rayleigh-Ritz method.In order to validate the model,the natural frequency and velocity response of the model are firstly checked against results published in literatures and the ANSYS data,and good agreement was observed.Then,numerical simulation of the effects of several relevant parameters on the vibration characteristics and power transmission of the coupled structure were performed,including boundary conditions,coupling conditions,coupling angle,and location of the external forces.Vibration and energy transmission behaviors were analyzed numerically.The results show that the power transmission can be significantly influenced by the boundary restraints and the location of excitation.When the excitation is located at the central symmetry point of the model,the energy flow shows a symmetrical distribution.Once the location deviates from the central symmetry point,the power circumfluence occurs and the vortex energy field is formed at high frequency.展开更多
The rapid growth in US-Sri Lanka relations is the latest attempt by the US to implement its Indo-Pacific strategy in South Asia. As the strategy materializes, the intensified US involvement in the region will bring ne...The rapid growth in US-Sri Lanka relations is the latest attempt by the US to implement its Indo-Pacific strategy in South Asia. As the strategy materializes, the intensified US involvement in the region will bring new variables to the security situation in the Bay of Bengal and the Indian Ocean.展开更多
Purpose: This study sought to clarify the relationship between a nurse’s exposure to elderly relatives and their perspective in using restraints on the elderly in health care situations. Methods: We approached nursin...Purpose: This study sought to clarify the relationship between a nurse’s exposure to elderly relatives and their perspective in using restraints on the elderly in health care situations. Methods: We approached nursing staff supervisors at 17 general hospital wards and explained the objectives of the study. Supervisors at 14 hospitals agreed to participate, giving us a sampling pool of 1929 nurses. We used a chi square test to compare nurses who had spent time with elderly relatives and those who had not on several variables related to using restraints on elderly patients. Results and Conclusion: This study found that nurses who live with elderly family members were significantly more likely to believe that restraints cause diseases (including chronic diseases) based on a chi square test (p < 0.05). Therefore it would be important that essential was the experiences of individuals with elderly family members when making programs of decreasing nurse’s dilemma to restraining the elderly.展开更多
Purpose: This study aimed to develop an ethical dilemma scale for nurses faced with the use of physical restraint when caring for elderly patients with dementia. Methods: We used a previously established 20-item dilem...Purpose: This study aimed to develop an ethical dilemma scale for nurses faced with the use of physical restraint when caring for elderly patients with dementia. Methods: We used a previously established 20-item dilemma scale. The objective and method of the study were explained to the head of nursing at 17 selected hospitals, and 121 nurses working in the general wards of 14 hospitals (excluding emergency department wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms and intensive care units) who agreed to participate were enrolled in 2000. Seventy-six nurses from one of the hospitals were selected after eight years (2008) to provide a comparison. Ethical considerations: The study was conducted with the approval of the ethics committee at Meiji University of Integrative Medicine. Results and discussion: Four factors were compared between 2000 and 2008: “execution of treatment and security”, “characteristic features in nursing of elderly patients with dementia”, “cooperative relationship in nursing”, and “priorities in nursing”. The cumulative contribution ratio was 65.3% (KMO = 0.77, p = 0.000) in 2000 and 72.5% (KMO = 0.78, p = 0.000) in 2008. Therefore, the scale dilemma nurse faced physical restraints to elderly patients with dementia in Japan was developed 4 facoters from 17-delremmas items of 20 items.展开更多
Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restrai...Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restraints is significantly higher in China than in other countries.Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients.Therefore,this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China.This study synthesized the ethical issue according to the ethical principle of autonomy,justice,beneficence,and nonmaleficence.Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China,applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial.In regard to respect the basic rights of psychiatric patients,it is recommended to protect the their autonomy,and eliminate the adverse effects of physical restraint.This goal would be achieved by ensuring the informed consent,providing humane care,and regulating the implementation of physical restraints.展开更多
The aeroelastic stability of rotating beams with elastic restraints is investigated.The coupled bending-torsional Euler-Bernoulli beam and Timoshenko beam models are adopted for the structural modeling.The Greenberg a...The aeroelastic stability of rotating beams with elastic restraints is investigated.The coupled bending-torsional Euler-Bernoulli beam and Timoshenko beam models are adopted for the structural modeling.The Greenberg aerodynamic model is used to describe the unsteady aerodynamic forces.The additional centrifugal stiffness effect and elastic boundary conditions are considered in the form of potential energy.A modified Fourier series method is used to assume the displacement field function and solve the governing equation.The convergence and accuracy of the method are verified by comparison of numerical results.Then,the flutter analysis of the rotating beam structure is carried out,and the critical rotational velocity of the flutter is predicted.The results show that the elastic boundary reduces the critical flutter velocity of the rotating beam,and the elastic range of torsional spring is larger than the elastic range of linear spring.展开更多
Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospita...Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospitals who also live with elderly adults at home. Method: The study used the questionnaire method with an independently prepared questionnaire. Participants: The objective of the study was explained to the persons in charge of nursing in the selected 17 hospitals, and 1929. Finally, this study of participants were 524 female nurses working in general 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units) at community hospitals who also live with elderly adults at home. Results and conclusions: Cronbach’s overall coefficient for the 20 items of dilemma was high (0.78) and the factor analysis extracted four dilemma factors as having a characteristic value of 1 (Kaiser-Meyer-Olkin measure value = 0.81) with a cumulative contribution ratio of 64.5%. The high Cronbach’s for these items (0.86, 0.88, 0.87 and 0.81) confirmed the internal consistencies. With respect to the dilemma where nurses working in general wards at community hospitals who also live with elderly adults at home are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: accomplishment of medical-treatment and accident prevention, characteristic features in nursing for elderly patients with dementia, healthcare professional relationship in nursing for elderly patients with dementia, and priorities on the accident prevention for elderly patients with dementia. Therefore, the construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to: (i) institution of policies to encourage discussion between nurses and other medical staff to reach consensus on treatment;(ii) allocating elderly care specialists to wards to promote alternatives to restraints;(iii) establishment of safety standards to define nurses’ responsibilities;and (iv) institution of continuous ethical education for nurses.展开更多
The prediction of protein–protein complex structures is crucial for fundamental understanding of celluar processes and drug design. Despite significant progresses in the field, the accuracy of ab initio docking witho...The prediction of protein–protein complex structures is crucial for fundamental understanding of celluar processes and drug design. Despite significant progresses in the field, the accuracy of ab initio docking without using any experimental restraints remains relatively low. With the rapid advancement of structural biology, more and more information about binding can be derived from experimental data such as NMR experiments or chemical cross-linking. In addition, information about the residue contacts between proteins may also be derived from their sequences by using evolutionary analysis or deep learning. Here, we propose an efficient approach to incorporate interface residue restraints into protein–protein docking, which is named as HDOCKsite. Extensive evaluations on the protein–protein docking benchmark 4.0 showed that HDOCKsite significantly improved the docking performance and obtained a much higher success rate in binding mode predictions than original ab initio docking.展开更多
Based on von Karman＇s plate theory, the axisymmetric thermal buckling and post-buckling of the functionally graded material （FGM） circular plates with in- plane elastic restraints under transversely non-uniform tem...Based on von Karman＇s plate theory, the axisymmetric thermal buckling and post-buckling of the functionally graded material （FGM） circular plates with in- plane elastic restraints under transversely non-uniform temperature rise are studied. The properties of the FGM media are varied through the thickness based on a simple power law. The governing equations are numerically solved by a shooting method. The results of the critical buckling temperature, post-buckling equilibrium paths, and configurations for the in-plane elastically restrained plates are presented. The effects of the in-plane elastic restraints, material property gradient, and temperature variation on the responses of thermal buckling and post-buckling are examined in detail.展开更多
Background: Physical Restraint (PR) has been widely used in the intensive care units, which aims to protect patients and maintain their safety. With all benefits of PR, there are many complications and risks from impr...Background: Physical Restraint (PR) has been widely used in the intensive care units, which aims to protect patients and maintain their safety. With all benefits of PR, there are many complications and risks from improper utilization. Further, no Jordanian studies have found to educate nurses regarding the proper PR utilization. Purpose: To evaluate the impact of an educational program on nurses’ knowledge, attitude and practice regarding PR use in ICUs. Methods: A pre-experiment with one-group pretest-posttest design was used among 40 ICU nurses. A self-administered questionnaire was used to evaluate nurses before the education program and two weeks after its completion. Results: After implementation of the program, nurses demonstrated a significant difference in knowledge scores between pretest (M = 10.35 ± 1.73) and posttest (M = 13.30 ± 1.47) (t = 9.92;df = 39;P = 0.000), attitudes scores (M = 27.90 ± 2.79 vs. M = 30.40 ± 2.32) (t = 4.61;df = 39;P = 0.000), and practice scores (M = 36.85 ± 1.98 vs. M = 40.52 ± 1.60) (t = 11.59;df = 39;P = 0.000). Conclusion: Service-education program can improve ICU nurses’ knowledge, and enhance their attitudes and practices towards physical restraint. Such improvement is expected to be reflected in improving the quality of care delivered to the patients, and decreasing complications of malpractice regarding physical restraint.展开更多
Post-tensioned(PT)self-centering moment frames have been developed as an alternative to typical moment-resisting frames(MRFs)for earthquake resistance.When a PT frame deforms laterally,gaps between the beams and colum...Post-tensioned(PT)self-centering moment frames have been developed as an alternative to typical moment-resisting frames(MRFs)for earthquake resistance.When a PT frame deforms laterally,gaps between the beams and columns open.However,the gaps are constrained by the columns and the slab in a real PT selfcentering building frame.This paper presents a methodology for evaluating the column restraint and beam compression force based on the column deformation and gap openings at all stories.The method is verified by cyclic tests of a full-scale,two-bay by one-story PT frame.Moreover,a sliding slab is proposed to minimize restraints on the expansion of the PT frame.Shaking table tests were conducted on a reduced-scale,two-by-two bay one-story specimen,which comprises one PT frame and two gravitational frames.The PT frame and gravitational frames are self-centering throughout the tests,responding in phase with only minor differences in peak drifts caused by expansion of the PT frame.When the specimen is excited by a simulation of the 1999 Chi-Chi earthquake with a peak ground acceleration of 1.87 g,the maximum interstory drift and the residual drift are 7.2%and 0.01%,respectively.展开更多
The girder end restraint devices such as bearings and dampers on long span suspension bridge will deteriorate over time.However,it is difficult to achieve the quantitative assessment of the performance of the restrain...The girder end restraint devices such as bearings and dampers on long span suspension bridge will deteriorate over time.However,it is difficult to achieve the quantitative assessment of the performance of the restraint device through existing detection methods in actual inspections,making it difficult to obtain the impact of changes in the performance of the restraint device on the bridge structure.In this paper,a random vehicle load model is firstly established based on the WIM data of Jiangyin Bridge,and the displacement of girder end under the actual traffic flow is simulated by using finite element dynamic time history analysis.On this basis,according to the performance test data of the bearings and dampers,the performance degradation laws of the above two restraint devices are summarized,and the performance degradation process of the two restraint devices and the effects of different restraint parameters on the bridge structure are simulated.The results show that the performance degradation of the damper will significantly reduce the damping force at low speed,resulting in a significant increase in the cumulative displacement of the girder end;in the presence of longitudinal dampers,the increase in the friction coefficient caused by the deterioration of the bearing sliding plate has little effect on the cumulative displacement,but excessive wear of the bearing sliding plate adversely affects the structural dynamic performance.展开更多
Dysregulation of neurotransmitter metabolism in the central nervous system contributes to mood disorders such as depression, anxiety, and post–traumatic stress disorder. Monoamines and amino acids are important types...Dysregulation of neurotransmitter metabolism in the central nervous system contributes to mood disorders such as depression, anxiety, and post–traumatic stress disorder. Monoamines and amino acids are important types of neurotransmitters. Our previous results have shown that disco-interacting protein 2 homolog A(Dip2a) knockout mice exhibit brain development disorders and abnormal amino acid metabolism in serum. This suggests that DIP2A is involved in the metabolism of amino acid–associated neurotransmitters. Therefore, we performed targeted neurotransmitter metabolomics analysis and found that Dip2a deficiency caused abnormal metabolism of tryptophan and thyroxine in the basolateral amygdala and medial prefrontal cortex. In addition, acute restraint stress induced a decrease in 5-hydroxytryptamine in the basolateral amygdala. Additionally, Dip2a was abundantly expressed in excitatory neurons of the basolateral amygdala, and deletion of Dip2a in these neurons resulted in hopelessness-like behavior in the tail suspension test. Altogether, these findings demonstrate that DIP2A in the basolateral amygdala may be involved in the regulation of stress susceptibility. This provides critical evidence implicating a role of DIP2A in affective disorders.展开更多
Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital f...Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.展开更多
This study aimed to evaluate the antidepressant effects of the combined administration of total saikosaponins(SSA)and volatile oil of Cyperi Rhizoma(VO)using a mouse depression model induced by chronic restraint plus ...This study aimed to evaluate the antidepressant effects of the combined administration of total saikosaponins(SSA)and volatile oil of Cyperi Rhizoma(VO)using a mouse depression model induced by chronic restraint plus mild stress(CRMS),and to compare the effects with the traditional antidepressant fluoxetine.Male Kunming mice were subjected to 14-day CRMS modeling and then randomly divided into four groups:the combined treatment group(intraperitoneal injection of SSA 3.5 mg·kg^(-1)+VO 35 mg·kg^(-1)),the fluoxetine treatment group(20 mg·kg^(-1)),the normal saline treatment group,and the non-model group.Drugs were administered continuously for 14 days.Depressive-like behaviors were assessed using the Forced Swimming Test(FST),Tail Suspension Test(TST),and Open-Field Test(OFT).The results showed that the absolute immobility time of mice in the CRMS model group was significantly prolonged in FST and TST.Combined administration of SSA and VO significantly improved depressive-like behaviors,restoring the absolute immobility time in FST and TST to levels close to the control group,with efficacy comparable to fluoxetine.This study confirms that the combination of SSA and VO exhibits antidepressant effects equivalent to fluoxetine in the CRMS model,providing experimental evidence for the further clinical development of this traditional Chinese medicine(TCM)compatibility.展开更多
Effects of Mingzhu Oral Liquid on the Hypothalamic-Pituitary-Adrenal Axis in Rats with Liver-Kidney Yin Deficiency WANG Yi-ting1,ZHAO Yang1,ZHU Fei-ya1,WANG Si-qiong1,ZHU Ling-lei1,LI Tao2,TANG Min-ke1,1.Beijing Unive...Effects of Mingzhu Oral Liquid on the Hypothalamic-Pituitary-Adrenal Axis in Rats with Liver-Kidney Yin Deficiency WANG Yi-ting1,ZHAO Yang1,ZHU Fei-ya1,WANG Si-qiong1,ZHU Ling-lei1,LI Tao2,TANG Min-ke1,1.Beijing University of Chinese Medicine,Beijing,100029,China 2.Guangzhou Yitong Technology Co.,Ltd.,Guangzhou,510653,China【ABSTRACT】Objective:This study aimed to observe the effects of Mingzhu Oral Liquid on the hypothalamic-pituitary-adrenal(HPA)axis in rats with“liver-kidney yin deficiency”,in order to provide scientific research support for its clinical application in treating related disorders.Methods:A“liver-kidney yin deficiency”model was established in male Sprague-Dawley(SD)rats using a combination of chronic restraint stress and a single lipopolysaccharide(LPS)challenge.The rats were randomly divided into four groups:a blank control group,a model group,a low-dose Mingzhu Oral Liquid group,and a high-dose Mingzhu Oral Liquid group.The blank control group and model group were given normal saline by gavage,while the treatment groups received respective doses of Mingzhu Oral Liquid.Gavage administration was performed once daily for 30 consecutive days.During this period,all groups except the blank control group were subjected to restraint stress.Following the final gavage,all groups except the blank control received an intraperitoneal injection of LPS.Samples were collected 24 h post-injection.Serum levels of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP)were measured by enzyme-linked immunosorbent assay(ELISA)to evaluate the model state.The serum concentrations of corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),and glucocorticoid(GC)were determined to assess HPA axis activity.Changes in proinflammatory factors[tumor necrosis factor-alpha(TNF-α),interleukin-1 beta(IL-1β)]and the anti-inflammatory factor interleukin-10(IL-10)were also measured.Results:One week into the experiment,the weight gain rate slowed in all stress groups.By the end of the experiment,the body weight of these groups was significantly lower than that of the blank control group.Biochemical and hematological analyses revealed that the model group exhibited a significant decrease in lymphocyte count,an increased cAMP/cGMP ratio,reduced activities of glutathione S-transferase(GST)and glutathione transferase(GLT),elevated levels of blood urea nitrogen(BUN)and serum creatinine(Scr),increased serum contents of TNF-αand IL-1β,and a decreased content of IL-10.These findings confirmed the successful establishment of the rat model.Although the body weight of animals treated with Mingzhu Oral Liquid remained lower than that of the normal group,the treatment improved weight gain compared to the model group.Furthermore,Mingzhu Oral Liquid administration increased lymphocyte count,decreased the cAMP/cGMP ratio,restored GST and GLT activities,reduced BUN and Scr levels,lowered serum TNF-αand IL-1βcontents,and increased IL-10 levels,indicating a significant ameliorative effect on the deficiency symptoms.Additionally,serum levels of CRH,ACTH,and GC were elevated in the model rats,suggesting HPA axis hyperactivity.Treatment with Mingzhu Oral Liquid reduced the serum concentrations of these hormones,significantly alleviating the excited state of the HPA axis in stressed rats.Conclusion:Mingzhu Oral Liquid significantly improves the abnormal overall physical signs,blood biochemical parameters,and systemic inflammation in rats with“liver-kidney yin deficiency.”These therapeutic effects may be associated with the corrective action of Mingzhu Oral Liquid on the dysfunctional HPA axis in this model.展开更多
Objective To search novel genes or pathways involved in the recovery process after restraint stress in rats. Methods We compared the hypothalamus transcriptional profiles of two different recovery patterns （fast reco...Objective To search novel genes or pathways involved in the recovery process after restraint stress in rats. Methods We compared the hypothalamus transcriptional profiles of two different recovery patterns （fast recovery vs slow recovery） from restraint stress in rats using oligonucleotide microarray, the recovery pattern was determined by the decrement of plasma adrenocorticotropic-hormone （ACTH） and corticosterone levels during one hour recovery period after stress. A real-time quantitative RT-PCR was applied to validate the differential expressed genes. Results Analysis of the microarray data showed that most of genes were not differentially expressed between fast recovery group and slow recovery group. Among the differentially expressed genes we found that talin, together with serine/threonine protein phosphatase PPl-beta catalytic subunit （PP-1B） and integrin α-6 precursor （VLA-6） genes, were at least 1.5 fold upregulated in the fast recovery group, while junctional adhesion molecule 1 （F11r） was 1.5 fold down-regulated in the fast recovery group. Conclusion The results implied that integrin signaling pathway may be involved in the recovery from restraint stress in rats. The present study provided a global overview of hypothalamus transcriptional profiles during the process of recovery from the restraint stress in rats. The integrin signaling pathway seems to be involved in the recovery process, which deserves further study to clarify the integrin-mediated recovery mechanism after restraint stress.展开更多
文摘Physical restraint is one of the most controversial methods in managing aggressive behaviors and maintaining patients' safety. This manuscript purposed to convince stockholders and policymakers of the negative impact of physical restraint on patients' psychological and physical health. The current authors review the ethical and legal underpinnings of the opponents' and proponents' views. On one hand, there is a clear violation of the main principles of the code of ethics. Autonomy and justice;as the patients are tied against their will and without obtaining their consent, non-maleficent;as physical restraints are reported in many cases of physical and psychological traumas, thus many agencies prohibited the use of physical restraints as a safety method to be replaced with other deescalating techniques. On the other hand, physical restraints are a precious method in controlling aggressive behaviors and maintaining patients' safety, which is the selective beneficence in providing patient care. Also, most of the same agencies who prohibited the use of restraints, agreed the use of physical restraint as the last resor t.Summary statement What is already known about this topic?· Currently, physical restraint is used as the first accessible method to manage patients' behaviors, without considering the negative aura that surrounds the way of treatment. The usage of physical restraint has gone beyond the purpose of maintaining patient safety and managing aggressive behaviors to be a punishment method.· The Ethical and Legal context of using physical restraints is still vague and needs more clarification.What does this paper add?· This manuscript illustrates the Ethical and Legal points of view of the opponents and proponents of using physical restraints.· The current manuscript clearly justifies the authors' point of view to oppose physical restraints usage and how physical restraints violate the core principles of the code of ethics. In addition, it illustrates the legal agencies that suppor t/oppose the usage of physical restraint and the rationale beyond that position.· This manuscript provides alternatives to manage patients' aggressive behaviors and other ways to protect patients' safety as well as patient's dignity and code of ethics.The implications of this paper This argumentative essay provides an accessible, relevant exploration of public health policy, and its impact on nursing practice, mental health services, and patient health. Moreover, it provides a forum for mental health services to evaluate the current implications of physical restraints. The manuscript creates a paradigm for future studies and projects on physical restraints usage.
文摘Factors that influence the development of China's modern flower arrangement art are analyzed in this study,countermeasures and suggestions are proposed for the future development.
基金supported by National Natural Science Foundation of China (Grant No. 10802024)Research Fund for the Doctoral Program of Higher Education of China (Grant No. 200802171009)Innovative Talents Fund of Harbin of China(Grant No.2009RFQXG211)
文摘Coupled-plate structures are widely used in the practical engineering such as aeronautical,civil and naval engineering etc.Limited works can be found on the vibration of the coupled-plate structure due to the increased mathematical complexity compared with the single plate structure.In order to study analytically the vibration characteristics and power transmission of the coupled-plate structure,an analytical model consisting of three coupled plates elastically restrained along boundary edges and elastically coupled with arbitrary angle is considered,in which four groups of springs are distributed consistently along each edge of the model to simulate the transverse shearing forces,bending moments,in-plane longitudinal forces and in-plane shearing forces separately.With elastic coupling condition and general boundary condition of both flexural and in-plane vibrations taken into account by setting the stiffness of corresponding springs,the double Fourier series solution to the dynamic response of the structure was obtained by employing the Rayleigh-Ritz method.In order to validate the model,the natural frequency and velocity response of the model are firstly checked against results published in literatures and the ANSYS data,and good agreement was observed.Then,numerical simulation of the effects of several relevant parameters on the vibration characteristics and power transmission of the coupled structure were performed,including boundary conditions,coupling conditions,coupling angle,and location of the external forces.Vibration and energy transmission behaviors were analyzed numerically.The results show that the power transmission can be significantly influenced by the boundary restraints and the location of excitation.When the excitation is located at the central symmetry point of the model,the energy flow shows a symmetrical distribution.Once the location deviates from the central symmetry point,the power circumfluence occurs and the vortex energy field is formed at high frequency.
文摘The rapid growth in US-Sri Lanka relations is the latest attempt by the US to implement its Indo-Pacific strategy in South Asia. As the strategy materializes, the intensified US involvement in the region will bring new variables to the security situation in the Bay of Bengal and the Indian Ocean.
文摘Purpose: This study sought to clarify the relationship between a nurse’s exposure to elderly relatives and their perspective in using restraints on the elderly in health care situations. Methods: We approached nursing staff supervisors at 17 general hospital wards and explained the objectives of the study. Supervisors at 14 hospitals agreed to participate, giving us a sampling pool of 1929 nurses. We used a chi square test to compare nurses who had spent time with elderly relatives and those who had not on several variables related to using restraints on elderly patients. Results and Conclusion: This study found that nurses who live with elderly family members were significantly more likely to believe that restraints cause diseases (including chronic diseases) based on a chi square test (p < 0.05). Therefore it would be important that essential was the experiences of individuals with elderly family members when making programs of decreasing nurse’s dilemma to restraining the elderly.
文摘Purpose: This study aimed to develop an ethical dilemma scale for nurses faced with the use of physical restraint when caring for elderly patients with dementia. Methods: We used a previously established 20-item dilemma scale. The objective and method of the study were explained to the head of nursing at 17 selected hospitals, and 121 nurses working in the general wards of 14 hospitals (excluding emergency department wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms and intensive care units) who agreed to participate were enrolled in 2000. Seventy-six nurses from one of the hospitals were selected after eight years (2008) to provide a comparison. Ethical considerations: The study was conducted with the approval of the ethics committee at Meiji University of Integrative Medicine. Results and discussion: Four factors were compared between 2000 and 2008: “execution of treatment and security”, “characteristic features in nursing of elderly patients with dementia”, “cooperative relationship in nursing”, and “priorities in nursing”. The cumulative contribution ratio was 65.3% (KMO = 0.77, p = 0.000) in 2000 and 72.5% (KMO = 0.78, p = 0.000) in 2008. Therefore, the scale dilemma nurse faced physical restraints to elderly patients with dementia in Japan was developed 4 facoters from 17-delremmas items of 20 items.
基金funded by the grant of the Scientific Research Project of the Twelfth Five-year Plan Internal Medicine of the Affiliated Brain Hospital of Guangzhou Medical University (Grant Number:GBH2014-HL07).
文摘Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restraints is significantly higher in China than in other countries.Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients.Therefore,this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China.This study synthesized the ethical issue according to the ethical principle of autonomy,justice,beneficence,and nonmaleficence.Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China,applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial.In regard to respect the basic rights of psychiatric patients,it is recommended to protect the their autonomy,and eliminate the adverse effects of physical restraint.This goal would be achieved by ensuring the informed consent,providing humane care,and regulating the implementation of physical restraints.
基金Project supported by the National Science Fund for Distinguished Young Scholars(No.11925205)the National Natural Science Foundation of China(Nos.51921003 and 51805250)the Natural Science Foundation of Jiangsu Province of China(No.BK20180429)。
文摘The aeroelastic stability of rotating beams with elastic restraints is investigated.The coupled bending-torsional Euler-Bernoulli beam and Timoshenko beam models are adopted for the structural modeling.The Greenberg aerodynamic model is used to describe the unsteady aerodynamic forces.The additional centrifugal stiffness effect and elastic boundary conditions are considered in the form of potential energy.A modified Fourier series method is used to assume the displacement field function and solve the governing equation.The convergence and accuracy of the method are verified by comparison of numerical results.Then,the flutter analysis of the rotating beam structure is carried out,and the critical rotational velocity of the flutter is predicted.The results show that the elastic boundary reduces the critical flutter velocity of the rotating beam,and the elastic range of torsional spring is larger than the elastic range of linear spring.
文摘Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospitals who also live with elderly adults at home. Method: The study used the questionnaire method with an independently prepared questionnaire. Participants: The objective of the study was explained to the persons in charge of nursing in the selected 17 hospitals, and 1929. Finally, this study of participants were 524 female nurses working in general 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units) at community hospitals who also live with elderly adults at home. Results and conclusions: Cronbach’s overall coefficient for the 20 items of dilemma was high (0.78) and the factor analysis extracted four dilemma factors as having a characteristic value of 1 (Kaiser-Meyer-Olkin measure value = 0.81) with a cumulative contribution ratio of 64.5%. The high Cronbach’s for these items (0.86, 0.88, 0.87 and 0.81) confirmed the internal consistencies. With respect to the dilemma where nurses working in general wards at community hospitals who also live with elderly adults at home are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: accomplishment of medical-treatment and accident prevention, characteristic features in nursing for elderly patients with dementia, healthcare professional relationship in nursing for elderly patients with dementia, and priorities on the accident prevention for elderly patients with dementia. Therefore, the construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to: (i) institution of policies to encourage discussion between nurses and other medical staff to reach consensus on treatment;(ii) allocating elderly care specialists to wards to promote alternatives to restraints;(iii) establishment of safety standards to define nurses’ responsibilities;and (iv) institution of continuous ethical education for nurses.
基金Project supported by the National Natural Science Foundation of China(Grant No.31670724)the Startup Grant of Huazhong University of Science and Technology。
文摘The prediction of protein–protein complex structures is crucial for fundamental understanding of celluar processes and drug design. Despite significant progresses in the field, the accuracy of ab initio docking without using any experimental restraints remains relatively low. With the rapid advancement of structural biology, more and more information about binding can be derived from experimental data such as NMR experiments or chemical cross-linking. In addition, information about the residue contacts between proteins may also be derived from their sequences by using evolutionary analysis or deep learning. Here, we propose an efficient approach to incorporate interface residue restraints into protein–protein docking, which is named as HDOCKsite. Extensive evaluations on the protein–protein docking benchmark 4.0 showed that HDOCKsite significantly improved the docking performance and obtained a much higher success rate in binding mode predictions than original ab initio docking.
基金Project supported by the National Natural Science Foundation of China(Nos.11272278 and11672260)the China Postdoctoral Science Foundation(No.149558)
文摘Based on von Karman＇s plate theory, the axisymmetric thermal buckling and post-buckling of the functionally graded material （FGM） circular plates with in- plane elastic restraints under transversely non-uniform temperature rise are studied. The properties of the FGM media are varied through the thickness based on a simple power law. The governing equations are numerically solved by a shooting method. The results of the critical buckling temperature, post-buckling equilibrium paths, and configurations for the in-plane elastically restrained plates are presented. The effects of the in-plane elastic restraints, material property gradient, and temperature variation on the responses of thermal buckling and post-buckling are examined in detail.
文摘Background: Physical Restraint (PR) has been widely used in the intensive care units, which aims to protect patients and maintain their safety. With all benefits of PR, there are many complications and risks from improper utilization. Further, no Jordanian studies have found to educate nurses regarding the proper PR utilization. Purpose: To evaluate the impact of an educational program on nurses’ knowledge, attitude and practice regarding PR use in ICUs. Methods: A pre-experiment with one-group pretest-posttest design was used among 40 ICU nurses. A self-administered questionnaire was used to evaluate nurses before the education program and two weeks after its completion. Results: After implementation of the program, nurses demonstrated a significant difference in knowledge scores between pretest (M = 10.35 ± 1.73) and posttest (M = 13.30 ± 1.47) (t = 9.92;df = 39;P = 0.000), attitudes scores (M = 27.90 ± 2.79 vs. M = 30.40 ± 2.32) (t = 4.61;df = 39;P = 0.000), and practice scores (M = 36.85 ± 1.98 vs. M = 40.52 ± 1.60) (t = 11.59;df = 39;P = 0.000). Conclusion: Service-education program can improve ICU nurses’ knowledge, and enhance their attitudes and practices towards physical restraint. Such improvement is expected to be reflected in improving the quality of care delivered to the patients, and decreasing complications of malpractice regarding physical restraint.
基金The test programs were supported by the Science Council and Center for Research on Earthquake Engineering(NCREE),Taiwan.
文摘Post-tensioned(PT)self-centering moment frames have been developed as an alternative to typical moment-resisting frames(MRFs)for earthquake resistance.When a PT frame deforms laterally,gaps between the beams and columns open.However,the gaps are constrained by the columns and the slab in a real PT selfcentering building frame.This paper presents a methodology for evaluating the column restraint and beam compression force based on the column deformation and gap openings at all stories.The method is verified by cyclic tests of a full-scale,two-bay by one-story PT frame.Moreover,a sliding slab is proposed to minimize restraints on the expansion of the PT frame.Shaking table tests were conducted on a reduced-scale,two-by-two bay one-story specimen,which comprises one PT frame and two gravitational frames.The PT frame and gravitational frames are self-centering throughout the tests,responding in phase with only minor differences in peak drifts caused by expansion of the PT frame.When the specimen is excited by a simulation of the 1999 Chi-Chi earthquake with a peak ground acceleration of 1.87 g,the maximum interstory drift and the residual drift are 7.2%and 0.01%,respectively.
基金supported by the National Key Research and Development Program of China(No.2022YFB3706704)the Academician Special Science Research Project of CCCC(No.YSZX-03-2022-01-B).
文摘The girder end restraint devices such as bearings and dampers on long span suspension bridge will deteriorate over time.However,it is difficult to achieve the quantitative assessment of the performance of the restraint device through existing detection methods in actual inspections,making it difficult to obtain the impact of changes in the performance of the restraint device on the bridge structure.In this paper,a random vehicle load model is firstly established based on the WIM data of Jiangyin Bridge,and the displacement of girder end under the actual traffic flow is simulated by using finite element dynamic time history analysis.On this basis,according to the performance test data of the bearings and dampers,the performance degradation laws of the above two restraint devices are summarized,and the performance degradation process of the two restraint devices and the effects of different restraint parameters on the bridge structure are simulated.The results show that the performance degradation of the damper will significantly reduce the damping force at low speed,resulting in a significant increase in the cumulative displacement of the girder end;in the presence of longitudinal dampers,the increase in the friction coefficient caused by the deterioration of the bearing sliding plate has little effect on the cumulative displacement,but excessive wear of the bearing sliding plate adversely affects the structural dynamic performance.
基金supported by the STI 2030—Major Projects 2021ZD0204000,No.2021ZD0204003 (to XZ)the National Natural Science Foundation of China,Nos.32170973 (to XZ),32071018 (to ZH)。
文摘Dysregulation of neurotransmitter metabolism in the central nervous system contributes to mood disorders such as depression, anxiety, and post–traumatic stress disorder. Monoamines and amino acids are important types of neurotransmitters. Our previous results have shown that disco-interacting protein 2 homolog A(Dip2a) knockout mice exhibit brain development disorders and abnormal amino acid metabolism in serum. This suggests that DIP2A is involved in the metabolism of amino acid–associated neurotransmitters. Therefore, we performed targeted neurotransmitter metabolomics analysis and found that Dip2a deficiency caused abnormal metabolism of tryptophan and thyroxine in the basolateral amygdala and medial prefrontal cortex. In addition, acute restraint stress induced a decrease in 5-hydroxytryptamine in the basolateral amygdala. Additionally, Dip2a was abundantly expressed in excitatory neurons of the basolateral amygdala, and deletion of Dip2a in these neurons resulted in hopelessness-like behavior in the tail suspension test. Altogether, these findings demonstrate that DIP2A in the basolateral amygdala may be involved in the regulation of stress susceptibility. This provides critical evidence implicating a role of DIP2A in affective disorders.
文摘Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.
基金Guangdong Provincial Natural Science Foundation General Project[2214050002848]Jiaying University College Students’Innovation Projects(S202410582051,S202310582053,202310582018)。
文摘This study aimed to evaluate the antidepressant effects of the combined administration of total saikosaponins(SSA)and volatile oil of Cyperi Rhizoma(VO)using a mouse depression model induced by chronic restraint plus mild stress(CRMS),and to compare the effects with the traditional antidepressant fluoxetine.Male Kunming mice were subjected to 14-day CRMS modeling and then randomly divided into four groups:the combined treatment group(intraperitoneal injection of SSA 3.5 mg·kg^(-1)+VO 35 mg·kg^(-1)),the fluoxetine treatment group(20 mg·kg^(-1)),the normal saline treatment group,and the non-model group.Drugs were administered continuously for 14 days.Depressive-like behaviors were assessed using the Forced Swimming Test(FST),Tail Suspension Test(TST),and Open-Field Test(OFT).The results showed that the absolute immobility time of mice in the CRMS model group was significantly prolonged in FST and TST.Combined administration of SSA and VO significantly improved depressive-like behaviors,restoring the absolute immobility time in FST and TST to levels close to the control group,with efficacy comparable to fluoxetine.This study confirms that the combination of SSA and VO exhibits antidepressant effects equivalent to fluoxetine in the CRMS model,providing experimental evidence for the further clinical development of this traditional Chinese medicine(TCM)compatibility.
文摘Effects of Mingzhu Oral Liquid on the Hypothalamic-Pituitary-Adrenal Axis in Rats with Liver-Kidney Yin Deficiency WANG Yi-ting1,ZHAO Yang1,ZHU Fei-ya1,WANG Si-qiong1,ZHU Ling-lei1,LI Tao2,TANG Min-ke1,1.Beijing University of Chinese Medicine,Beijing,100029,China 2.Guangzhou Yitong Technology Co.,Ltd.,Guangzhou,510653,China【ABSTRACT】Objective:This study aimed to observe the effects of Mingzhu Oral Liquid on the hypothalamic-pituitary-adrenal(HPA)axis in rats with“liver-kidney yin deficiency”,in order to provide scientific research support for its clinical application in treating related disorders.Methods:A“liver-kidney yin deficiency”model was established in male Sprague-Dawley(SD)rats using a combination of chronic restraint stress and a single lipopolysaccharide(LPS)challenge.The rats were randomly divided into four groups:a blank control group,a model group,a low-dose Mingzhu Oral Liquid group,and a high-dose Mingzhu Oral Liquid group.The blank control group and model group were given normal saline by gavage,while the treatment groups received respective doses of Mingzhu Oral Liquid.Gavage administration was performed once daily for 30 consecutive days.During this period,all groups except the blank control group were subjected to restraint stress.Following the final gavage,all groups except the blank control received an intraperitoneal injection of LPS.Samples were collected 24 h post-injection.Serum levels of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP)were measured by enzyme-linked immunosorbent assay(ELISA)to evaluate the model state.The serum concentrations of corticotropin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),and glucocorticoid(GC)were determined to assess HPA axis activity.Changes in proinflammatory factors[tumor necrosis factor-alpha(TNF-α),interleukin-1 beta(IL-1β)]and the anti-inflammatory factor interleukin-10(IL-10)were also measured.Results:One week into the experiment,the weight gain rate slowed in all stress groups.By the end of the experiment,the body weight of these groups was significantly lower than that of the blank control group.Biochemical and hematological analyses revealed that the model group exhibited a significant decrease in lymphocyte count,an increased cAMP/cGMP ratio,reduced activities of glutathione S-transferase(GST)and glutathione transferase(GLT),elevated levels of blood urea nitrogen(BUN)and serum creatinine(Scr),increased serum contents of TNF-αand IL-1β,and a decreased content of IL-10.These findings confirmed the successful establishment of the rat model.Although the body weight of animals treated with Mingzhu Oral Liquid remained lower than that of the normal group,the treatment improved weight gain compared to the model group.Furthermore,Mingzhu Oral Liquid administration increased lymphocyte count,decreased the cAMP/cGMP ratio,restored GST and GLT activities,reduced BUN and Scr levels,lowered serum TNF-αand IL-1βcontents,and increased IL-10 levels,indicating a significant ameliorative effect on the deficiency symptoms.Additionally,serum levels of CRH,ACTH,and GC were elevated in the model rats,suggesting HPA axis hyperactivity.Treatment with Mingzhu Oral Liquid reduced the serum concentrations of these hormones,significantly alleviating the excited state of the HPA axis in stressed rats.Conclusion:Mingzhu Oral Liquid significantly improves the abnormal overall physical signs,blood biochemical parameters,and systemic inflammation in rats with“liver-kidney yin deficiency.”These therapeutic effects may be associated with the corrective action of Mingzhu Oral Liquid on the dysfunctional HPA axis in this model.
文摘Objective To search novel genes or pathways involved in the recovery process after restraint stress in rats. Methods We compared the hypothalamus transcriptional profiles of two different recovery patterns （fast recovery vs slow recovery） from restraint stress in rats using oligonucleotide microarray, the recovery pattern was determined by the decrement of plasma adrenocorticotropic-hormone （ACTH） and corticosterone levels during one hour recovery period after stress. A real-time quantitative RT-PCR was applied to validate the differential expressed genes. Results Analysis of the microarray data showed that most of genes were not differentially expressed between fast recovery group and slow recovery group. Among the differentially expressed genes we found that talin, together with serine/threonine protein phosphatase PPl-beta catalytic subunit （PP-1B） and integrin α-6 precursor （VLA-6） genes, were at least 1.5 fold upregulated in the fast recovery group, while junctional adhesion molecule 1 （F11r） was 1.5 fold down-regulated in the fast recovery group. Conclusion The results implied that integrin signaling pathway may be involved in the recovery from restraint stress in rats. The present study provided a global overview of hypothalamus transcriptional profiles during the process of recovery from the restraint stress in rats. The integrin signaling pathway seems to be involved in the recovery process, which deserves further study to clarify the integrin-mediated recovery mechanism after restraint stress.
