Apparel exports China:The decline in exports widened from January to September(-2.4%,compared to-0.2%in January-June).Exports to the EU increased(+5.9%),though the growth rate moderated.Exports to the US saw a larger ...Apparel exports China:The decline in exports widened from January to September(-2.4%,compared to-0.2%in January-June).Exports to the EU increased(+5.9%),though the growth rate moderated.Exports to the US saw a larger contraction(January-June:-1.6%,January-September:-8.2%).While exports to ASEAN countries still fell by over 10%(-17.7%),shipments to the Philippines(+6.9%),Indonesia(+19.0%),and Cambodia(+64.9%)demonstrated stronger growth performance within the year.Regarding tariffs,on October 30,China and the US agreed to lower the rates on goods subject to additional duties(effectively reducing the average tariff rate on Chinese imports to the US from about 57%to approximately 47%,though this remains significantly higher than the 19.5%overall average rate applied to other countries).展开更多
Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorp...Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorptiometry assessed percent body fat(%BF).Ultrasonography determined muscle cross-sectional area(CSA),echo intensity(EI),and subcutaneous fat(s FAT).MU behavior was assessed during isometric muscle actions at 50%of maximal voluntary contraction(MVC)by analyzing the y-intercepts and slopes for the MU action potential amplitude(MUAPAMP)vs.recruitment threshold(RT)relationships,the A and B terms for the mean firing rate(MFR)vs.RT relationships,and normalized electromyographic amplitude(N-EMGRMS).MU firing times and waveforms were validated with reconstruct-and-test and spike trigger average procedures.Results:%BF was greater for OF(25.70%±5.40%)than NF(16.50%±2.20%;p<0.001).MVC was greater for NF(27.13±7.16)N than OF([19.89±4.96]N;p=0.014).CSA was greater for NF(2.48±0.39)cm^(2)than OF([1.95±0.47]cm^(2);p=0.011).The y-intercepts for the MUAPAMPvs.RT relationships were greater for NF(0.283±0.254)m V than OF([-0.221±0.659]m V;p=0.004).The B terms for the MFR vs.RT relationships were greater for NF(-0.024±0.003)pps/%MVC than OF([-0.031±0.009]pps/%MVC;p=0.038).N-EMGRMSwas similar between groups(p=0.463).Conclusion:Maximal strength,muscle size,and MU recruitment and firing rate patterns for a non-weight bearing muscle differed between normal-fat and over-fat males.展开更多
As a public basic course and the core general course of undergraduate education,moral education(ME)in College English is imperative.It is necessary to design specific teaching programs flexibly and creatively on the b...As a public basic course and the core general course of undergraduate education,moral education(ME)in College English is imperative.It is necessary to design specific teaching programs flexibly and creatively on the basis of fully understanding the ideas,objectives and tasks,basic principles and implementation methods of ME.This paper tries integrating literature reading into unit topic teaching as a new approach to ME in College English.The specific pathways of integration include:expansion of literary reading content,diversified teaching of literary reading,diversified media of literary reading,and diversified assessment system of literary quality.The integration of literature reading and unit topic teaching is conducive to the realization of the teaching goal of cultivating students’language ability,humanistic quality,and correct values.展开更多
Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automaticall...Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automatically and manually corrected hydrological slope unit division,the Longhua District,Shenzhen City,Guangdong Province,was selected as the study area.A total of 15 influencing factors,namely Fluctuation,slope,slope aspect,curvature,topographic witness index(TWI),stream power index(SPI),topographic roughness index(TRI),annual average rainfall,distance to water system,engineering rock group,distance to fault,land use,normalized difference vegetation index(NDVI),nighttime light,and distance to road,were selected as evaluation indicators.The information volume model(IV)and random points were used to select non-geological disaster units,and then the random forest model(RF)was used to evaluate the susceptibility to geological disasters.The automatic slope unit and the hydrological slope unit were compared and analyzed in the random forest and information volume random forest models.The results show that the area under the curve(AUC)values of the automatic slope unit evaluation results are 0.931 for the IV-RF model and 0.716 for the RF model,which are 0.6%(IV-RF model)and 1.9%(RF model)higher than those for the hydrological slope unit.Based on a comparison of the evaluation methods based on the two types of slope units,the hydrological slope unit evaluation method based on manual correction is highly subjective,is complicated to operate,and has a low evaluation accuracy,whereas the evaluation method based on automatic slope unit division is efficient and accurate,is suitable for large-scale efficient geological disaster evaluation,and can better deal with the problem of geological disaster susceptibility evaluation.展开更多
1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconn...1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. Th...The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
Despite advances in current anti-cancer therapies,challenges such as drug resistance,toxicity,and tumor heterogeneity persist.The limitations of traditional single-target drugs and simple combination therapies are bec...Despite advances in current anti-cancer therapies,challenges such as drug resistance,toxicity,and tumor heterogeneity persist.The limitations of traditional single-target drugs and simple combination therapies are becoming increasingly apparent1.To address these issues,a novel treatment strategy,the artificially intelligent synergistic engineered drug(AISED)paradigm,merits further exploration.This paradigm is based on the systematic engineered integration of multiple active ingredients into a unified single entity through artificial intelligence(AI).This strategy is aimed at developing new anti-cancer drug designs involving multiple ingredients,multiple molecular targets,and multiple biological effects,for multiple cancer types,thereby providing a novel theoretical paradigm for overcoming existing treatment bottlenecks.展开更多
On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported...On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported by China Institute of International Studies(CIIS),the United Nations Association of China.展开更多
Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibitin...Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.展开更多
本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―...本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―内容整合―标准研制―实践实施”四步策略,以重构层级化、主题化的单元目标体系。同时,本研究以“人教版”七年级上册Unit 3 My School为例进行实证检验,结果显示,上述策略能有效提升学生的语言、文化、思维、学习能力,实现核心素养的课堂转化,为教师提供可操作的单元整体教学设计指南。展开更多
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
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged f...Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.展开更多
This study provides an in-depth comparative evaluation of landslide susceptibility using two distinct spatial units:and slope units(SUs)and hydrological response units(HRUs),within Goesan County,South Korea.Leveraging...This study provides an in-depth comparative evaluation of landslide susceptibility using two distinct spatial units:and slope units(SUs)and hydrological response units(HRUs),within Goesan County,South Korea.Leveraging the capabilities of the extreme gradient boosting(XGB)algorithm combined with Shapley Additive Explanations(SHAP),this work assesses the precision and clarity with which each unit predicts areas vulnerable to landslides.SUs focus on the geomorphological features like ridges and valleys,focusing on slope stability and landslide triggers.Conversely,HRUs are established based on a variety of hydrological factors,including land cover,soil type and slope gradients,to encapsulate the dynamic water processes of the region.The methodological framework includes the systematic gathering,preparation and analysis of data,ranging from historical landslide occurrences to topographical and environmental variables like elevation,slope angle and land curvature etc.The XGB algorithm used to construct the Landslide Susceptibility Model(LSM)was combined with SHAP for model interpretation and the results were evaluated using Random Cross-validation(RCV)to ensure accuracy and reliability.To ensure optimal model performance,the XGB algorithm’s hyperparameters were tuned using Differential Evolution,considering multicollinearity-free variables.The results show that SU and HRU are effective for LSM,but their effectiveness varies depending on landscape characteristics.The XGB algorithm demonstrates strong predictive power and SHAP enhances model transparency of the influential variables involved.This work underscores the importance of selecting appropriate assessment units tailored to specific landscape characteristics for accurate LSM.The integration of advanced machine learning techniques with interpretative tools offers a robust framework for landslide susceptibility assessment,improving both predictive capabilities and model interpretability.Future research should integrate broader data sets and explore hybrid analytical models to strengthen the generalizability of these findings across varied geographical settings.展开更多
Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
We examine possible funding sources for constructing Climate Change Haven Communities on a global basis. Areas of the planet that have the potential to house persons migrating to “safe havens” in their own or other ...We examine possible funding sources for constructing Climate Change Haven Communities on a global basis. Areas of the planet that have the potential to house persons migrating to “safe havens” in their own or other countries will require the rapid construction of communities capable of supporting them, their families, businesses and farms. However, different political-economic conditions are found across the areas which can serve as locations for these Climate Change Haven Communities. We develop funding and construction strategies for the United States (free-market capitalism), France and Spain (European Union supported economies), and Taiwan region (state-directed economy). The proposals for the Taiwan region should also be applicable to the rest of China.展开更多
The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,...The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.展开更多
文摘Apparel exports China:The decline in exports widened from January to September(-2.4%,compared to-0.2%in January-June).Exports to the EU increased(+5.9%),though the growth rate moderated.Exports to the US saw a larger contraction(January-June:-1.6%,January-September:-8.2%).While exports to ASEAN countries still fell by over 10%(-17.7%),shipments to the Philippines(+6.9%),Indonesia(+19.0%),and Cambodia(+64.9%)demonstrated stronger growth performance within the year.Regarding tariffs,on October 30,China and the US agreed to lower the rates on goods subject to additional duties(effectively reducing the average tariff rate on Chinese imports to the US from about 57%to approximately 47%,though this remains significantly higher than the 19.5%overall average rate applied to other countries).
文摘Purpose:This study examined potential differences in strength,muscle morphology,and motor unit(MU)behavior of the abductor digiti minimi(ADM)between normal-fat(NF)and over-fat(OF)males.Methods:Dual-energy X-ray absorptiometry assessed percent body fat(%BF).Ultrasonography determined muscle cross-sectional area(CSA),echo intensity(EI),and subcutaneous fat(s FAT).MU behavior was assessed during isometric muscle actions at 50%of maximal voluntary contraction(MVC)by analyzing the y-intercepts and slopes for the MU action potential amplitude(MUAPAMP)vs.recruitment threshold(RT)relationships,the A and B terms for the mean firing rate(MFR)vs.RT relationships,and normalized electromyographic amplitude(N-EMGRMS).MU firing times and waveforms were validated with reconstruct-and-test and spike trigger average procedures.Results:%BF was greater for OF(25.70%±5.40%)than NF(16.50%±2.20%;p<0.001).MVC was greater for NF(27.13±7.16)N than OF([19.89±4.96]N;p=0.014).CSA was greater for NF(2.48±0.39)cm^(2)than OF([1.95±0.47]cm^(2);p=0.011).The y-intercepts for the MUAPAMPvs.RT relationships were greater for NF(0.283±0.254)m V than OF([-0.221±0.659]m V;p=0.004).The B terms for the MFR vs.RT relationships were greater for NF(-0.024±0.003)pps/%MVC than OF([-0.031±0.009]pps/%MVC;p=0.038).N-EMGRMSwas similar between groups(p=0.463).Conclusion:Maximal strength,muscle size,and MU recruitment and firing rate patterns for a non-weight bearing muscle differed between normal-fat and over-fat males.
文摘As a public basic course and the core general course of undergraduate education,moral education(ME)in College English is imperative.It is necessary to design specific teaching programs flexibly and creatively on the basis of fully understanding the ideas,objectives and tasks,basic principles and implementation methods of ME.This paper tries integrating literature reading into unit topic teaching as a new approach to ME in College English.The specific pathways of integration include:expansion of literary reading content,diversified teaching of literary reading,diversified media of literary reading,and diversified assessment system of literary quality.The integration of literature reading and unit topic teaching is conducive to the realization of the teaching goal of cultivating students’language ability,humanistic quality,and correct values.
文摘Slope units are divided according to the real topography and have clear geological characteristics,making them ideal units for evaluating the susceptibility to geological disasters.Based on the results of automatically and manually corrected hydrological slope unit division,the Longhua District,Shenzhen City,Guangdong Province,was selected as the study area.A total of 15 influencing factors,namely Fluctuation,slope,slope aspect,curvature,topographic witness index(TWI),stream power index(SPI),topographic roughness index(TRI),annual average rainfall,distance to water system,engineering rock group,distance to fault,land use,normalized difference vegetation index(NDVI),nighttime light,and distance to road,were selected as evaluation indicators.The information volume model(IV)and random points were used to select non-geological disaster units,and then the random forest model(RF)was used to evaluate the susceptibility to geological disasters.The automatic slope unit and the hydrological slope unit were compared and analyzed in the random forest and information volume random forest models.The results show that the area under the curve(AUC)values of the automatic slope unit evaluation results are 0.931 for the IV-RF model and 0.716 for the RF model,which are 0.6%(IV-RF model)and 1.9%(RF model)higher than those for the hydrological slope unit.Based on a comparison of the evaluation methods based on the two types of slope units,the hydrological slope unit evaluation method based on manual correction is highly subjective,is complicated to operate,and has a low evaluation accuracy,whereas the evaluation method based on automatic slope unit division is efficient and accurate,is suitable for large-scale efficient geological disaster evaluation,and can better deal with the problem of geological disaster susceptibility evaluation.
文摘1.Background The United Nations(UN)2030 Agenda for Sustainable Development,adopted in 2015,established the Sustainable Development Goals(SDGs)as a comprehensive framework to address global challenges through interconnected social,economic,and environmental targets.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
文摘The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘Despite advances in current anti-cancer therapies,challenges such as drug resistance,toxicity,and tumor heterogeneity persist.The limitations of traditional single-target drugs and simple combination therapies are becoming increasingly apparent1.To address these issues,a novel treatment strategy,the artificially intelligent synergistic engineered drug(AISED)paradigm,merits further exploration.This paradigm is based on the systematic engineered integration of multiple active ingredients into a unified single entity through artificial intelligence(AI).This strategy is aimed at developing new anti-cancer drug designs involving multiple ingredients,multiple molecular targets,and multiple biological effects,for multiple cancer types,thereby providing a novel theoretical paradigm for overcoming existing treatment bottlenecks.
文摘On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported by China Institute of International Studies(CIIS),the United Nations Association of China.
文摘Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.
文摘本研究基于单元整体教学视角,旨在探索初中英语“教―学―评”一致性课堂构建策略。针对当前初中英语教学中的目标碎片化、内容割裂、评价模糊、闭环断裂等困境,文章以逆向设计与结构主义为理论支撑,以核心素养为导向,提出“目标锚定―内容整合―标准研制―实践实施”四步策略,以重构层级化、主题化的单元目标体系。同时,本研究以“人教版”七年级上册Unit 3 My School为例进行实证检验,结果显示,上述策略能有效提升学生的语言、文化、思维、学习能力,实现核心素养的课堂转化,为教师提供可操作的单元整体教学设计指南。
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BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
文摘Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.
基金supported by a National Research Foundation of Korea(NRF)grant funded by the Korean government(MSIT)(RS-2023-00222536).
文摘This study provides an in-depth comparative evaluation of landslide susceptibility using two distinct spatial units:and slope units(SUs)and hydrological response units(HRUs),within Goesan County,South Korea.Leveraging the capabilities of the extreme gradient boosting(XGB)algorithm combined with Shapley Additive Explanations(SHAP),this work assesses the precision and clarity with which each unit predicts areas vulnerable to landslides.SUs focus on the geomorphological features like ridges and valleys,focusing on slope stability and landslide triggers.Conversely,HRUs are established based on a variety of hydrological factors,including land cover,soil type and slope gradients,to encapsulate the dynamic water processes of the region.The methodological framework includes the systematic gathering,preparation and analysis of data,ranging from historical landslide occurrences to topographical and environmental variables like elevation,slope angle and land curvature etc.The XGB algorithm used to construct the Landslide Susceptibility Model(LSM)was combined with SHAP for model interpretation and the results were evaluated using Random Cross-validation(RCV)to ensure accuracy and reliability.To ensure optimal model performance,the XGB algorithm’s hyperparameters were tuned using Differential Evolution,considering multicollinearity-free variables.The results show that SU and HRU are effective for LSM,but their effectiveness varies depending on landscape characteristics.The XGB algorithm demonstrates strong predictive power and SHAP enhances model transparency of the influential variables involved.This work underscores the importance of selecting appropriate assessment units tailored to specific landscape characteristics for accurate LSM.The integration of advanced machine learning techniques with interpretative tools offers a robust framework for landslide susceptibility assessment,improving both predictive capabilities and model interpretability.Future research should integrate broader data sets and explore hybrid analytical models to strengthen the generalizability of these findings across varied geographical settings.
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
文摘We examine possible funding sources for constructing Climate Change Haven Communities on a global basis. Areas of the planet that have the potential to house persons migrating to “safe havens” in their own or other countries will require the rapid construction of communities capable of supporting them, their families, businesses and farms. However, different political-economic conditions are found across the areas which can serve as locations for these Climate Change Haven Communities. We develop funding and construction strategies for the United States (free-market capitalism), France and Spain (European Union supported economies), and Taiwan region (state-directed economy). The proposals for the Taiwan region should also be applicable to the rest of China.
基金supported by the State Grid Corporation of China Science and Technology Project,grant number 52270723000900K.
文摘The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.
