The world is facing the third important global power shift.The United States,EU, Japan,Russia,China,and the newly emerging power group are becoming the six big forces in the international center stage,while the former...The world is facing the third important global power shift.The United States,EU, Japan,Russia,China,and the newly emerging power group are becoming the six big forces in the international center stage,while the former three forces and the latter three belong to two groups,waning and waxing respectively.The major shift in the global balance of power is bound to give rise to the transitional multi-polar configuration,which implies a shifting of leadership over the configuration,China and U.S.outweighing other forces,global issues looming large,homogeneity blending with heterogeneity,and a shifting center of world powers.The transitional multi-polar configuration is all about change,upon which China is one of the decisive forces.展开更多
Soil science has remained basically an agricultural science since its establishment more than a century ago.However,given its multi-dimensional connections with human society and multi-functions and services to be uti...Soil science has remained basically an agricultural science since its establishment more than a century ago.However,given its multi-dimensional connections with human society and multi-functions and services to be utilized in the future,the theoretical and technological boundary of soil science is expanding from agricultural science to newly emerged soil science sectors,which can be termed as nontraditional soil science.To build a more comprehensive and up-to-date soil science system,new description methods,recommendation standards,interpretation principles,and criteria for non-agricultural applications should be developed.展开更多
The article summarizes previous studies on the flow in open channels with rigid vegetation, and constructs a mathematical model for submerged and emerged rigid vegetation. The model involves the forces balance in the ...The article summarizes previous studies on the flow in open channels with rigid vegetation, and constructs a mathematical model for submerged and emerged rigid vegetation. The model involves the forces balance in the control volume in one-dimensional steady uniform flow. For submerged vegetation, the whole flow is divided into four regions： external region, upper vegetated region, transition region and viscous region. According to the Karrnan similarity theory, the article improves the mixing length expression, and then gives an analytical solution to predict the vertical distribution of stream-wise velocity in the external region. For emerged vegetation, the flow is divided into two region： outer region and viscous region. In the two circumstances, the thicknesses of each region are determined respectively. The comparison between the calculated results and our experimental data and other researchers＇ data proves that the proposed model is effective.展开更多
In this paper,we study wave interaction with an emerged porous media.The governing equation is shallow water equations with a friction term of the linearized Dupuit-Forcheimer’s formula.From the continuity of surface...In this paper,we study wave interaction with an emerged porous media.The governing equation is shallow water equations with a friction term of the linearized Dupuit-Forcheimer’s formula.From the continuity of surface and horizontal flux,we derived the wave reflection and transmission coefficient formulas.They are similar with the corresponding formulas of the submerged solid bar breakwater.We solve the equations numerically using finite volume method on a staggered grid.The numerical wave reduction in the porous media confirms the analytical wave transmission curve.展开更多
Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly rel...Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly related to both the degree and duration of hyperthermia,timely recognition and management of heat exhaustion and heat stroke are critical for preventing death and reducing healthcare burdens.展开更多
Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff...Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff retention.[1,2]Emergency physicians(EPs)face unique pressures,including shift work,high patient volumes and acuities,overcrowding,and systemic inefficiencies that escalate their risk of burnout.As a result,EPs have reported the highest rates of burnout among physician specialties.展开更多
BACKGROUND:Airway management is a core competence in emergency medicine.International registries have described indications,techniques,and outcomes of endotracheal intubation,yet contemporary data from German emergenc...BACKGROUND:Airway management is a core competence in emergency medicine.International registries have described indications,techniques,and outcomes of endotracheal intubation,yet contemporary data from German emergency departments(EDs) are scarce.We conducted a multicenter prospective registry study in Thuringia,to characterize indications,techniques,success rates,and complications of ED intubations.METHODS:From February 2023 to January 2024,six Thuringian EDs participated in a prospective observational registry(www.airwayregistry.eu).All consecutive intubations were documented anonymously using a standardized digital form.Demographics,indications,methods,equipment,operator characteristics,first pass success(FPS),overall success,and complications were captured.Descriptive statistics were used.RESULTS:We analyzed 117 intubations(63.2% male;mean age 68.4 years,range 2–98 years).FPS was 88.9%(104/117),second pass success was 4.3% and third pass success was 6.8%;overall success was 100%.Rapid sequence intubation(RSI) was used in 77.8% of intubations and delayed sequence intubation(DSI) in 21.4%;10.3% were performed without medication.Direct laryngoscopy(DL) was used in 65.0% and videolaryngoscopy(VL) in 34.2%.FPS was higher with VL than DL(92.5% vs.88.2%).The most common indications were cardiopulmonary resuscitation(14.5%) and stroke/ischemia(13.7%);intracranial hemorrhage accounted for 13.7%.Complications occurred in 39% of cases,most frequently hypotension(23.9%) and catecholamine requirement(12.0%).A difficult airway was anticipated in 30.8%.CONCLUSION:In this multicenter snapshot from German EDs,overall intubation success was high but complications—especially peri-intubation hypotension—were common.VL yielded higher FPS yet was used less frequently than DL.Standardized protocols,hemodynamic optimization,and broader VL adoption may improve safety and performance.展开更多
Objective:To analyze the impact of improved emergency integrated nursing on the treatment effectiveness and safety of emergency trauma patients.Methods:Study duration:December 2024 to December 2025.Observation target:...Objective:To analyze the impact of improved emergency integrated nursing on the treatment effectiveness and safety of emergency trauma patients.Methods:Study duration:December 2024 to December 2025.Observation target:emergency trauma patients in our hospital.Sample size:92 cases.Using computer-based grouping,the 92 patients were divided into two equally sized groups:a control group of 46 patients who received conventional emergency nursing care,and an observation group of 46 patients who underwent an improved emergency integrated nursing model.The treatment-related indicators,treatment effectiveness,and incidence of adverse events were evaluated in both groups.Results:After intervention,the pre-hospital emergency care time,emergency diagnosis time,total emergency rescue duration,and examination waiting time in the control group were all longer than those in the observation group(p<0.05);the treatment effectiveness in the control group(effective rate:82.61%)was worse than that in the observation group(effective rate:95.65%),p<0.05;compared with the control group,the observation group had a lower incidence of adverse events,p<0.05.Conclusion:Implementing an improved emergency integrated nursing model for emergency trauma patients helps streamline the treatment process,enhance treatment effectiveness,and reduce the incidence of adverse events.展开更多
Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized ...Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized clinical trial,eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine.Block randomization was used,and patients,treating physicians,and outcome assessors were blinded to treatment allocation.Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration.Results:Eighty patients were enrolled,with a mean age of 36.6 years(SD,15.0),and 42.5%were male.Mean pain scores decreased significantly over time in both treatment groups.In the pantoprazole group,pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes,whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54,respectively.There was no significant difference in baseline pain scores between groups(P=.92).Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes(P=.04)and 60 minutes(P=.05).Conclusions:Both medications were effective in relieving epigastric pain;however,pantoprazole provided greater and more sustained pain reduction,supporting its preferential use in emergency settings.展开更多
Acute exposure to high altitude can cause acute altitude illnesses and is associated with impaired cognitive and physical performance.The most effective preventive strategies currently recommended include environmenta...Acute exposure to high altitude can cause acute altitude illnesses and is associated with impaired cognitive and physical performance.The most effective preventive strategies currently recommended include environmental acclimatization(slow ascent and/or pre-acclimatization)or pharmacological support of acclimatization using acetazolamide.However,these strategies are not practical for high-altitude exposures that require rapid and unplanned ascent,high physical and mental performance,such as rescue missions or military operations.Dexamethasone and other modulators of the glucocorticoid system take effect quickly and are effective alternatives for preventing acute altitude illnesses when rapidly ascending to high altitudes.As the efficacy of dexamethasone in preventing acute mountain illnesses remains controversial,a review of existing studies on the use of dexamethasone for the prevention of acute mountain sickness was conducted,aiming to determine the best strategy.Possible mechanisms of protection against acute altitude illnesses are discussed based on the results of clinical trials.The data indicate that dexamethasone is most effective at altitudes above 4000 m at doses of 8–16 mg/d.Appropriately designed and powered trials are needed to obtain more evidence-based results on the dosage and timing of dexamethasone administration,and to provide optimized recommendations for the application of this powerful pharmacological tool.展开更多
Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to...Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to assess morbidity and mortality of patients with sepsis and to compare the effectiveness of a simple bedside satisfiable Quick Sequential Organ Failure Assessment(qSOFA)score with National Early Warning Score(NEWS)in prognosticating sepsis.Methods:This prospective observational study was conducted among patients>18 years old presenting with sepsis at B.J.Medical College.The SOFA,qSOFA and NEWS scores were calculated.The effectiveness in predicting mortality was evaluated using receiver operating characteristic curve analysis.Results:A total of 200 patients were evaluated(56%male)with a mean age of 51.7 years.The mortality rate was 23%.Patients categorized under high risk according to SOFA score>8,qSOFA score of 2-3 and NEWS>7 had a mortality rate of 33.3%,27.5%and 28.4%,respectively.AUC for mortality prediction was 0.695 using SOFA score,0.665 using qSOFA and 0.725 using NEWS.At a cut off of 7.50,NEWS demonstrated a sensitivity of 97.8%with a specificity of 28.0%and outperformed both SOFA and qSOFA which yielded a sensitivity of 43.5%and 91.3%and a specificity of 77.9%and 27.9%,respectively.Conclusions:The NEWS score outperforms SOFA and qSOFA in predicting mortality among sepsis patients.However,qSOFA is more helpful in identifying high risk patients and performs better in intensive care setting.展开更多
BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making ...BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
This study investigated microplastics(MPs)sized 10–5000μm across stages of a conventional municipal wastewater treatment plant using multiple analytical techniques.Samples were collected via pumping and filtration,t...This study investigated microplastics(MPs)sized 10–5000μm across stages of a conventional municipal wastewater treatment plant using multiple analytical techniques.Samples were collected via pumping and filtration,treated with the Fenton reaction for wet peroxidation,and separated by density separation.Analysis employed Focal Plane Array Micro-Fourier Transform Infrared Spectroscopy(FPA micro-FTIR),a widely used technique in MPs analysis,alongside the less common Laser Direct Infrared Spectroscopy(LDIR),providing complementary data on particle composition,shape,size,and colour.To enhance insights,spectroscopic methods were supplemented with Thermal Desorption Gas Chromatography-Mass Spectrometry(TD-GC/MS),calibrated for specific polymers,to quantify MPs by mass and assess removal efficiency.Wastewater treatment effectively reduced MPs.In influent samples,concentrations reached 72 MPs/L(FTIR),2117 MPs/L(LDIR),and 177μg/L(TD-GC/MS).Primary treatments removed 41%–55%,while the wastewater treatment plant effluent contained 1 MPs/L(FTIR),93 MPs/L(LDIR),and 2μg/L(TD-GC/MS),reflecting 96%–99%removal efficiency.Activated sludge showed concentrations of 123 MPs/L(FTIR),10,800 MPs/L(LDIR),and 0.3 mg/g dry weight(TD-GC/MS),underscoring its role in MPs capture.However,sludge dewatering released significant MPs into centrifuge rejected water:484 MPs/L(FTIR),23,000 MPs/L(LDIR),and 1100μg/L(TD-GC/MS).These results highlight the effectiveness of conventional treatments in MPs removal and the critical role of sludge in capturing these contaminants.However,sludge dewatering poses a risk of reintroducing MPs into the environment.Effective sludge management should prioritize nutrient recovery and biomass valorisation to mitigate these risks and minimise harmful environmental impacts.展开更多
Peroxymonosulfate(PMS)-based advanced oxidation processes(AOPs)are an effective way to remove emerging contaminants(ECs)from water.The catalytic process involving PMS is hindered by the suboptimal electron trans-fer e...Peroxymonosulfate(PMS)-based advanced oxidation processes(AOPs)are an effective way to remove emerging contaminants(ECs)from water.The catalytic process involving PMS is hindered by the suboptimal electron trans-fer efficiency of current catalysts,the further application of AOPs technology is limited.Here,it is proposed that the interfacial electric field can be controlled by bor(B)-doped FeNC catalysts,which shows significant advantages in the efficient generation,release and participation of reactive oxygen species(ROS)in the reaction.The super exchange interaction between Fe sites and N and B sites is realized through the directional transfer of electrons in the interfacial electric field,which ensures the high efficiency and stability of the PMS catalytic process.B doping increases the d orbitals distribution at Fermi level,which facilitates enhanced electron transition activity,thereby promoting the effective generation of (1)^O_(2).At the same time,orbital hybridization causes the center of the d band to move to a lower energy level,which not only contributes to the desorption process of (1)^O_(2),but also accelerates its release.In addition,B-doping also improved the adsorption capacity of organic pollutants and shortened the migration distance of ROS,thereby significantly improving the degradation efficiency of ECs.The B-doping strategy outlined offers a novel approach to the development of FeNC catalysts,it lays a theoretical foundation and offers technical insights for the integration of PMS/AOPs technology in the ECs management.展开更多
Objective: To analyze the impact of whole-process nursing on the rescue of emergency critically ill patients by setting a control group and an experimental group and comparing their experimental results. Methods: A to...Objective: To analyze the impact of whole-process nursing on the rescue of emergency critically ill patients by setting a control group and an experimental group and comparing their experimental results. Methods: A total of 50 critically ill patients admitted to the Emergency Department from October 2022 to October 2023 were randomly divided into the experimental group (25 cases) and the control group (25 cases). The control group received routine nursing, while the experimental group received whole-process nursing. The rescue success rate and nursing satisfaction were compared between the two groups. Results: In the experimental group, 24 patients were rescued successfully, with a success rate of 96%;in the control group, 19 patients were rescued successfully, with a success rate of 76%, showing a significant difference (χ2 = 4.1528, p = 0.0415 < 0.05). The nursing satisfaction was 92% in the experimental group and 68% in the control group. Conclusion: Whole-process nursing can effectively improve the rescue success rate of critically ill patients, enhance the satisfaction of patients and their families, and improve patients’ quality of life.展开更多
文摘The world is facing the third important global power shift.The United States,EU, Japan,Russia,China,and the newly emerging power group are becoming the six big forces in the international center stage,while the former three forces and the latter three belong to two groups,waning and waxing respectively.The major shift in the global balance of power is bound to give rise to the transitional multi-polar configuration,which implies a shifting of leadership over the configuration,China and U.S.outweighing other forces,global issues looming large,homogeneity blending with heterogeneity,and a shifting center of world powers.The transitional multi-polar configuration is all about change,upon which China is one of the decisive forces.
基金supported by the National Natural Science Foundation of China(No.42130715)the National Key Research and Development Program of China(No.2023YFD1500101)。
文摘Soil science has remained basically an agricultural science since its establishment more than a century ago.However,given its multi-dimensional connections with human society and multi-functions and services to be utilized in the future,the theoretical and technological boundary of soil science is expanding from agricultural science to newly emerged soil science sectors,which can be termed as nontraditional soil science.To build a more comprehensive and up-to-date soil science system,new description methods,recommendation standards,interpretation principles,and criteria for non-agricultural applications should be developed.
基金support by the National Natural Science Foundation of China (Grant Nos.50679061,50709025 and 10972163)
文摘The article summarizes previous studies on the flow in open channels with rigid vegetation, and constructs a mathematical model for submerged and emerged rigid vegetation. The model involves the forces balance in the control volume in one-dimensional steady uniform flow. For submerged vegetation, the whole flow is divided into four regions： external region, upper vegetated region, transition region and viscous region. According to the Karrnan similarity theory, the article improves the mixing length expression, and then gives an analytical solution to predict the vertical distribution of stream-wise velocity in the external region. For emerged vegetation, the flow is divided into two region： outer region and viscous region. In the two circumstances, the thicknesses of each region are determined respectively. The comparison between the calculated results and our experimental data and other researchers＇ data proves that the proposed model is effective.
基金We acknowledge financial support from riset dan inovasi KK ITB 122.21/ALJ/DIPA/PN/SPK/2013partially support from Riset Disentralisasi 1063c/l1.C01.2/PL/2014.
文摘In this paper,we study wave interaction with an emerged porous media.The governing equation is shallow water equations with a friction term of the linearized Dupuit-Forcheimer’s formula.From the continuity of surface and horizontal flux,we derived the wave reflection and transmission coefficient formulas.They are similar with the corresponding formulas of the submerged solid bar breakwater.We solve the equations numerically using finite volume method on a staggered grid.The numerical wave reduction in the porous media confirms the analytical wave transmission curve.
文摘Extreme heat events contribute to high mortality[1,2]and overwhelm emergency medical services through increased ambulance calls and overcrowded emergency departments.[3]Because morbidity and mortality are directly related to both the degree and duration of hyperthermia,timely recognition and management of heat exhaustion and heat stroke are critical for preventing death and reducing healthcare burdens.
文摘Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff retention.[1,2]Emergency physicians(EPs)face unique pressures,including shift work,high patient volumes and acuities,overcrowding,and systemic inefficiencies that escalate their risk of burnout.As a result,EPs have reported the highest rates of burnout among physician specialties.
文摘BACKGROUND:Airway management is a core competence in emergency medicine.International registries have described indications,techniques,and outcomes of endotracheal intubation,yet contemporary data from German emergency departments(EDs) are scarce.We conducted a multicenter prospective registry study in Thuringia,to characterize indications,techniques,success rates,and complications of ED intubations.METHODS:From February 2023 to January 2024,six Thuringian EDs participated in a prospective observational registry(www.airwayregistry.eu).All consecutive intubations were documented anonymously using a standardized digital form.Demographics,indications,methods,equipment,operator characteristics,first pass success(FPS),overall success,and complications were captured.Descriptive statistics were used.RESULTS:We analyzed 117 intubations(63.2% male;mean age 68.4 years,range 2–98 years).FPS was 88.9%(104/117),second pass success was 4.3% and third pass success was 6.8%;overall success was 100%.Rapid sequence intubation(RSI) was used in 77.8% of intubations and delayed sequence intubation(DSI) in 21.4%;10.3% were performed without medication.Direct laryngoscopy(DL) was used in 65.0% and videolaryngoscopy(VL) in 34.2%.FPS was higher with VL than DL(92.5% vs.88.2%).The most common indications were cardiopulmonary resuscitation(14.5%) and stroke/ischemia(13.7%);intracranial hemorrhage accounted for 13.7%.Complications occurred in 39% of cases,most frequently hypotension(23.9%) and catecholamine requirement(12.0%).A difficult airway was anticipated in 30.8%.CONCLUSION:In this multicenter snapshot from German EDs,overall intubation success was high but complications—especially peri-intubation hypotension—were common.VL yielded higher FPS yet was used less frequently than DL.Standardized protocols,hemodynamic optimization,and broader VL adoption may improve safety and performance.
文摘Objective:To analyze the impact of improved emergency integrated nursing on the treatment effectiveness and safety of emergency trauma patients.Methods:Study duration:December 2024 to December 2025.Observation target:emergency trauma patients in our hospital.Sample size:92 cases.Using computer-based grouping,the 92 patients were divided into two equally sized groups:a control group of 46 patients who received conventional emergency nursing care,and an observation group of 46 patients who underwent an improved emergency integrated nursing model.The treatment-related indicators,treatment effectiveness,and incidence of adverse events were evaluated in both groups.Results:After intervention,the pre-hospital emergency care time,emergency diagnosis time,total emergency rescue duration,and examination waiting time in the control group were all longer than those in the observation group(p<0.05);the treatment effectiveness in the control group(effective rate:82.61%)was worse than that in the observation group(effective rate:95.65%),p<0.05;compared with the control group,the observation group had a lower incidence of adverse events,p<0.05.Conclusion:Implementing an improved emergency integrated nursing model for emergency trauma patients helps streamline the treatment process,enhance treatment effectiveness,and reduce the incidence of adverse events.
文摘Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized clinical trial,eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine.Block randomization was used,and patients,treating physicians,and outcome assessors were blinded to treatment allocation.Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration.Results:Eighty patients were enrolled,with a mean age of 36.6 years(SD,15.0),and 42.5%were male.Mean pain scores decreased significantly over time in both treatment groups.In the pantoprazole group,pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes,whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54,respectively.There was no significant difference in baseline pain scores between groups(P=.92).Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes(P=.04)and 60 minutes(P=.05).Conclusions:Both medications were effective in relieving epigastric pain;however,pantoprazole provided greater and more sustained pain reduction,supporting its preferential use in emergency settings.
文摘Acute exposure to high altitude can cause acute altitude illnesses and is associated with impaired cognitive and physical performance.The most effective preventive strategies currently recommended include environmental acclimatization(slow ascent and/or pre-acclimatization)or pharmacological support of acclimatization using acetazolamide.However,these strategies are not practical for high-altitude exposures that require rapid and unplanned ascent,high physical and mental performance,such as rescue missions or military operations.Dexamethasone and other modulators of the glucocorticoid system take effect quickly and are effective alternatives for preventing acute altitude illnesses when rapidly ascending to high altitudes.As the efficacy of dexamethasone in preventing acute mountain illnesses remains controversial,a review of existing studies on the use of dexamethasone for the prevention of acute mountain sickness was conducted,aiming to determine the best strategy.Possible mechanisms of protection against acute altitude illnesses are discussed based on the results of clinical trials.The data indicate that dexamethasone is most effective at altitudes above 4000 m at doses of 8–16 mg/d.Appropriately designed and powered trials are needed to obtain more evidence-based results on the dosage and timing of dexamethasone administration,and to provide optimized recommendations for the application of this powerful pharmacological tool.
文摘Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to assess morbidity and mortality of patients with sepsis and to compare the effectiveness of a simple bedside satisfiable Quick Sequential Organ Failure Assessment(qSOFA)score with National Early Warning Score(NEWS)in prognosticating sepsis.Methods:This prospective observational study was conducted among patients>18 years old presenting with sepsis at B.J.Medical College.The SOFA,qSOFA and NEWS scores were calculated.The effectiveness in predicting mortality was evaluated using receiver operating characteristic curve analysis.Results:A total of 200 patients were evaluated(56%male)with a mean age of 51.7 years.The mortality rate was 23%.Patients categorized under high risk according to SOFA score>8,qSOFA score of 2-3 and NEWS>7 had a mortality rate of 33.3%,27.5%and 28.4%,respectively.AUC for mortality prediction was 0.695 using SOFA score,0.665 using qSOFA and 0.725 using NEWS.At a cut off of 7.50,NEWS demonstrated a sensitivity of 97.8%with a specificity of 28.0%and outperformed both SOFA and qSOFA which yielded a sensitivity of 43.5%and 91.3%and a specificity of 77.9%and 27.9%,respectively.Conclusions:The NEWS score outperforms SOFA and qSOFA in predicting mortality among sepsis patients.However,qSOFA is more helpful in identifying high risk patients and performs better in intensive care setting.
文摘BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
基金the Italian Ministry of Universities and Research for funding his PhD scholarship(37th Cycle Ph D Programmes supported by ESF REACT-EU funds,National Operational Programme on Research and Innovation)CSGI(Consorzio Interuniversitario per lo Sviluppo dei Sistemi a Grande Interfase-Center for Colloid and Surface Science),Florence(Italy)for financial support.
文摘This study investigated microplastics(MPs)sized 10–5000μm across stages of a conventional municipal wastewater treatment plant using multiple analytical techniques.Samples were collected via pumping and filtration,treated with the Fenton reaction for wet peroxidation,and separated by density separation.Analysis employed Focal Plane Array Micro-Fourier Transform Infrared Spectroscopy(FPA micro-FTIR),a widely used technique in MPs analysis,alongside the less common Laser Direct Infrared Spectroscopy(LDIR),providing complementary data on particle composition,shape,size,and colour.To enhance insights,spectroscopic methods were supplemented with Thermal Desorption Gas Chromatography-Mass Spectrometry(TD-GC/MS),calibrated for specific polymers,to quantify MPs by mass and assess removal efficiency.Wastewater treatment effectively reduced MPs.In influent samples,concentrations reached 72 MPs/L(FTIR),2117 MPs/L(LDIR),and 177μg/L(TD-GC/MS).Primary treatments removed 41%–55%,while the wastewater treatment plant effluent contained 1 MPs/L(FTIR),93 MPs/L(LDIR),and 2μg/L(TD-GC/MS),reflecting 96%–99%removal efficiency.Activated sludge showed concentrations of 123 MPs/L(FTIR),10,800 MPs/L(LDIR),and 0.3 mg/g dry weight(TD-GC/MS),underscoring its role in MPs capture.However,sludge dewatering released significant MPs into centrifuge rejected water:484 MPs/L(FTIR),23,000 MPs/L(LDIR),and 1100μg/L(TD-GC/MS).These results highlight the effectiveness of conventional treatments in MPs removal and the critical role of sludge in capturing these contaminants.However,sludge dewatering poses a risk of reintroducing MPs into the environment.Effective sludge management should prioritize nutrient recovery and biomass valorisation to mitigate these risks and minimise harmful environmental impacts.
基金supported by the National Natural Science Foundation of China(No.22278156)the Guangdong Special Support Program Project(No.2021JC060580)+1 种基金the Young Elite Scientists Sponsorship Program by CAST-Doctoral Student Special Plan,the China Scholarship Council Program(No.202406150148)the Natural Science Foundation of Guangdong Province(No.2023A1515011186).
文摘Peroxymonosulfate(PMS)-based advanced oxidation processes(AOPs)are an effective way to remove emerging contaminants(ECs)from water.The catalytic process involving PMS is hindered by the suboptimal electron trans-fer efficiency of current catalysts,the further application of AOPs technology is limited.Here,it is proposed that the interfacial electric field can be controlled by bor(B)-doped FeNC catalysts,which shows significant advantages in the efficient generation,release and participation of reactive oxygen species(ROS)in the reaction.The super exchange interaction between Fe sites and N and B sites is realized through the directional transfer of electrons in the interfacial electric field,which ensures the high efficiency and stability of the PMS catalytic process.B doping increases the d orbitals distribution at Fermi level,which facilitates enhanced electron transition activity,thereby promoting the effective generation of (1)^O_(2).At the same time,orbital hybridization causes the center of the d band to move to a lower energy level,which not only contributes to the desorption process of (1)^O_(2),but also accelerates its release.In addition,B-doping also improved the adsorption capacity of organic pollutants and shortened the migration distance of ROS,thereby significantly improving the degradation efficiency of ECs.The B-doping strategy outlined offers a novel approach to the development of FeNC catalysts,it lays a theoretical foundation and offers technical insights for the integration of PMS/AOPs technology in the ECs management.
文摘Objective: To analyze the impact of whole-process nursing on the rescue of emergency critically ill patients by setting a control group and an experimental group and comparing their experimental results. Methods: A total of 50 critically ill patients admitted to the Emergency Department from October 2022 to October 2023 were randomly divided into the experimental group (25 cases) and the control group (25 cases). The control group received routine nursing, while the experimental group received whole-process nursing. The rescue success rate and nursing satisfaction were compared between the two groups. Results: In the experimental group, 24 patients were rescued successfully, with a success rate of 96%;in the control group, 19 patients were rescued successfully, with a success rate of 76%, showing a significant difference (χ2 = 4.1528, p = 0.0415 < 0.05). The nursing satisfaction was 92% in the experimental group and 68% in the control group. Conclusion: Whole-process nursing can effectively improve the rescue success rate of critically ill patients, enhance the satisfaction of patients and their families, and improve patients’ quality of life.
