The aim of this paper is to analyze the results from the implemented projects and trainings which were aimed to minimize violence in health care area in CR （the Czech Republic） in years 2010-2013. The paper describe...The aim of this paper is to analyze the results from the implemented projects and trainings which were aimed to minimize violence in health care area in CR （the Czech Republic） in years 2010-2013. The paper describes the results and experience from the communication trainings which were gained within the projects： CR lacks the support of government agencies so as employers and research on the issue, medical staff are not professional enough in communication, there are more requirements for the quality of lecturers; there is no existing general system of monitoring of violent incidents; there is no relevant education at schools. The article contains also new general ways about how to resolve mentioned problems. These results include the special mini project where educated 550 staff members in the health care area in a short time period and taught them key skills for how to approach the aggressive patients-50.6% respondents used successfully the gained skills in their practice （negotiation with patients, aggressive related）; 42.7% respondents also used successfully the gained skills in their private life. It was found out that with the used skills the courage by conflict resolution was created.展开更多
The idea of lifelong education has aroused great concern of domestic researchers for adult non-academic training. Colleges and universities, as the main venue for adult training, provide the basic guarantee for the tr...The idea of lifelong education has aroused great concern of domestic researchers for adult non-academic training. Colleges and universities, as the main venue for adult training, provide the basic guarantee for the training of talents in our country. This also makes the social service function of colleges and universities become increasingly prominent under the current social background. However, in the aspects of the management system and organizational reform, the college adult training shall be differentiated from normal talent cultivation and construct an organizational structure with features such as networking and diversification. Only that would lay a good foundation for the development of colleges' adult training industry. Based on this, this study analyzes the management system innovation, organizational change and organizational culture and characteristics of adult training in colleges and hopes to improve the management of adult training in colleges and universities.展开更多
Effective biosecurity training is essential for disease prevention in livestock systems;however,substan-tial gaps persist.We combined an online survey(74 fully completed questionnaires;267 views)with two World Caf...Effective biosecurity training is essential for disease prevention in livestock systems;however,substan-tial gaps persist.We combined an online survey(74 fully completed questionnaires;267 views)with two World Caféworkshops(∼60 participants)to map the current provision,competence levels,and training needs across Europe.Key findings:(i)self-rated biosecurity knowledge differed markedly between stake-holder groups and veterinarians and other stakeholders reported median scores close to 80/100;(ii)more than three-quarters of cattle(77%)and 70%of swine veterinarians perceived a major gap in their ability to demonstrate the economic benefits of biosecurity to clients;(iii)39–44%of cattle and small-ruminant veterinarians reported inadequate mixed(theory+practice)training formats,and up to 50%of poultry veterinarians identified deficits in communication and behavior-change skills;(iv)across all discussions,participants favored modular,blended delivery that couples concise e-learning with on-farm coaching,supported by externally audited certification and greater farmer co-design.Therefore,rec-ommendations focus on developing species-specific,flexible modules that embed communication and cost-benefit elements,provide micro-learning units for time-constrained farmers,and operate within a tiered certification framework linked to continuing professional development.Implementing these mea-sures will narrow competence gaps,strengthen veterinarian–farmer engagement,and enhance disease preparedness throughout European livestock production.展开更多
After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the tim...After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the timing of interventions,combined with the limitations of current methods.To address these challenges,various techniques have been developed to aid in the repair and reconstruction of neural circuits at different stages of injury.Notably,neuromodulation has garnered considerable attention for its potential to enhance nerve regeneration,provide neuroprotection,restore neurons,and regulate the neural reorganization of circuits within the cerebral cortex and corticospinal tract.To improve the effectiveness of these interventions,the implementation of multitarget early interventional neuromodulation strategies,such as electrical and magnetic stimulation,is recommended to enhance functional recovery across different phases of nerve injury.This review concisely outlines the challenges encountered following spinal cord injury,synthesizes existing neurostimulation techniques while emphasizing neuroprotection,repair,and regeneration of impaired connections,and advocates for multi-targeted,task-oriented,and timely interventions.展开更多
BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking rec...BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.展开更多
BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints...BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.展开更多
Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid adv...Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.展开更多
Safer,smarter,faster...In China,people prefer high-speed trains to flights if the journey time is under five hours.High-speed train travel is set to become even more attractive with the addition of a new member to the...Safer,smarter,faster...In China,people prefer high-speed trains to flights if the journey time is under five hours.High-speed train travel is set to become even more attractive with the addition of a new member to the high-speed train family:the CR450,the world’s fastest electric multiple unit(EMU).展开更多
The lack of routine and training of command units and emergency managers is among the main causes of suboptimal decisions and could lead to serious consequences.To ensure optimal standards of emergency management trai...The lack of routine and training of command units and emergency managers is among the main causes of suboptimal decisions and could lead to serious consequences.To ensure optimal standards of emergency management training,specific and valid evaluation tools are needed—but are lacking.Thus,the present study’s purpose is to validate instruments for the evaluation of tactical and strategic leader trainings,in particular command unit trainings,based on survey data of n=288 German Command Unit members.Resulting questionnaires were named"FIRE-CU"(Feedback Instrument for Rescue forces Education–Command Unit)and"FIRE-CPX"(Feedback Instrument for Rescue forces Education-Command Post e Xercise scale).Results of confirmatory factor analyses show a good fit for the postulated four-dimensional structure of process scales in the FIRE-CU(trainer’s behavior,structure,overextension,group),for the two-dimensional structure of outcome scales in the FIRE-CU(self-rated competence,transfer),and for the one-dimensional structure of the FIRE-CPX.Further,strong evidence is found for reliability as well as for convergent,divergent,and concurrent validity of both the FIRE-CU and FIRE-CPX.Implications for research and practical application are also discussed to enable broad applicability in various educational programs for public security and crisis management.展开更多
Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level.However,because of prolonged inactivity,initial attempts to activate these...Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level.However,because of prolonged inactivity,initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway.A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation,as measured by surface electromyography.In this study,we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury.Eleven patients with chronic complete thoracic spinal cord injury were recruited.Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol.The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation.Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity,the difference was not statistically significant.These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.展开更多
Deep neural networks(DNNs)are effective in solving both forward and inverse problems for nonlinear partial differential equations(PDEs).However,conventional DNNs are not effective in handling problems such as delay di...Deep neural networks(DNNs)are effective in solving both forward and inverse problems for nonlinear partial differential equations(PDEs).However,conventional DNNs are not effective in handling problems such as delay differential equations(DDEs)and delay integrodifferential equations(DIDEs)with constant delays,primarily due to their low regularity at delayinduced breaking points.In this paper,a DNN method that combines multi-task learning(MTL)which is proposed to solve both the forward and inverse problems of DIDEs.The core idea of this approach is to divide the original equation into multiple tasks based on the delay,using auxiliary outputs to represent the integral terms,followed by the use of MTL to seamlessly incorporate the properties at the breaking points into the loss function.Furthermore,given the increased training dificulty associated with multiple tasks and outputs,we employ a sequential training scheme to reduce training complexity and provide reference solutions for subsequent tasks.This approach significantly enhances the approximation accuracy of solving DIDEs with DNNs,as demonstrated by comparisons with traditional DNN methods.We validate the effectiveness of this method through several numerical experiments,test various parameter sharing structures in MTL and compare the testing results of these structures.Finally,this method is implemented to solve the inverse problem of nonlinear DIDE and the results show that the unknown parameters of DIDE can be discovered with sparse or noisy data.展开更多
BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
Purpose–The study aims to build a high-precision longitudinal dynamics model for heavy-haul trains and validate it with line test data,present an optimization method for multi-stage cyclic brakes based on the model a...Purpose–The study aims to build a high-precision longitudinal dynamics model for heavy-haul trains and validate it with line test data,present an optimization method for multi-stage cyclic brakes based on the model and conduct a multi-objective detailed evaluation of the driver’s manipulation during cyclic braking.Design/methodology/approach–The high-precision longitudinal train dynamics model was established and verified by the cyclic braking test data of the 20,000 t heavy-haul combination train on the long and steep downgrade.Then the genetic algorithm is employed for optimization subsequent to decoupling multiple cyclic braking procedures,with due consideration of driver operation rules.For evaluation,key manipulation assessments in the scenario are prioritized,supplemented by multi-objective evaluation requirements,and the computational model is employed for detailed evaluation analysis.Findings–Based on the model,experimental data reveal that the probability of longitudinal force error being less than 64.6 kN is approximately 68%,95%for less than 129.2 kN and 99.7%for less than 193.8 kN.Upon optimizing manipulations during the cyclic braking,the maximum reduction in coupler force spans from 21%∼23.9%.Andtheevaluation scoresimply that a proper elevationof the releasingspeed favorssafety.A high electric braking force,although beneficial to some extent for energy-saving,is detrimental to reducing coupler force.Originality/value–The results will provide a theoretical basis and practical guidance for further ensuring the safety and energy-efficient operation of heavy haul trains on long downhill sections and improving the operational quality of heavy-haul trains.展开更多
In recent years,railway construction in China has developed vigorously.With continuous improvements in the highspeed railway network,the focus is gradually shifting from large-scale construction to large-scale operati...In recent years,railway construction in China has developed vigorously.With continuous improvements in the highspeed railway network,the focus is gradually shifting from large-scale construction to large-scale operations.However,several challenges have emerged within the high-speed railway dispatching and command system,including the heavy workload faced by dispatchers,the difficulty of quantifying subjective expertise,and the need for effective training of professionals.Amid the growing application of artificial intelligence technologies in railway systems,this study leverages Large Language Model(LLM)technology.LLMs bring enhanced intelligence,predictive capabilities,robust memory,and adaptability to diverse real-world scenarios.This study proposes a human-computer interactive intelligent scheduling auxiliary training system built on LLM technology.The system offers capabilities including natural dialogue,knowledge reasoning,and human feedback learning.With broad applicability,the system is suitable for vocational education,guided inquiry,knowledge-based Q&A,and other training scenarios.Validation results demonstrate its effectiveness in auxiliary training,providing substantial support for educators,students,and dispatching personnel in colleges and professional settings.展开更多
Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesit...Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesity drug alone or combined with exercise training on body weight,body fat,fat-free mass and cardiorespiratory fitness in obese patients were retrieved from Pubmed and EMBASE up to May 2024.Risk of bias assessment was performed with RoB 2.0,and the GRADE approach assessed the certainty of evidence(CoE)of each main outcome.We included four publications summing up 202 patients.Two publications used orlistat as an anti-obesity drug treatment,while the other two adopted GLP-1 receptor agonist(liraglutide or tirzepatide)as a pharmacotherapy for weight management.Orlistat combined with exercise was superior to change body weight(mean difference(MD):−2.27 kg;95%CI:−2.86 to−1.69;CoE:very low),fat mass(MD:−2.89;95%CI:−3.87 to−1.91;CoE:very low),fat-free mass(MD:0.56;95%CI:0.40–0.72;CoE:very low),and VO_(2)Peak(MD:2.64;95%CI:2.52–2.76;CoE:very low).GLP-1 receptor agonist drugs combined with exercise had a great effect on body weight(MD:−3.96 kg;95%CI:−5.07 to−2.85;CoE:low),fat mass(MD:−1.76;95%CI:−2.24 to−1.27;CoE:low),fat-free mass(MD:0.50;95%CI:−0.98 to 1.98;CoE:very low)and VO_(2)Peak(MD:2.47;95%CI:1.31–3.63;CoE:very low).The results reported here suggest that exercise training remains an important approach in weight management when combined with pharmacological treatment.展开更多
This paper introduces the Surrogate-assisted Multi-objective Grey Wolf Optimizer(SMOGWO)as a novel methodology for addressing the complex problem of empty-heavy train allocation,with a focus on line utilization balanc...This paper introduces the Surrogate-assisted Multi-objective Grey Wolf Optimizer(SMOGWO)as a novel methodology for addressing the complex problem of empty-heavy train allocation,with a focus on line utilization balance.By integrating surrogate models to approximate the objective functions,SMOGWO significantly improves the efficiency and accuracy of the optimization process.The effectiveness of this approach is evaluated using the CEC2009 multi-objective test function suite,where SMOGWO achieves a superiority rate of 76.67%compared to other leading multi-objective algorithms.Furthermore,the practical applicability of SMOGWO is demonstrated through a case study on empty and heavy train allocation,which validates its ability to balance line capacity,minimize transportation costs,and optimize the technical combination of heavy trains.The research highlights SMOGWO's potential as a robust solution for optimization challenges in railway transportation,offering valuable contributions toward enhancing operational efficiency and promoting sustainable development in the sector.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
In recent years,train-tail swaying of 160 km/h electric multiple units(EMUs)inside single-line tunnels has been heavily researched,because the issue needs to be solved urgently.In this paper,a co-simulation model of v...In recent years,train-tail swaying of 160 km/h electric multiple units(EMUs)inside single-line tunnels has been heavily researched,because the issue needs to be solved urgently.In this paper,a co-simulation model of vortex-induced vibration(VIV)of the tail car body is established,and the aerodynamics of train-tail swaying is studied.The simulation results were confirmed through a field test of operating EMUs.Furthermore,the influence mechanism of train-tail swaying on the wake flow field is studied in detail through a wind-tunnel experiment and a simulation of a reduced-scaled train model.The results demonstrate that the aerodynamic force frequency(i.e.,vortex-induced frequency)of the train tail increases linearly with train speed.When the train runs at 130 km/h,with a small amplitude of train-tail swaying(within 10 mm),the vortex-induced frequency is 1.7 Hz,which primarily depends on the nose shape of the train tail.After the tail car body nose is extended,the vortex-induced frequency is decreased.As the swaying amplitude of the train tail increases(exceeding 25 mm),the separation point of the high-intensity vortex in the train wake shifts downstream to the nose tip,and the vortex-induced frequency shifts from 1.7 Hz to the nearby car body hunting(i.e.,the primary hunting)frequency of 1.3 Hz,which leads to the frequency-locking phenomenon of VIV,and the resonance intensifies train-tail swaying.For the motor vehicle of the train tail,optimization of the yaw damper to improve its primary hunting stability can effectively alleviate train-tail swaying inside single-line tunnels.Optimization of the tail car body nose shape reduces the amplitude of the vortex-induced force,thereby weakening the aerodynamic effect and solving the problem of train-tail swaying inside the single-line tunnels.展开更多
文摘The aim of this paper is to analyze the results from the implemented projects and trainings which were aimed to minimize violence in health care area in CR （the Czech Republic） in years 2010-2013. The paper describes the results and experience from the communication trainings which were gained within the projects： CR lacks the support of government agencies so as employers and research on the issue, medical staff are not professional enough in communication, there are more requirements for the quality of lecturers; there is no existing general system of monitoring of violent incidents; there is no relevant education at schools. The article contains also new general ways about how to resolve mentioned problems. These results include the special mini project where educated 550 staff members in the health care area in a short time period and taught them key skills for how to approach the aggressive patients-50.6% respondents used successfully the gained skills in their practice （negotiation with patients, aggressive related）; 42.7% respondents also used successfully the gained skills in their private life. It was found out that with the used skills the courage by conflict resolution was created.
文摘The idea of lifelong education has aroused great concern of domestic researchers for adult non-academic training. Colleges and universities, as the main venue for adult training, provide the basic guarantee for the training of talents in our country. This also makes the social service function of colleges and universities become increasingly prominent under the current social background. However, in the aspects of the management system and organizational reform, the college adult training shall be differentiated from normal talent cultivation and construct an organizational structure with features such as networking and diversification. Only that would lay a good foundation for the development of colleges' adult training industry. Based on this, this study analyzes the management system innovation, organizational change and organizational culture and characteristics of adult training in colleges and hopes to improve the management of adult training in colleges and universities.
文摘Effective biosecurity training is essential for disease prevention in livestock systems;however,substan-tial gaps persist.We combined an online survey(74 fully completed questionnaires;267 views)with two World Caféworkshops(∼60 participants)to map the current provision,competence levels,and training needs across Europe.Key findings:(i)self-rated biosecurity knowledge differed markedly between stake-holder groups and veterinarians and other stakeholders reported median scores close to 80/100;(ii)more than three-quarters of cattle(77%)and 70%of swine veterinarians perceived a major gap in their ability to demonstrate the economic benefits of biosecurity to clients;(iii)39–44%of cattle and small-ruminant veterinarians reported inadequate mixed(theory+practice)training formats,and up to 50%of poultry veterinarians identified deficits in communication and behavior-change skills;(iv)across all discussions,participants favored modular,blended delivery that couples concise e-learning with on-farm coaching,supported by externally audited certification and greater farmer co-design.Therefore,rec-ommendations focus on developing species-specific,flexible modules that embed communication and cost-benefit elements,provide micro-learning units for time-constrained farmers,and operate within a tiered certification framework linked to continuing professional development.Implementing these mea-sures will narrow competence gaps,strengthen veterinarian–farmer engagement,and enhance disease preparedness throughout European livestock production.
基金supported by the National Key Research and Development Program of China,No.2023YFC3603705(to DX)the National Natural Science Foundation of China,No.82302866(to YZ).
文摘After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the timing of interventions,combined with the limitations of current methods.To address these challenges,various techniques have been developed to aid in the repair and reconstruction of neural circuits at different stages of injury.Notably,neuromodulation has garnered considerable attention for its potential to enhance nerve regeneration,provide neuroprotection,restore neurons,and regulate the neural reorganization of circuits within the cerebral cortex and corticospinal tract.To improve the effectiveness of these interventions,the implementation of multitarget early interventional neuromodulation strategies,such as electrical and magnetic stimulation,is recommended to enhance functional recovery across different phases of nerve injury.This review concisely outlines the challenges encountered following spinal cord injury,synthesizes existing neurostimulation techniques while emphasizing neuroprotection,repair,and regeneration of impaired connections,and advocates for multi-targeted,task-oriented,and timely interventions.
文摘BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.
文摘BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.
基金Supported by the Key Special Project of“Cutting-Edge Biotechnology”in the National Key Research and Development Program of China(No.2024YFC3406200)Sanming Project of Medicine in Shenzhen(No.SZSM202411007)Shenzhen Science and Technology Program(No.JCYJ20240813152704006).
文摘Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.
文摘Safer,smarter,faster...In China,people prefer high-speed trains to flights if the journey time is under five hours.High-speed train travel is set to become even more attractive with the addition of a new member to the high-speed train family:the CR450,the world’s fastest electric multiple unit(EMU).
基金supported by the State Fire Service Institute NRW with non-monetary resources。
文摘The lack of routine and training of command units and emergency managers is among the main causes of suboptimal decisions and could lead to serious consequences.To ensure optimal standards of emergency management training,specific and valid evaluation tools are needed—but are lacking.Thus,the present study’s purpose is to validate instruments for the evaluation of tactical and strategic leader trainings,in particular command unit trainings,based on survey data of n=288 German Command Unit members.Resulting questionnaires were named"FIRE-CU"(Feedback Instrument for Rescue forces Education–Command Unit)and"FIRE-CPX"(Feedback Instrument for Rescue forces Education-Command Post e Xercise scale).Results of confirmatory factor analyses show a good fit for the postulated four-dimensional structure of process scales in the FIRE-CU(trainer’s behavior,structure,overextension,group),for the two-dimensional structure of outcome scales in the FIRE-CU(self-rated competence,transfer),and for the one-dimensional structure of the FIRE-CPX.Further,strong evidence is found for reliability as well as for convergent,divergent,and concurrent validity of both the FIRE-CU and FIRE-CPX.Implications for research and practical application are also discussed to enable broad applicability in various educational programs for public security and crisis management.
基金supported by the Fundamental Research Funds for Central Public Welfare Research Institute,No.2020CZ-5(to WS and GS)the National Natural Science Foundation of China,No.31970970(to JSR)Fundamental Research Funds for the Central Universities,No.YWF-23-YG-QB-010(to JSR)。
文摘Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level.However,because of prolonged inactivity,initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway.A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation,as measured by surface electromyography.In this study,we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury.Eleven patients with chronic complete thoracic spinal cord injury were recruited.Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol.The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation.Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity,the difference was not statistically significant.These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.
文摘Deep neural networks(DNNs)are effective in solving both forward and inverse problems for nonlinear partial differential equations(PDEs).However,conventional DNNs are not effective in handling problems such as delay differential equations(DDEs)and delay integrodifferential equations(DIDEs)with constant delays,primarily due to their low regularity at delayinduced breaking points.In this paper,a DNN method that combines multi-task learning(MTL)which is proposed to solve both the forward and inverse problems of DIDEs.The core idea of this approach is to divide the original equation into multiple tasks based on the delay,using auxiliary outputs to represent the integral terms,followed by the use of MTL to seamlessly incorporate the properties at the breaking points into the loss function.Furthermore,given the increased training dificulty associated with multiple tasks and outputs,we employ a sequential training scheme to reduce training complexity and provide reference solutions for subsequent tasks.This approach significantly enhances the approximation accuracy of solving DIDEs with DNNs,as demonstrated by comparisons with traditional DNN methods.We validate the effectiveness of this method through several numerical experiments,test various parameter sharing structures in MTL and compare the testing results of these structures.Finally,this method is implemented to solve the inverse problem of nonlinear DIDE and the results show that the unknown parameters of DIDE can be discovered with sparse or noisy data.
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
文摘Purpose–The study aims to build a high-precision longitudinal dynamics model for heavy-haul trains and validate it with line test data,present an optimization method for multi-stage cyclic brakes based on the model and conduct a multi-objective detailed evaluation of the driver’s manipulation during cyclic braking.Design/methodology/approach–The high-precision longitudinal train dynamics model was established and verified by the cyclic braking test data of the 20,000 t heavy-haul combination train on the long and steep downgrade.Then the genetic algorithm is employed for optimization subsequent to decoupling multiple cyclic braking procedures,with due consideration of driver operation rules.For evaluation,key manipulation assessments in the scenario are prioritized,supplemented by multi-objective evaluation requirements,and the computational model is employed for detailed evaluation analysis.Findings–Based on the model,experimental data reveal that the probability of longitudinal force error being less than 64.6 kN is approximately 68%,95%for less than 129.2 kN and 99.7%for less than 193.8 kN.Upon optimizing manipulations during the cyclic braking,the maximum reduction in coupler force spans from 21%∼23.9%.Andtheevaluation scoresimply that a proper elevationof the releasingspeed favorssafety.A high electric braking force,although beneficial to some extent for energy-saving,is detrimental to reducing coupler force.Originality/value–The results will provide a theoretical basis and practical guidance for further ensuring the safety and energy-efficient operation of heavy haul trains on long downhill sections and improving the operational quality of heavy-haul trains.
基金the Talent Fund of Beijing Jiaotong University(Grant No.2024XKRC055).
文摘In recent years,railway construction in China has developed vigorously.With continuous improvements in the highspeed railway network,the focus is gradually shifting from large-scale construction to large-scale operations.However,several challenges have emerged within the high-speed railway dispatching and command system,including the heavy workload faced by dispatchers,the difficulty of quantifying subjective expertise,and the need for effective training of professionals.Amid the growing application of artificial intelligence technologies in railway systems,this study leverages Large Language Model(LLM)technology.LLMs bring enhanced intelligence,predictive capabilities,robust memory,and adaptability to diverse real-world scenarios.This study proposes a human-computer interactive intelligent scheduling auxiliary training system built on LLM technology.The system offers capabilities including natural dialogue,knowledge reasoning,and human feedback learning.With broad applicability,the system is suitable for vocational education,guided inquiry,knowledge-based Q&A,and other training scenarios.Validation results demonstrate its effectiveness in auxiliary training,providing substantial support for educators,students,and dispatching personnel in colleges and professional settings.
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金supported by Brazilian agencies CAPES(Finance Code 001)CNPq through PQ productivity scholarship.
文摘Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesity drug alone or combined with exercise training on body weight,body fat,fat-free mass and cardiorespiratory fitness in obese patients were retrieved from Pubmed and EMBASE up to May 2024.Risk of bias assessment was performed with RoB 2.0,and the GRADE approach assessed the certainty of evidence(CoE)of each main outcome.We included four publications summing up 202 patients.Two publications used orlistat as an anti-obesity drug treatment,while the other two adopted GLP-1 receptor agonist(liraglutide or tirzepatide)as a pharmacotherapy for weight management.Orlistat combined with exercise was superior to change body weight(mean difference(MD):−2.27 kg;95%CI:−2.86 to−1.69;CoE:very low),fat mass(MD:−2.89;95%CI:−3.87 to−1.91;CoE:very low),fat-free mass(MD:0.56;95%CI:0.40–0.72;CoE:very low),and VO_(2)Peak(MD:2.64;95%CI:2.52–2.76;CoE:very low).GLP-1 receptor agonist drugs combined with exercise had a great effect on body weight(MD:−3.96 kg;95%CI:−5.07 to−2.85;CoE:low),fat mass(MD:−1.76;95%CI:−2.24 to−1.27;CoE:low),fat-free mass(MD:0.50;95%CI:−0.98 to 1.98;CoE:very low)and VO_(2)Peak(MD:2.47;95%CI:1.31–3.63;CoE:very low).The results reported here suggest that exercise training remains an important approach in weight management when combined with pharmacological treatment.
基金supported by the National Natural Science Foundation of China(Project No.5217232152102391)+2 种基金Sichuan Province Science and Technology Innovation Talent Project(2024JDRC0020)China Shenhua Energy Company Limited Technology Project(GJNY-22-7/2300-K1220053)Key science and technology projects in the transportation industry of the Ministry of Transport(2022-ZD7-132).
文摘This paper introduces the Surrogate-assisted Multi-objective Grey Wolf Optimizer(SMOGWO)as a novel methodology for addressing the complex problem of empty-heavy train allocation,with a focus on line utilization balance.By integrating surrogate models to approximate the objective functions,SMOGWO significantly improves the efficiency and accuracy of the optimization process.The effectiveness of this approach is evaluated using the CEC2009 multi-objective test function suite,where SMOGWO achieves a superiority rate of 76.67%compared to other leading multi-objective algorithms.Furthermore,the practical applicability of SMOGWO is demonstrated through a case study on empty and heavy train allocation,which validates its ability to balance line capacity,minimize transportation costs,and optimize the technical combination of heavy trains.The research highlights SMOGWO's potential as a robust solution for optimization challenges in railway transportation,offering valuable contributions toward enhancing operational efficiency and promoting sustainable development in the sector.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
基金supported by the National Natural Science Foundation of China(Nos.52372403 and U2268211)the Natural Science Foundation of Sichuan Province(No.2022NSFSC0034),China+1 种基金the National Railway Group Science and Technology Program(No.2023J071)the Traction Power State Key Laboratory of the Independent Research and Development Projects(No.2022TPL-T02),China.
文摘In recent years,train-tail swaying of 160 km/h electric multiple units(EMUs)inside single-line tunnels has been heavily researched,because the issue needs to be solved urgently.In this paper,a co-simulation model of vortex-induced vibration(VIV)of the tail car body is established,and the aerodynamics of train-tail swaying is studied.The simulation results were confirmed through a field test of operating EMUs.Furthermore,the influence mechanism of train-tail swaying on the wake flow field is studied in detail through a wind-tunnel experiment and a simulation of a reduced-scaled train model.The results demonstrate that the aerodynamic force frequency(i.e.,vortex-induced frequency)of the train tail increases linearly with train speed.When the train runs at 130 km/h,with a small amplitude of train-tail swaying(within 10 mm),the vortex-induced frequency is 1.7 Hz,which primarily depends on the nose shape of the train tail.After the tail car body nose is extended,the vortex-induced frequency is decreased.As the swaying amplitude of the train tail increases(exceeding 25 mm),the separation point of the high-intensity vortex in the train wake shifts downstream to the nose tip,and the vortex-induced frequency shifts from 1.7 Hz to the nearby car body hunting(i.e.,the primary hunting)frequency of 1.3 Hz,which leads to the frequency-locking phenomenon of VIV,and the resonance intensifies train-tail swaying.For the motor vehicle of the train tail,optimization of the yaw damper to improve its primary hunting stability can effectively alleviate train-tail swaying inside single-line tunnels.Optimization of the tail car body nose shape reduces the amplitude of the vortex-induced force,thereby weakening the aerodynamic effect and solving the problem of train-tail swaying inside the single-line tunnels.
