Enhancement of the nonlinear optical(NLO)output power of lasers requires urgent development of an NLO crystal with a significant second-harmonic generation(SHG)response and sufficient birefringence for phase-matching ...Enhancement of the nonlinear optical(NLO)output power of lasers requires urgent development of an NLO crystal with a significant second-harmonic generation(SHG)response and sufficient birefringence for phase-matching capability;however,simultaneously optimizing these two key parameters remains a great challenge.In contrast to traditional single-anion units,the stereochemically-active lone pair Sb^(3+)ion is coordinated by S^(2-)and I^(-) ions to yield the mixed-anionic Sb SI chalcohalide that can enhance hyperpolarizability and anisotropic polarizability concurrently.As anticipated,Sb SI exhibited the largest SHG response(5.7×Ag Ga S_(2)@1.91μm)among phase-matching Sb-based sulfides,the favorable laser-induced damage threshold(LIDT,2.3×Ag Ga S_(2)@2.09μm),and the giant calculated birefringence(0.62@1.91μm).Structural analysis and computational simulations indicate that the highly polarizable mixed anion determine the enormous SHG response and birefringence.展开更多
Load deviations between the output of ultra-supercritical(USC)coal-fired power units and automatic generation control(AGC)commands can adversely affect the safe and stable operation of these units and grid load dispat...Load deviations between the output of ultra-supercritical(USC)coal-fired power units and automatic generation control(AGC)commands can adversely affect the safe and stable operation of these units and grid load dispatching.Data-driven diagnostic methods often fail to account for the imbalanced distribution of data samples,leading to reduced classification performance in diagnosing load deviations in USC units.To address the class imbalance issue in USC load deviation datasets,this study proposes a diagnostic method based on the multi-label natural neighbor boundary oversampling technique(MLNaNBDOS).The method is articulated in three phases.Initially,the traditional binary oversampling strategy is improved by constructing a binary multi-label relationship for the load deviations in coal-fired units.Subsequently,an adaptive adjustment of the oversampling factor is implemented to determine the oversampling weight for each sample class.Finally,the generation of new instances is refined by dynamically evaluating the similarity between new cases and natural neighbors through a random factor,ensuring precise control over the instance generation process.In comparisons with nine benchmark methods across three imbalanced USC load deviation datasets,the proposed method demonstrates superior performance on several key evaluation metrics,including Micro-F1,Micro-G-mean,and Hamming Loss,with average values of 0.8497,0.9150,and 0.1503,respectively.These results substantiate the effectiveness of the proposed method in accurately diagnosing the sources of load deviations in USC units.展开更多
In high-renewable-energy power systems,the demand for fast-responding capabilities is growing.To address the limitations of conventional closed-loop frequency control,where the integral coefficient cannot dynamically ...In high-renewable-energy power systems,the demand for fast-responding capabilities is growing.To address the limitations of conventional closed-loop frequency control,where the integral coefficient cannot dynamically adjust the frequency regulation command based on the state of charge(SoC)of energy storage units,this paper proposes a secondary frequency regulation control strategy based on variable integral coefficients for multiple energy storage units.First,a power-uniform controller is designed to ensure that thermal power units gradually take on more regulation power during the frequency regulation process.Next,a control framework based on variable integral coefficients is proposed within the secondary frequency regulation model,along with an objective function that simultaneously considers both Automatic Generation Control(AGC)command tracking performance and SoC recovery requirements of energy storage units.Finally,a gradient descent optimization method is used to dynamically adjust the gain of the energy storage integral controller,allowingmultiple energy storage units to respond in real-time to AGC instructions and SoC variations.Simulation results confirmthe effectiveness of the proposedmethod.Compared to traditional strategies,the proposed approach takes into account the SoCdiscrepancies amongmultiple energy storage units and the duration of system net power imbalances.It successfully implements secondary frequency regulation while achieving dynamic power allocation among the units.展开更多
Coking at the fractionating tower bottom and the decant oil circulation system disrupts the heat balance,leading to unplanned shutdown and destroying the long period stable operation of the Fluid Catalytic Cracking Un...Coking at the fractionating tower bottom and the decant oil circulation system disrupts the heat balance,leading to unplanned shutdown and destroying the long period stable operation of the Fluid Catalytic Cracking Unit(FCCU).The FCCU operates through interconnected subsystems,generating high-dimensional,nonlinear,and non-stationary data characterized by spatiotemporally correlated.The decant oil solid content is the crucial indicator for monitoring catalyst loss from the reactor-regenerator system and coking risk tendency at the fractionating tower bottom that relies on sampling and laboratory testing,which is lagging responsiveness and labor-intensive.Developing the online decant oil solid content soft sensor using industrial data to support operators in conducting predictive maintenance is essential.Therefore,this paper proposes a hybrid deep learning framework for soft sensor development that combines spatiotemporal pattern extraction with interpretability,enabling accurate risk identification in dynamic operational conditions.This framework employs a Filter-Wrapper method for dimensionality reduction,followed by a 2D Convolutional Neural Network(2DCNN)for extracting spatial patterns,and a Bidirectional Gated Recurrent Unit(BiGRU)for capturing long-term temporal dependencies,with an Attention Mechanism(AM)to highlight critical features adaptively.The integration of SHapley Additive exPlanations(SHAP),Complementary Ensemble Empirical Mode Decomposition with Adaptive Noise(CEEMDAN),2DCNN,and expert knowledge precisely quantifies feature contributions and decomposes signals,significantly enhancing the practicality of risk identification.Applied to a China refinery with processing capacity of 2.80×10^(6) t/a,the soft sensor achieved the R^(2) value of 0.93 and five-level risk identification accuracy of 96.42%.These results demonstrate the framework's accuracy,robustness,and suitability for complex industrial scenarios,advancing risk visualization and management.展开更多
Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluct...Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
BACKGROUND Parental presence in neonatal units(NUs)is essential for infant development and family well-being.A deeper understanding of the factors influencing parental presence is vital and will contribute to the deve...BACKGROUND Parental presence in neonatal units(NUs)is essential for infant development and family well-being.A deeper understanding of the factors influencing parental presence is vital and will contribute to the development of targeted interventions and policies that enhance parental engagement in neonatal care,thereby improving outcomes for infants and their families.AIM To identify and analyze primary factors influencing parental involvement in their child’s care in a neonatal intensive care unit(NICU).METHODS A literature search was conducted using the PubMed,MEDLINE,and Cochrane Library for systematic reviews databases,with the following search terms:“parental presence neonatology”,“couplet care”,“zero separation neonatal care”,“family integrated care”,“couplet care intervention”,“mother-child separation”,“parents newborn togetherness”,“mother-baby care”,“closeness and separation NICU”,“mother-infant interaction NICU”,“kangaroo care”,“dyad mother-infant”,and“newborn integrated care”.The database search for this literature review began on December 10,2024,with the final search conducted on April 10,2025.RESULTS The literature search yielded 281 articles,out of which 23 were selected for a detailed review.The factors associated with parental presence in NUs were grouped into five main categories:Parents’socio-demographic and cultural traits;the physical layout and care model of the NUs;the quality of parents’relationships with the healthcare staff;their active involvement in neonatal care;and the newborn’s health status.CONCLUSION The identification of factors that affect parental presence in NUs is critical for developing effective strategies aimed at encouraging increased parental involvement and ultimately improving neonatal and family outcomes.展开更多
Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell...Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell proliferation and differentiation,thereby exerting neuroprotective effects.However,the beneficial effects of endogenous VEGFA/b FGF are limited as their expression is only transiently increased.In this study,we generated multilayered nanofiber membranes loaded with VEGFA/b FGF using layer-by-layer self-assembly and electrospinning techniques.We found that a membrane containing 10 layers had an ideal ultrastructure and could efficiently and stably release growth factors for more than 1 month.This 10-layered nanofiber membrane promoted brain microvascular endothelial cell tube formation and proliferation,inhibited neuronal apoptosis,upregulated the expression of tight junction proteins,and improved the viability of various cellular components of neurovascular units under conditions of oxygen/glucose deprivation.Furthermore,this nanofiber membrane decreased the expression of Janus kinase-2/signal transducer and activator of transcription-3(JAK2/STAT3),Bax/Bcl-2,and cleaved caspase-3.Therefore,this nanofiber membrane exhibits a neuroprotective effect on oxygen/glucose-deprived neurovascular units by inhibiting the JAK2/STAT3 pathway.展开更多
Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadr...Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadruped robots show great potential in unstructured environments due to their discrete landing positions and large payloads.As the most critical movement unit of a quadruped robot,the limb leg unit(LLU)directly affects movement speed and reliability,and requires a compact and lightweight design.Inspired by the dexterous skeleton–muscle systems of cheetahs and humans,this paper proposes a highly integrated bionic actuator system for a better dynamic performance of an LLU.We propose that a cylinder barrel with multiple element interfaces and internal smooth channels is realized using metal additive manufacturing,and hybrid lattice structures are introduced into the lightweight design of the piston rod.In addition,additive manufacturing and topology optimization are incorporated to reduce the redundant material of the structural parts of the LLU.The mechanical properties of the actuator system are verified by numerical simulation and experiments,and the power density of the actuators is far greater than that of cheetah muscle.The mass of the optimized LLU is reduced by 24.5%,and the optimized LLU shows better response time performance when given a step signal,and presents a good trajectory tracking ability with the increase in motion frequency.展开更多
BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modi...BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.展开更多
Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(M...Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(MFSM)method.Methods This study established the MFSM method.To demonstrate its effectiveness,we applied this novel approach to analyze Danxi Granules(丹膝颗粒,DXG)and its constituent herbal materials.To begin with,the ultra-performance liquid chromatography(UPLC)was applied to obtain the chromatographic fingerprints of DXG and its constituent herbal materi-als.Next,the MFSM was leveraged to compress and integrate them into a new fingerprint with fewer analytical units.Then,we characterized the properties and variability of both the original and integrated fingerprints by calculating total quantum statistical moment(TQSM)parameters,information entropy and information amount,along with their relative standard deviation(RSD).Finally,we compared the TQSM parameters,information entropy and infor-mation amount,and their RSD between the traditional and novel fingerprints to validate the new analytical method.Results The chromatographic peaks of DXG and its 12 raw herbal materials were divided and integrated into peak families by the MFSM method.Before integration,the ranges of the peak number,three TQSM parameters,information entropy and information amount for each peak or peak family of UPLC fingerprints of DXG and its 12 raw herbal materials were 95.07−209.73,9390−183064μv·s,5.928−21.33 min,22.62−106.69 min^(2),4.230−6.539,and 50530−974186μv·s,respectively.After integration,the ranges of these parameters were 10.00−88.00,9390−183064μv·s,5.951−22.02 min,22.27−104.73 min^(2),2.223−5.277,and 38159−807200μv·s,respectively.Correspondingly,the RSD of all the aforementioned pa-rameters before integration were 2.12%−9.15%,6.04%−49.78%,1.15%−23.10%,3.97%−25.79%,1.49%−19.86%,and 6.64%−51.20%,respectively.However,after integration,they changed to 0.00%,6.04%−49.87%,1.73%−23.02%,3.84%−26.85%,1.17%−16.54%,and 6.40%−48.59%,respectively.The results demonstrated that in the newly integrated fingerprint,the analytical units of constituent herbal materials,information entropy and information amount were significantly reduced(P<0.05),while the TQSM parameters remained unchanged(P>0.05).Additionally,the RSD of the TQSM parameters,information entropy,and information amount didn’t show significant difference before and after integration(P>0.05),but the RSD of the number and area of the integrated analytical units significantly decreased(P<0.05).Conclusion The MFSM method could reduce the analytical units of constituent herbal mate-rials while maintain the properties and variability from their original fingerprint.Thus,it could serve as a feasible and reliable tool to reduce difficulties in analyzing multi-compo-nents within CMMs and facilitating the evaluation of their quality.展开更多
There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore,...There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.展开更多
Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains un...Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains unprecise in a critical care context despite its frequent usage in nursing education and clinical practice.This study aimed to report a thorough concept analysis to clarify the meaning of facilitation in the critical care context by formulating attributes,antecedents,and consequences and providing model cases related to facilitation.Methods:This analysis was performed by searching online sources published from 1999 to 2023.EBSCOhost,CINAHL,PubMed,and Google Scholar databases were searched using online search engines.The analysis also included the manual search of books,thesaurus and dictionaries that showed relevance to facilitation.Walker and Avant’s eight-step approach was applied to explore and analyze the meaning of facilitation in critical care units.Results:A total of 68 articles were included in the analysis of this study.Eleven attributes,six antecedents,and seven consequences related to facilitation were formulated.The attributes included dynamic,interactive processes,creating a positive environment,mobilizing resources,assistance,studentcentered,shared goals,collaboration,engagement,participation,and feedback.Antecedents were facilitator qualities,motivation,a positive learning environment,student-facilitator relationship,time availability,and specified learning outcomes.The consequences of facilitation were identified as follows:change,professional development,competency,quality development,increased job satisfaction,staff retention,and self-confidence.Conclusions:The findings from the analysis indicated that effective facilitation results in nurses and critical care staff developing competency,caring,critical thinking,and independence.Therefore,clinical outcomes in critical care environments are improved through teamwork,decision-making,and problemsolving in life-threatening situations.展开更多
Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. Th...Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. This letter reports a dropout neuronal unit(1R1T-DNU) based on one memristor–one electrolyte-gated transistor with an ultralow energy consumption of 25 p J/spike. A dropout neural network is constructed based on such a device and has been verified by MNIST dataset, demonstrating high recognition accuracies(> 90%) within a large range of dropout probabilities up to40%. The running time can be reduced by increasing dropout probability without a significant loss in accuracy. Our results indicate the great potential of introducing such 1R1T-DNUs in full-hardware neural networks to enhance energy efficiency and to solve the overfitting problem.展开更多
BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognos...BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.展开更多
Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patie...Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.展开更多
Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, ac...Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.展开更多
BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-...BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.展开更多
In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden produc...In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden production. Today, the dynamics of the filao strip in the Dakar region tend to take on significant proportions under the impetus of natural and anthropogenic factors that threaten its sustainability. It is in this context that this study attempts to analyze the relationship between the dynamics of the land-use units of the filao strip and the natural and anthropogenic factors at the origin of its modification. The diachronic study of Landsat Multispectral Scanner System (1978), Thematic Mapper (1990), Enhance Thematic Mapper Plus (2006) and Operational Land Imager (2020) satellite images through the directed pixel-oriented classification method, cartographic information systems and qualitative surveys have been applied. The results based on the analysis of the data obtained show that both natural and anthropogenic factors are at the root of the profound changes observed in the filao strip. They reveal that the average annual progression rates of the open filao strip and the built-up area exceed 100%, and that the closed filao strip classes regressed by −16.2%, the sand dunes by −62.9% and the beach by −18.2% between 1978 and 2020. In short, the study shows that the landscape of the Niayes zone is marked by anthropization, leading to the degradation of the filao strip and natural ecosystems. The shrinking surface area of the increasingly anthropized closed filao strip represents a threat to its future.展开更多
Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The ant...Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The antimicrobial agents for antimicrobial susceptibility tests was selected based on the 2022 China Antimicrobial Resistance surveillance system(CARSS)technical scheme,and the specific experimental operation was based on the requirements of the CLSI M02 and M07 documents.The commercial instruments were used following the manufacturer’s instructions.The interpretation of antimicrobial susceptibility test results was based on the 2023 CLSI M100 standard.Results:There were 15585,19258,23423 and 22395 clinical isolates in the ICU from 2020 to 2023,respectively.Among them,gram-positive bacteria accounted for 20.5%(3190/15585),21.2%(4089/19258),21.6%(5067/23423)and 21.6%(4831/22395),respectively.Gram-negative bacteria accounted for 79.5%(12395/15585),78.8%(15169/19258),78.4%(18356/23423)and 78.4%(17564/22395)of the bacteria,respectively.The top 5 isolates of gram-positive bacteria were Staphylococcus aureus,Enterococcus faecium,Streptococcus pneumoniae,Enterococcus faecalis,Staphylococcus epidermidis and gram-negative bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa and Stenotrophomonas maltophil,respectively,but the proportions and rankings of the isolates in different years slightly differed.The detection rate of methicillin-resistant S.aureus(MRSA)decreased from 44.4%in 2020 to 36%in 2023,and that of methicillin-resistant coagulase-negative Staphylococcus(MRCNS)decreased from 79.8%in 2020 to 73.8%in 2022 and increased to 78.4%in 2023.The detection rates of both vancomycin-resistant E.faecium and E.faecalis were lower than 1%.The detection rate of carbapenem-resistant P.aeruginosa(CRPA)decreased from 25%in 2020 to 19.7%in 2022 and increased slightly to 20.6%in 2023.The detection rate of carbapenem-resistant A.baumannii(CRAB)decreased from 81.9%in 2020 to 79.7%in 2022 and increased to 82.9%in 2023.The detection rate of third-generation cephalosporin-resistant E.coli decreased from 59.8%in 2020 to 53.1%in 2022 and increased to 52.5%in 2023.The detection rate of fluoroquinolone-resistant E.coli decreased from 62.7%in 2020 to 50.2%in 2022 and increased slightly to 51.0%in 2023.The detection rate of carbapenem-resistant E.coli(CRECO)decreased from 3.3%in 2020 to 1.8%in 2022 and slightly increased to 2.1%in 2023.The detection rate of third-generation cephalosporin-resistant K.pneumoniae decreased from 34.3%in 2020 to 26.3%in 2022 and then increased to 32.4%in 2023.The detection rate of carbapenem-resistant K.pneumoniae(CRKPN)increased from 17.9%to 19.4%in 2020,decreased to 13.2%in 2022,and rose sharply to 20.4%in 2023.Conclusion:MRSA showed a continuous downwards trend from 2020 to 2023,while the detection rates of MRCNS and most multidrug-resistant gram-negative bacteria continuously decreased from 2020 to 2022 but tended to increase in 2023.Therefore,it is still necessary to strengthen the monitoring of bacterial resistance and rational application of antibiotics and actively and effectively control nosocomial infections.展开更多
基金supported by the National Natural Science Foundation of China(Nos.21921001,22075283,92161125,22175172,21827813,U21A20508)the Youth Innovation Promotion Association of Chinese Academy of Sciences(Nos.2020303,2021300)the Fujian Science&Technology Innovation Laboratory for Optoelectronic Information of China(No.2020ZZ108)。
文摘Enhancement of the nonlinear optical(NLO)output power of lasers requires urgent development of an NLO crystal with a significant second-harmonic generation(SHG)response and sufficient birefringence for phase-matching capability;however,simultaneously optimizing these two key parameters remains a great challenge.In contrast to traditional single-anion units,the stereochemically-active lone pair Sb^(3+)ion is coordinated by S^(2-)and I^(-) ions to yield the mixed-anionic Sb SI chalcohalide that can enhance hyperpolarizability and anisotropic polarizability concurrently.As anticipated,Sb SI exhibited the largest SHG response(5.7×Ag Ga S_(2)@1.91μm)among phase-matching Sb-based sulfides,the favorable laser-induced damage threshold(LIDT,2.3×Ag Ga S_(2)@2.09μm),and the giant calculated birefringence(0.62@1.91μm).Structural analysis and computational simulations indicate that the highly polarizable mixed anion determine the enormous SHG response and birefringence.
基金supported by the National Natural Science Foundation of China(Grant No.62173050)Shenzhen Municipal Science and Technology Innovation Committee(Grant No.KCXFZ20211020165004006)+3 种基金Natural Science Foundation of Hunan Province of China(Grant No.2023JJ30051)Hunan Provincial Graduate Student Research Innovation Project(Grant No.QL20230214)Major Scientific and Technological Innovation Platform Project of Hunan Province(2024JC1003)Hunan Provincial University Students’Energy Conservation and Emission Reduction Innovation and Entrepreneurship Education Center(Grant No.2019-10).
文摘Load deviations between the output of ultra-supercritical(USC)coal-fired power units and automatic generation control(AGC)commands can adversely affect the safe and stable operation of these units and grid load dispatching.Data-driven diagnostic methods often fail to account for the imbalanced distribution of data samples,leading to reduced classification performance in diagnosing load deviations in USC units.To address the class imbalance issue in USC load deviation datasets,this study proposes a diagnostic method based on the multi-label natural neighbor boundary oversampling technique(MLNaNBDOS).The method is articulated in three phases.Initially,the traditional binary oversampling strategy is improved by constructing a binary multi-label relationship for the load deviations in coal-fired units.Subsequently,an adaptive adjustment of the oversampling factor is implemented to determine the oversampling weight for each sample class.Finally,the generation of new instances is refined by dynamically evaluating the similarity between new cases and natural neighbors through a random factor,ensuring precise control over the instance generation process.In comparisons with nine benchmark methods across three imbalanced USC load deviation datasets,the proposed method demonstrates superior performance on several key evaluation metrics,including Micro-F1,Micro-G-mean,and Hamming Loss,with average values of 0.8497,0.9150,and 0.1503,respectively.These results substantiate the effectiveness of the proposed method in accurately diagnosing the sources of load deviations in USC units.
文摘In high-renewable-energy power systems,the demand for fast-responding capabilities is growing.To address the limitations of conventional closed-loop frequency control,where the integral coefficient cannot dynamically adjust the frequency regulation command based on the state of charge(SoC)of energy storage units,this paper proposes a secondary frequency regulation control strategy based on variable integral coefficients for multiple energy storage units.First,a power-uniform controller is designed to ensure that thermal power units gradually take on more regulation power during the frequency regulation process.Next,a control framework based on variable integral coefficients is proposed within the secondary frequency regulation model,along with an objective function that simultaneously considers both Automatic Generation Control(AGC)command tracking performance and SoC recovery requirements of energy storage units.Finally,a gradient descent optimization method is used to dynamically adjust the gain of the energy storage integral controller,allowingmultiple energy storage units to respond in real-time to AGC instructions and SoC variations.Simulation results confirmthe effectiveness of the proposedmethod.Compared to traditional strategies,the proposed approach takes into account the SoCdiscrepancies amongmultiple energy storage units and the duration of system net power imbalances.It successfully implements secondary frequency regulation while achieving dynamic power allocation among the units.
基金supported by the Innovative Research Group Project of the National Natural Science Foundation of China(22021004)Sinopec Major Science and Technology Projects(321123-1)。
文摘Coking at the fractionating tower bottom and the decant oil circulation system disrupts the heat balance,leading to unplanned shutdown and destroying the long period stable operation of the Fluid Catalytic Cracking Unit(FCCU).The FCCU operates through interconnected subsystems,generating high-dimensional,nonlinear,and non-stationary data characterized by spatiotemporally correlated.The decant oil solid content is the crucial indicator for monitoring catalyst loss from the reactor-regenerator system and coking risk tendency at the fractionating tower bottom that relies on sampling and laboratory testing,which is lagging responsiveness and labor-intensive.Developing the online decant oil solid content soft sensor using industrial data to support operators in conducting predictive maintenance is essential.Therefore,this paper proposes a hybrid deep learning framework for soft sensor development that combines spatiotemporal pattern extraction with interpretability,enabling accurate risk identification in dynamic operational conditions.This framework employs a Filter-Wrapper method for dimensionality reduction,followed by a 2D Convolutional Neural Network(2DCNN)for extracting spatial patterns,and a Bidirectional Gated Recurrent Unit(BiGRU)for capturing long-term temporal dependencies,with an Attention Mechanism(AM)to highlight critical features adaptively.The integration of SHapley Additive exPlanations(SHAP),Complementary Ensemble Empirical Mode Decomposition with Adaptive Noise(CEEMDAN),2DCNN,and expert knowledge precisely quantifies feature contributions and decomposes signals,significantly enhancing the practicality of risk identification.Applied to a China refinery with processing capacity of 2.80×10^(6) t/a,the soft sensor achieved the R^(2) value of 0.93 and five-level risk identification accuracy of 96.42%.These results demonstrate the framework's accuracy,robustness,and suitability for complex industrial scenarios,advancing risk visualization and management.
基金supported by the National Natural Science Foundation of China(Project No.52377082)the Scientific Research Program of Jilin Provincial Department of Education(Project No.JJKH20230123KJ).
文摘Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
文摘BACKGROUND Parental presence in neonatal units(NUs)is essential for infant development and family well-being.A deeper understanding of the factors influencing parental presence is vital and will contribute to the development of targeted interventions and policies that enhance parental engagement in neonatal care,thereby improving outcomes for infants and their families.AIM To identify and analyze primary factors influencing parental involvement in their child’s care in a neonatal intensive care unit(NICU).METHODS A literature search was conducted using the PubMed,MEDLINE,and Cochrane Library for systematic reviews databases,with the following search terms:“parental presence neonatology”,“couplet care”,“zero separation neonatal care”,“family integrated care”,“couplet care intervention”,“mother-child separation”,“parents newborn togetherness”,“mother-baby care”,“closeness and separation NICU”,“mother-infant interaction NICU”,“kangaroo care”,“dyad mother-infant”,and“newborn integrated care”.The database search for this literature review began on December 10,2024,with the final search conducted on April 10,2025.RESULTS The literature search yielded 281 articles,out of which 23 were selected for a detailed review.The factors associated with parental presence in NUs were grouped into five main categories:Parents’socio-demographic and cultural traits;the physical layout and care model of the NUs;the quality of parents’relationships with the healthcare staff;their active involvement in neonatal care;and the newborn’s health status.CONCLUSION The identification of factors that affect parental presence in NUs is critical for developing effective strategies aimed at encouraging increased parental involvement and ultimately improving neonatal and family outcomes.
基金supported by the National Natural Science Foundation of China,Nos.81974207(to JH),82001383(to DW)the Special Clinical Research Project of Health Profession of Shanghai Municipal Health Commission,No.20204Y0076(to DW)。
文摘Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell proliferation and differentiation,thereby exerting neuroprotective effects.However,the beneficial effects of endogenous VEGFA/b FGF are limited as their expression is only transiently increased.In this study,we generated multilayered nanofiber membranes loaded with VEGFA/b FGF using layer-by-layer self-assembly and electrospinning techniques.We found that a membrane containing 10 layers had an ideal ultrastructure and could efficiently and stably release growth factors for more than 1 month.This 10-layered nanofiber membrane promoted brain microvascular endothelial cell tube formation and proliferation,inhibited neuronal apoptosis,upregulated the expression of tight junction proteins,and improved the viability of various cellular components of neurovascular units under conditions of oxygen/glucose deprivation.Furthermore,this nanofiber membrane decreased the expression of Janus kinase-2/signal transducer and activator of transcription-3(JAK2/STAT3),Bax/Bcl-2,and cleaved caspase-3.Therefore,this nanofiber membrane exhibits a neuroprotective effect on oxygen/glucose-deprived neurovascular units by inhibiting the JAK2/STAT3 pathway.
基金The work is supported by the National Natural Science Foundation of China(Nos.U21A20124 and 52205059)the Key Research and Development Program of Zhejiang Province(No.2022C01039)。
文摘Galloping cheetahs,climbing mountain goats,and load hauling horses all show desirable locomotion capability,which motivates the development of quadruped robots.Among various quadruped robots,hydraulically driven quadruped robots show great potential in unstructured environments due to their discrete landing positions and large payloads.As the most critical movement unit of a quadruped robot,the limb leg unit(LLU)directly affects movement speed and reliability,and requires a compact and lightweight design.Inspired by the dexterous skeleton–muscle systems of cheetahs and humans,this paper proposes a highly integrated bionic actuator system for a better dynamic performance of an LLU.We propose that a cylinder barrel with multiple element interfaces and internal smooth channels is realized using metal additive manufacturing,and hybrid lattice structures are introduced into the lightweight design of the piston rod.In addition,additive manufacturing and topology optimization are incorporated to reduce the redundant material of the structural parts of the LLU.The mechanical properties of the actuator system are verified by numerical simulation and experiments,and the power density of the actuators is far greater than that of cheetah muscle.The mass of the optimized LLU is reduced by 24.5%,and the optimized LLU shows better response time performance when given a step signal,and presents a good trajectory tracking ability with the increase in motion frequency.
基金Supported by Research Project of Zhejiang Provincial Department of Education,No.Y202045115.
文摘BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.
基金Natural Science Foundation of Hunan province(2022JJ30453 and 2024JJ6362)the Key Research and Development Program of Hunan Province(2022SK2014).
文摘Objective To facilitate the quality evaluation suitable for the unique characteristics of Chinese materia medica(CMM)by developing and implementing a novel approach known as the matching frequency statistical moment(MFSM)method.Methods This study established the MFSM method.To demonstrate its effectiveness,we applied this novel approach to analyze Danxi Granules(丹膝颗粒,DXG)and its constituent herbal materials.To begin with,the ultra-performance liquid chromatography(UPLC)was applied to obtain the chromatographic fingerprints of DXG and its constituent herbal materi-als.Next,the MFSM was leveraged to compress and integrate them into a new fingerprint with fewer analytical units.Then,we characterized the properties and variability of both the original and integrated fingerprints by calculating total quantum statistical moment(TQSM)parameters,information entropy and information amount,along with their relative standard deviation(RSD).Finally,we compared the TQSM parameters,information entropy and infor-mation amount,and their RSD between the traditional and novel fingerprints to validate the new analytical method.Results The chromatographic peaks of DXG and its 12 raw herbal materials were divided and integrated into peak families by the MFSM method.Before integration,the ranges of the peak number,three TQSM parameters,information entropy and information amount for each peak or peak family of UPLC fingerprints of DXG and its 12 raw herbal materials were 95.07−209.73,9390−183064μv·s,5.928−21.33 min,22.62−106.69 min^(2),4.230−6.539,and 50530−974186μv·s,respectively.After integration,the ranges of these parameters were 10.00−88.00,9390−183064μv·s,5.951−22.02 min,22.27−104.73 min^(2),2.223−5.277,and 38159−807200μv·s,respectively.Correspondingly,the RSD of all the aforementioned pa-rameters before integration were 2.12%−9.15%,6.04%−49.78%,1.15%−23.10%,3.97%−25.79%,1.49%−19.86%,and 6.64%−51.20%,respectively.However,after integration,they changed to 0.00%,6.04%−49.87%,1.73%−23.02%,3.84%−26.85%,1.17%−16.54%,and 6.40%−48.59%,respectively.The results demonstrated that in the newly integrated fingerprint,the analytical units of constituent herbal materials,information entropy and information amount were significantly reduced(P<0.05),while the TQSM parameters remained unchanged(P>0.05).Additionally,the RSD of the TQSM parameters,information entropy,and information amount didn’t show significant difference before and after integration(P>0.05),but the RSD of the number and area of the integrated analytical units significantly decreased(P<0.05).Conclusion The MFSM method could reduce the analytical units of constituent herbal mate-rials while maintain the properties and variability from their original fingerprint.Thus,it could serve as a feasible and reliable tool to reduce difficulties in analyzing multi-compo-nents within CMMs and facilitating the evaluation of their quality.
文摘There is considerable concern about the potential impact of climate change on agriculture, such as the accumulation of chilling hours needed to break the dormancy of many perennial plants, like fruit trees. Therefore, this study aimed to determine if there had been a significant change in air temperatures and chill hours, chill units, and chill portion accumulation in South Carolina over the last two decades. Two decades of daily maximum (T<sub>max</sub>) and minimum (T<sub>min</sub>) air temperature records were obtained from weather stations in thirty-one counties in South Carolina. Hourly temperature data, reconstructed from the daily data, were used to calculate the daily and annual chill hours, chill units, and chill portions accumulation using four different chill models for each location and year. The chill models included the T(t) °C model, the 0°C °C model, the Utah model, and the Dynamic model. For each county, regression analyses were conducted to evaluate the historical trends. Despite year-to-year variability, the tendency was a statistically significant (α = 0.05) increase in air temperature, averaging 0.089°C per year for 20 out of 31 counties in South Carolina. The other 11 counties had no significant change in temperature. The average temperature increase in the 31 counties was 0.072°C per year. The temperature increase resulted in a decrease in annual chill accumulation during the fall to spring, averaging 17.7 chill hours, 8.6 chill hours, 17.0 chill units, and 0.40 chill portions per year calculated with the T(t) °C, 0°C °C, Utah, and Dynamic models, respectively. However, whether this decrease in chill values was statistically significant or not depended on the chill model used. This study did not investigate the cause of the observed historical trends in temperature and chill accumulation. Still, if the trends continue, they could significantly impact the future of the temperate fruit tree industry in the state.
文摘Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains unprecise in a critical care context despite its frequent usage in nursing education and clinical practice.This study aimed to report a thorough concept analysis to clarify the meaning of facilitation in the critical care context by formulating attributes,antecedents,and consequences and providing model cases related to facilitation.Methods:This analysis was performed by searching online sources published from 1999 to 2023.EBSCOhost,CINAHL,PubMed,and Google Scholar databases were searched using online search engines.The analysis also included the manual search of books,thesaurus and dictionaries that showed relevance to facilitation.Walker and Avant’s eight-step approach was applied to explore and analyze the meaning of facilitation in critical care units.Results:A total of 68 articles were included in the analysis of this study.Eleven attributes,six antecedents,and seven consequences related to facilitation were formulated.The attributes included dynamic,interactive processes,creating a positive environment,mobilizing resources,assistance,studentcentered,shared goals,collaboration,engagement,participation,and feedback.Antecedents were facilitator qualities,motivation,a positive learning environment,student-facilitator relationship,time availability,and specified learning outcomes.The consequences of facilitation were identified as follows:change,professional development,competency,quality development,increased job satisfaction,staff retention,and self-confidence.Conclusions:The findings from the analysis indicated that effective facilitation results in nurses and critical care staff developing competency,caring,critical thinking,and independence.Therefore,clinical outcomes in critical care environments are improved through teamwork,decision-making,and problemsolving in life-threatening situations.
基金Project supported by the National Key Research and Development Program of China (Grant Nos. 2021YFA1202600 and 2023YFE0208600)in part by the National Natural Science Foundation of China (Grant Nos. 62174082, 92364106, 61921005, 92364204, and 62074075)。
文摘Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. This letter reports a dropout neuronal unit(1R1T-DNU) based on one memristor–one electrolyte-gated transistor with an ultralow energy consumption of 25 p J/spike. A dropout neural network is constructed based on such a device and has been verified by MNIST dataset, demonstrating high recognition accuracies(> 90%) within a large range of dropout probabilities up to40%. The running time can be reduced by increasing dropout probability without a significant loss in accuracy. Our results indicate the great potential of introducing such 1R1T-DNUs in full-hardware neural networks to enhance energy efficiency and to solve the overfitting problem.
文摘BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.
文摘Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.
文摘Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.
文摘BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.
文摘In 1948, the colonial authorities began to build a strip of filao on Dakar’s northern coastline to stem the advance of sand dunes and protect the inter-dune basins (Niayes), the site of important market-garden production. Today, the dynamics of the filao strip in the Dakar region tend to take on significant proportions under the impetus of natural and anthropogenic factors that threaten its sustainability. It is in this context that this study attempts to analyze the relationship between the dynamics of the land-use units of the filao strip and the natural and anthropogenic factors at the origin of its modification. The diachronic study of Landsat Multispectral Scanner System (1978), Thematic Mapper (1990), Enhance Thematic Mapper Plus (2006) and Operational Land Imager (2020) satellite images through the directed pixel-oriented classification method, cartographic information systems and qualitative surveys have been applied. The results based on the analysis of the data obtained show that both natural and anthropogenic factors are at the root of the profound changes observed in the filao strip. They reveal that the average annual progression rates of the open filao strip and the built-up area exceed 100%, and that the closed filao strip classes regressed by −16.2%, the sand dunes by −62.9% and the beach by −18.2% between 1978 and 2020. In short, the study shows that the landscape of the Niayes zone is marked by anthropization, leading to the degradation of the filao strip and natural ecosystems. The shrinking surface area of the increasingly anthropized closed filao strip represents a threat to its future.
文摘Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The antimicrobial agents for antimicrobial susceptibility tests was selected based on the 2022 China Antimicrobial Resistance surveillance system(CARSS)technical scheme,and the specific experimental operation was based on the requirements of the CLSI M02 and M07 documents.The commercial instruments were used following the manufacturer’s instructions.The interpretation of antimicrobial susceptibility test results was based on the 2023 CLSI M100 standard.Results:There were 15585,19258,23423 and 22395 clinical isolates in the ICU from 2020 to 2023,respectively.Among them,gram-positive bacteria accounted for 20.5%(3190/15585),21.2%(4089/19258),21.6%(5067/23423)and 21.6%(4831/22395),respectively.Gram-negative bacteria accounted for 79.5%(12395/15585),78.8%(15169/19258),78.4%(18356/23423)and 78.4%(17564/22395)of the bacteria,respectively.The top 5 isolates of gram-positive bacteria were Staphylococcus aureus,Enterococcus faecium,Streptococcus pneumoniae,Enterococcus faecalis,Staphylococcus epidermidis and gram-negative bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa and Stenotrophomonas maltophil,respectively,but the proportions and rankings of the isolates in different years slightly differed.The detection rate of methicillin-resistant S.aureus(MRSA)decreased from 44.4%in 2020 to 36%in 2023,and that of methicillin-resistant coagulase-negative Staphylococcus(MRCNS)decreased from 79.8%in 2020 to 73.8%in 2022 and increased to 78.4%in 2023.The detection rates of both vancomycin-resistant E.faecium and E.faecalis were lower than 1%.The detection rate of carbapenem-resistant P.aeruginosa(CRPA)decreased from 25%in 2020 to 19.7%in 2022 and increased slightly to 20.6%in 2023.The detection rate of carbapenem-resistant A.baumannii(CRAB)decreased from 81.9%in 2020 to 79.7%in 2022 and increased to 82.9%in 2023.The detection rate of third-generation cephalosporin-resistant E.coli decreased from 59.8%in 2020 to 53.1%in 2022 and increased to 52.5%in 2023.The detection rate of fluoroquinolone-resistant E.coli decreased from 62.7%in 2020 to 50.2%in 2022 and increased slightly to 51.0%in 2023.The detection rate of carbapenem-resistant E.coli(CRECO)decreased from 3.3%in 2020 to 1.8%in 2022 and slightly increased to 2.1%in 2023.The detection rate of third-generation cephalosporin-resistant K.pneumoniae decreased from 34.3%in 2020 to 26.3%in 2022 and then increased to 32.4%in 2023.The detection rate of carbapenem-resistant K.pneumoniae(CRKPN)increased from 17.9%to 19.4%in 2020,decreased to 13.2%in 2022,and rose sharply to 20.4%in 2023.Conclusion:MRSA showed a continuous downwards trend from 2020 to 2023,while the detection rates of MRCNS and most multidrug-resistant gram-negative bacteria continuously decreased from 2020 to 2022 but tended to increase in 2023.Therefore,it is still necessary to strengthen the monitoring of bacterial resistance and rational application of antibiotics and actively and effectively control nosocomial infections.
