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
Neoliberal economic policies implemented by the Justice and Development Party(AKP)in Turkey empowered the modernization process which is one of the main dynamics of transforming traditional societies.As a result of th...Neoliberal economic policies implemented by the Justice and Development Party(AKP)in Turkey empowered the modernization process which is one of the main dynamics of transforming traditional societies.As a result of this socio-economic transformation,new institutions and technical developments evolved,without any relation to religion or its institutions(Zubaida,2011).In fact,this course has accelerated the individualization process of the religiously educated Generation Z in Turkey,whereas the significance of collective religious identity shrank(Kara,2014).The expansion of social media platforms has influenced young people’s relationship with religion and faith.However,after the Gezi Parki protests in 2013,the government started using a more populist discourse with regard to religious and nationalist symbols.This type of political communication had a crucial impact on the political arena.This research sheds light on the result of a qualitative analysis,based on interviews conducted with Imam Hatip school students in Turkey.The results of these in-depth interviews show how digital media is creating a new ecosystem based on self-identity(Giddens,1991).展开更多
The role of the adhesive layer in the ballistic performance of ceramic multi-layer armour system is complex and multi-faceted,often with trade-offs between single-and multi-hit performance.However,research focused on ...The role of the adhesive layer in the ballistic performance of ceramic multi-layer armour system is complex and multi-faceted,often with trade-offs between single-and multi-hit performance.However,research focused on untangling the underlying impact of varying adhesive cohesive or adhesion properties is limited and sometimes appears to provide conflicting conclusions.Comparison between the available studies is also often difficult due to variations in armour systems or ballistic testing being conducted.This review scrutinises the available research,identifying six critical properties of an adhesive layer in determining ballistic performance:elastic modulus,fracture strain,acoustic impedance,tensile bond strength,shear bond strength,and thickness.The impact of each of these properties on ballistic performance is discussed in detail,with clear description of the underlying processes involved,allowing clear optimisation goals to be established depending on the ceramic armour specification.展开更多
Background:Globalization and increasing migration have amplified cultural diversity in healthcare services.This has rendered intercultural tolerance-a respectful and equity-based approach to differing values and belie...Background:Globalization and increasing migration have amplified cultural diversity in healthcare services.This has rendered intercultural tolerance-a respectful and equity-based approach to differing values and beliefs-a necessity in nursing care.Although intercultural tolerance is recognized in the literature as a core component of cultural competence the prevalence of this attitude among nurses and its associated factors remain underexplored in clinical practice.Methods:This cross-sectional study was conducted between October 2020 and May 2021 in a public hospital in Istanbul.The population consisted of 2,096 nurses,and 767 of them voluntarily participated in the study via an online survey(response rate:36.6%).The data collection tool included sociodemographic variables,culture-oriented descriptive characteristics,and literature-based items on intercultural tolerance.A self-assessment scale from 1 to 10 was used to evaluate personal tolerance levels.The instrument was not subjected to psychometric validation;only a pilot study for clarity was conducted.Data were analyzed using descriptive statistics,independent group comparisons,and multiple linear regression.Power analysis indicated a minimum sample size of 175,confirming the adequacy of the sample.Results:The majority of participants reported high tolerance scores(M=8.2±1.5).Most nurses endorsed the right to equal healthcare(96.7%),respect for cultural diversity(94.3%),and empathy(91.7%).However,41.3%reported awareness of their own biases,and 45.1%experienced discomfort related to language differences.Regression analysis revealed that empathy,attentiveness to cultural differences(i.e.,avoiding identical treatment of all),and egalitarian intercultural attitudes positively predicted tolerance.In contrast,discomfort with unfamiliar languages,overconfidence in cultural knowledge,and structural factors such as the clinical unit were negatively associated with tolerance.Conclusion:Although nurses generally demonstrate positive attitudes toward intercultural tolerance,internal biases and institutional barriers continue to hinder its full expression.Empathy and self-awareness should be supported not only cognitively but also through emotional and behavioral interventions.Accordingly,the integration of structured cultural competence programs into nursing education,institutional support mechanisms,and pedagogical strategies for managing prejudice are strongly recommended.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.展开更多
PFASs(per-and polyfluoroalkyl substances)are a group of more than 12,000 man-made chemicals used in industrial,commercial,and consumer products since the 1940s.Their unique chemical structure resists degradation and t...PFASs(per-and polyfluoroalkyl substances)are a group of more than 12,000 man-made chemicals used in industrial,commercial,and consumer products since the 1940s.Their unique chemical structure resists degradation and they are often referred to as“forever chemicals”because of how long they persist in the environment.PFASs are also known to accumulate in human tissue.Exposure to certain PFAS at very low concentrations can cause kidney and testicular cancer,hormone disruption,and liver and thyroid diseases.Based on our experience managing PFAS impacted soil and groundwater at geotechnical construction vertical(structures)and horizontal(infrastructure and roads)projects,we present case studies to describe the current federal and state regulatory landscape for this group of emerging contaminants.This paper will provide a summary of basic sampling,testing,and risk-assessment approaches as well as solutions for cost effective treatment and acceptable disposal options.展开更多
The Alaska North Slope(ANS)is endowed with a substantial reservoir of heavy oil,estimated at 12-18billion barrels,primarily concentrated within the Ugnu reservoirs.These deposits,situated at depths ranging from 2000 t...The Alaska North Slope(ANS)is endowed with a substantial reservoir of heavy oil,estimated at 12-18billion barrels,primarily concentrated within the Ugnu reservoirs.These deposits,situated at depths ranging from 2000 to 4000 feet,lie in close proximity to the permafrost and have undergone biodegradation,resulting in in-situ viscosities reaching thousands of centipoise.Following the success in recovering the somewhat less heavy,viscous oils through polymer injection,the deposits in Ugnu Formation are garnering significant interest.Although thermal recovery methods are commonplace for heavy oils,applying these methods on ANS is impractical,given the adjacency to continuous permafrost.Therefore,non-thermal hybrid enhanced oil recovery(cEOR)methods,such as solvent(e.g.,CO_(2))and low salinity water(LSW),or LSW and polymer-based techniques,emerge as the primarily feasible options for recovering these vast heavy oil resources.This study experimentally investigates,via systematically carried out fluid property and phase behavior tests and a series of sand-pack coreflood experiments,the potential to enhance the recovery of Ugnu heavy oils.The coreflood experiments reveal the synergistic effect of combining liquid-CO_(2)with LSW to be the most promising approach in this study as a water alternating gas(WAG)process results in the cumulative recovery factor of 83.5%,doubling the recovery obtained by continuous low salinity waterflood.Additionally,the liquid-CO_(2)-LSW WAG process demonstrated an additional benefit for CO_(2)storage,with about 25%of the pore volume of the liquid-CO_(2)injected being sequestered at the end of the injection process.This significant recovery improvement is attributed to a substantial reduction of oil viscosity upon contact with the liquid CO_(2)during the soaking period,with a reduction of up to 95%of the original oil viscosity.Meanwhile,in-situ emulsion generation was observed in the oil produced from the continuous LSW flooding.This was also evident by the increased differential pressure across the sand-pack compared to that of the liquid-CO_(2)alternating LSW process.The promising results of this study indicate significant potential for liquid-CO_(2)alternating LSW injection as an effective cEOR technique for Ugnu heavy oils.展开更多
Rolling noise is produced by vibration of the wheels and track,induced by their combined surface roughness.It is important to know the relative contributions of the different sources,as this affects noise control stra...Rolling noise is produced by vibration of the wheels and track,induced by their combined surface roughness.It is important to know the relative contributions of the different sources,as this affects noise control strategies as well as acceptance testing of new rolling stock.Three different techniques are described that aim to use pass-by measurements to separate the wheel and track components of rolling noise.One is based on the TWINS model,which is tuned to measured track vibration.The second is based on the advanced transfer path analysis method,which provides an entirely experimental assessment.The third is based on the pass-by analysis method in combination with static vibroacoustic transfer functions which are obtained using a reciprocity method.The development of these methods is described and comparisons between them are presented using the results from three experimental measurement campaigns.These covered a metro train,a regional train and a high-speed train at a range of speeds.The various methods agree reasonably well in terms of overall trends,with moderate agreement in the mid-frequency region,and less consistent results at low and high frequency.展开更多
In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,com...In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.展开更多
This study aims to determine the phytochemical composition and antioxidant activity(AA)of different plant parts(bulbs,stalk,leaves and flowers)of wild rosy garlic(Allium roseum)from Montenegro.The flower exhibited the...This study aims to determine the phytochemical composition and antioxidant activity(AA)of different plant parts(bulbs,stalk,leaves and flowers)of wild rosy garlic(Allium roseum)from Montenegro.The flower exhibited the highest concentration of total phenols(55.7 GAE/g d.e.),followed by the leaf(25.6mg GAE/g d.e.).The leaf displayed the highest concentration of total flavonoids(41.48 mg RE/g d.e.),followed by the flower(36.26 mg RE/g d.e.)and top part of the stalk(26.80 mg RE/g d.e.).The AA of different parts of A.roseum after 60 min of incubation decreased in the following order:flower(0.15mg/cm^(3))>upper stalk(0.32mg/cm^(3))>leaf(0.36mg/cm^(3))>basal stalk(0.80mg/cm^(3))>bulb(1.53 mg/cm^(3)).The flowers exhibited the lowest EC_(50) values,indicating the highest antioxidant potential throughout the entire incubation period.Among all plant parts analyzed,the flowers demonstrated the highest ferric reducing antioxidant power(FRAP),reaching 24.99 mg Fe^(2+)/g,thereby indicating their superior antioxidant potential.Given their edibility,pleasant flavor,and high nutritional value,A.roseum flowers may be considered a promising natural additive for functional food products or culinary applications,including dish enhancement and decoration.展开更多
A cyclonic eddy(CE)is often accompanied by an anticyclonic eddy(AE)to the east of Vietnam in the South China Sea(SCS)in summer,but the dipole lifetime and the intrinsic connection between CE and AE are still understud...A cyclonic eddy(CE)is often accompanied by an anticyclonic eddy(AE)to the east of Vietnam in the South China Sea(SCS)in summer,but the dipole lifetime and the intrinsic connection between CE and AE are still understudied.Data from 1993-2021 reveal that the dipole lifetime are significantly correlated with the wind direction and speed in the dipole region.Higher wind speed was found to be associated with more eastward wind direction and tends to longer dipole lifetime.The wind stress work(WW)on the eddy is much stronger in the eastward jet region than in the CE and AE regions.Comparing of results of 12 higher and lower wind speed years reveal that higher wind can produce stronger mean current,WW and barotropic instability(T4)that further enhances eddy kinetic energy(EKE)and dipole lifetime.The correlations between the dipole CE and AE characteristics are insignificant on interannual scales and mostly insignificant on seasonal scales in the surface layer but significant on seasonal scales in the subsurface layers.In addition,the daily mean vertical profiles(0-500 m)of EKE,vorticity and total deformation rate(TD)between CE and AE remain significantly correlated throughout the dipole’s lifetime,which can be a useful criterion for judging if two eddies are a dipole.展开更多
BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop ...BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop neonatal respiratory distress,nasal congestion,otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes.These changes have been shown by chest computed tomography(CT)to develop in infancy and early childhood.Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions,with chest CT doses now in the range of chest radiography(CR).AIM To evaluate the efficacy of ultra-low dose CT(ULDCT)chest in identifying pulmonary changes within a PCD paediatric patient cohort.METHODS Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period,were eligible for inclusion in the study.ULDCT and CR were performed on these patients and the results compared.Comparison metrics included radiation dose,subjective and objective image quality and disease severity.RESULTS Six paediatric patients(mean age 9 years)underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD.The mean effective dose was 0.08±0.02 mSv,a dose that approximates that of a frontal and lateral chest radiograph.The average Brody II score across the entire cohort was 12.92,with excellent interrater reliability and intra-class correlation coefficient(ICC)of 0.98.The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.CONCLUSION ULDCT demonstrates superior diagnostic capabilities,minimal radiation dose penalty,and high interobserver reliability in comparison to CR.Thus,we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.展开更多
Ferroelectric film materials have attracted significant interest due to their potential for harvesting various forms ofclean energy from natural environmental sources.However,the photoelectric performance of these mat...Ferroelectric film materials have attracted significant interest due to their potential for harvesting various forms ofclean energy from natural environmental sources.However,the photoelectric performance of these materials isfrequently constrained by heat generation during light absorption,resulting in significant thermal losses.Most offerroelectric films produce photocurrent and thermocurrent with opposite polarity,thus weakening the coupledphoto-thermoelectric output of the devices.Here we report on a LaNiO_(3)/BiMn_(2)O_(5)(BMO)/ITO ferroelectric film toproduce photocurrent and thermocurrent with the same polarity.The polarity of the photocurrent generated bythe BMO film is shown to be determined solely by the direction of spontaneous polarization,overcoming thedetrimental effect of Schottky barrier for energy harvesting in device.We propose a new strategy to enhance thecoupling factor,thereby offering valuable new insights for optimizing the utilization of ferroelectric materials inboth light and heat energy applications.展开更多
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.
文摘Neoliberal economic policies implemented by the Justice and Development Party(AKP)in Turkey empowered the modernization process which is one of the main dynamics of transforming traditional societies.As a result of this socio-economic transformation,new institutions and technical developments evolved,without any relation to religion or its institutions(Zubaida,2011).In fact,this course has accelerated the individualization process of the religiously educated Generation Z in Turkey,whereas the significance of collective religious identity shrank(Kara,2014).The expansion of social media platforms has influenced young people’s relationship with religion and faith.However,after the Gezi Parki protests in 2013,the government started using a more populist discourse with regard to religious and nationalist symbols.This type of political communication had a crucial impact on the political arena.This research sheds light on the result of a qualitative analysis,based on interviews conducted with Imam Hatip school students in Turkey.The results of these in-depth interviews show how digital media is creating a new ecosystem based on self-identity(Giddens,1991).
基金funding for this research was provided by Netherlands Ministry of Defence
文摘The role of the adhesive layer in the ballistic performance of ceramic multi-layer armour system is complex and multi-faceted,often with trade-offs between single-and multi-hit performance.However,research focused on untangling the underlying impact of varying adhesive cohesive or adhesion properties is limited and sometimes appears to provide conflicting conclusions.Comparison between the available studies is also often difficult due to variations in armour systems or ballistic testing being conducted.This review scrutinises the available research,identifying six critical properties of an adhesive layer in determining ballistic performance:elastic modulus,fracture strain,acoustic impedance,tensile bond strength,shear bond strength,and thickness.The impact of each of these properties on ballistic performance is discussed in detail,with clear description of the underlying processes involved,allowing clear optimisation goals to be established depending on the ceramic armour specification.
文摘Background:Globalization and increasing migration have amplified cultural diversity in healthcare services.This has rendered intercultural tolerance-a respectful and equity-based approach to differing values and beliefs-a necessity in nursing care.Although intercultural tolerance is recognized in the literature as a core component of cultural competence the prevalence of this attitude among nurses and its associated factors remain underexplored in clinical practice.Methods:This cross-sectional study was conducted between October 2020 and May 2021 in a public hospital in Istanbul.The population consisted of 2,096 nurses,and 767 of them voluntarily participated in the study via an online survey(response rate:36.6%).The data collection tool included sociodemographic variables,culture-oriented descriptive characteristics,and literature-based items on intercultural tolerance.A self-assessment scale from 1 to 10 was used to evaluate personal tolerance levels.The instrument was not subjected to psychometric validation;only a pilot study for clarity was conducted.Data were analyzed using descriptive statistics,independent group comparisons,and multiple linear regression.Power analysis indicated a minimum sample size of 175,confirming the adequacy of the sample.Results:The majority of participants reported high tolerance scores(M=8.2±1.5).Most nurses endorsed the right to equal healthcare(96.7%),respect for cultural diversity(94.3%),and empathy(91.7%).However,41.3%reported awareness of their own biases,and 45.1%experienced discomfort related to language differences.Regression analysis revealed that empathy,attentiveness to cultural differences(i.e.,avoiding identical treatment of all),and egalitarian intercultural attitudes positively predicted tolerance.In contrast,discomfort with unfamiliar languages,overconfidence in cultural knowledge,and structural factors such as the clinical unit were negatively associated with tolerance.Conclusion:Although nurses generally demonstrate positive attitudes toward intercultural tolerance,internal biases and institutional barriers continue to hinder its full expression.Empathy and self-awareness should be supported not only cognitively but also through emotional and behavioral interventions.Accordingly,the integration of structured cultural competence programs into nursing education,institutional support mechanisms,and pedagogical strategies for managing prejudice are strongly recommended.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
文摘PFASs(per-and polyfluoroalkyl substances)are a group of more than 12,000 man-made chemicals used in industrial,commercial,and consumer products since the 1940s.Their unique chemical structure resists degradation and they are often referred to as“forever chemicals”because of how long they persist in the environment.PFASs are also known to accumulate in human tissue.Exposure to certain PFAS at very low concentrations can cause kidney and testicular cancer,hormone disruption,and liver and thyroid diseases.Based on our experience managing PFAS impacted soil and groundwater at geotechnical construction vertical(structures)and horizontal(infrastructure and roads)projects,we present case studies to describe the current federal and state regulatory landscape for this group of emerging contaminants.This paper will provide a summary of basic sampling,testing,and risk-assessment approaches as well as solutions for cost effective treatment and acceptable disposal options.
基金financial support for this study and the Petroleum Development Laboratory(PDL)at University of Alaska Fairbanks(UAF)for allowing the use of the facilities。
文摘The Alaska North Slope(ANS)is endowed with a substantial reservoir of heavy oil,estimated at 12-18billion barrels,primarily concentrated within the Ugnu reservoirs.These deposits,situated at depths ranging from 2000 to 4000 feet,lie in close proximity to the permafrost and have undergone biodegradation,resulting in in-situ viscosities reaching thousands of centipoise.Following the success in recovering the somewhat less heavy,viscous oils through polymer injection,the deposits in Ugnu Formation are garnering significant interest.Although thermal recovery methods are commonplace for heavy oils,applying these methods on ANS is impractical,given the adjacency to continuous permafrost.Therefore,non-thermal hybrid enhanced oil recovery(cEOR)methods,such as solvent(e.g.,CO_(2))and low salinity water(LSW),or LSW and polymer-based techniques,emerge as the primarily feasible options for recovering these vast heavy oil resources.This study experimentally investigates,via systematically carried out fluid property and phase behavior tests and a series of sand-pack coreflood experiments,the potential to enhance the recovery of Ugnu heavy oils.The coreflood experiments reveal the synergistic effect of combining liquid-CO_(2)with LSW to be the most promising approach in this study as a water alternating gas(WAG)process results in the cumulative recovery factor of 83.5%,doubling the recovery obtained by continuous low salinity waterflood.Additionally,the liquid-CO_(2)-LSW WAG process demonstrated an additional benefit for CO_(2)storage,with about 25%of the pore volume of the liquid-CO_(2)injected being sequestered at the end of the injection process.This significant recovery improvement is attributed to a substantial reduction of oil viscosity upon contact with the liquid CO_(2)during the soaking period,with a reduction of up to 95%of the original oil viscosity.Meanwhile,in-situ emulsion generation was observed in the oil produced from the continuous LSW flooding.This was also evident by the increased differential pressure across the sand-pack compared to that of the liquid-CO_(2)alternating LSW process.The promising results of this study indicate significant potential for liquid-CO_(2)alternating LSW injection as an effective cEOR technique for Ugnu heavy oils.
基金supported by the TRANSIT project(funded by EU Horizon 2020 and the Europe’s Rail Joint Undertaking under grant agreement 881771).
文摘Rolling noise is produced by vibration of the wheels and track,induced by their combined surface roughness.It is important to know the relative contributions of the different sources,as this affects noise control strategies as well as acceptance testing of new rolling stock.Three different techniques are described that aim to use pass-by measurements to separate the wheel and track components of rolling noise.One is based on the TWINS model,which is tuned to measured track vibration.The second is based on the advanced transfer path analysis method,which provides an entirely experimental assessment.The third is based on the pass-by analysis method in combination with static vibroacoustic transfer functions which are obtained using a reciprocity method.The development of these methods is described and comparisons between them are presented using the results from three experimental measurement campaigns.These covered a metro train,a regional train and a high-speed train at a range of speeds.The various methods agree reasonably well in terms of overall trends,with moderate agreement in the mid-frequency region,and less consistent results at low and high frequency.
文摘In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.
基金funded by the Ministry of Education Science and Technological Development of the Republic of Serbia with grant numbers 451-03-47/2025-01/200133 and 451-34403-47/2025-01/200189.
文摘This study aims to determine the phytochemical composition and antioxidant activity(AA)of different plant parts(bulbs,stalk,leaves and flowers)of wild rosy garlic(Allium roseum)from Montenegro.The flower exhibited the highest concentration of total phenols(55.7 GAE/g d.e.),followed by the leaf(25.6mg GAE/g d.e.).The leaf displayed the highest concentration of total flavonoids(41.48 mg RE/g d.e.),followed by the flower(36.26 mg RE/g d.e.)and top part of the stalk(26.80 mg RE/g d.e.).The AA of different parts of A.roseum after 60 min of incubation decreased in the following order:flower(0.15mg/cm^(3))>upper stalk(0.32mg/cm^(3))>leaf(0.36mg/cm^(3))>basal stalk(0.80mg/cm^(3))>bulb(1.53 mg/cm^(3)).The flowers exhibited the lowest EC_(50) values,indicating the highest antioxidant potential throughout the entire incubation period.Among all plant parts analyzed,the flowers demonstrated the highest ferric reducing antioxidant power(FRAP),reaching 24.99 mg Fe^(2+)/g,thereby indicating their superior antioxidant potential.Given their edibility,pleasant flavor,and high nutritional value,A.roseum flowers may be considered a promising natural additive for functional food products or culinary applications,including dish enhancement and decoration.
基金Supported by the National Natural Science Foundation of China(No.42250710152)the Jiangsu Province Graduate Innovation and Entrepreneurship Project(No.KYCX22_1171)the National Key Research and Development Program of China(No.2023YFC3008200)。
文摘A cyclonic eddy(CE)is often accompanied by an anticyclonic eddy(AE)to the east of Vietnam in the South China Sea(SCS)in summer,but the dipole lifetime and the intrinsic connection between CE and AE are still understudied.Data from 1993-2021 reveal that the dipole lifetime are significantly correlated with the wind direction and speed in the dipole region.Higher wind speed was found to be associated with more eastward wind direction and tends to longer dipole lifetime.The wind stress work(WW)on the eddy is much stronger in the eastward jet region than in the CE and AE regions.Comparing of results of 12 higher and lower wind speed years reveal that higher wind can produce stronger mean current,WW and barotropic instability(T4)that further enhances eddy kinetic energy(EKE)and dipole lifetime.The correlations between the dipole CE and AE characteristics are insignificant on interannual scales and mostly insignificant on seasonal scales in the surface layer but significant on seasonal scales in the subsurface layers.In addition,the daily mean vertical profiles(0-500 m)of EKE,vorticity and total deformation rate(TD)between CE and AE remain significantly correlated throughout the dipole’s lifetime,which can be a useful criterion for judging if two eddies are a dipole.
文摘BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop neonatal respiratory distress,nasal congestion,otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes.These changes have been shown by chest computed tomography(CT)to develop in infancy and early childhood.Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions,with chest CT doses now in the range of chest radiography(CR).AIM To evaluate the efficacy of ultra-low dose CT(ULDCT)chest in identifying pulmonary changes within a PCD paediatric patient cohort.METHODS Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period,were eligible for inclusion in the study.ULDCT and CR were performed on these patients and the results compared.Comparison metrics included radiation dose,subjective and objective image quality and disease severity.RESULTS Six paediatric patients(mean age 9 years)underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD.The mean effective dose was 0.08±0.02 mSv,a dose that approximates that of a frontal and lateral chest radiograph.The average Brody II score across the entire cohort was 12.92,with excellent interrater reliability and intra-class correlation coefficient(ICC)of 0.98.The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.CONCLUSION ULDCT demonstrates superior diagnostic capabilities,minimal radiation dose penalty,and high interobserver reliability in comparison to CR.Thus,we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.
基金supported by the National Natural Science Foundation of China(grant no.52072041)the Beijing Natural Science Foundation(grant no.JQ21007).
文摘Ferroelectric film materials have attracted significant interest due to their potential for harvesting various forms ofclean energy from natural environmental sources.However,the photoelectric performance of these materials isfrequently constrained by heat generation during light absorption,resulting in significant thermal losses.Most offerroelectric films produce photocurrent and thermocurrent with opposite polarity,thus weakening the coupledphoto-thermoelectric output of the devices.Here we report on a LaNiO_(3)/BiMn_(2)O_(5)(BMO)/ITO ferroelectric film toproduce photocurrent and thermocurrent with the same polarity.The polarity of the photocurrent generated bythe BMO film is shown to be determined solely by the direction of spontaneous polarization,overcoming thedetrimental effect of Schottky barrier for energy harvesting in device.We propose a new strategy to enhance thecoupling factor,thereby offering valuable new insights for optimizing the utilization of ferroelectric materials inboth light and heat energy applications.
