Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease mana...Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.展开更多
The use of water resources for energy generation has become increasingly prevalent,encompassing the conversion of kinetic energy from streams,tides,and waves into renewable electrical power.Water energy sources offer ...The use of water resources for energy generation has become increasingly prevalent,encompassing the conversion of kinetic energy from streams,tides,and waves into renewable electrical power.Water energy sources offer numerous benefits,including widespread availability,stability,and the absence of carbon dioxide and other greenhouse gas emissions,making them a clean and environmentally friendly form of energy.In this work,we develop a droplet-based liquid-solid triboelectric nanogenerator(LS-TENG)using sophisticatedly designed inflatable columnar structures with inner and outer dual-electrodes.This device can be utilized to harvest both the internal droplet-rolling mechanical energy and the external droplet-falling mechanical energy,capable of being assembled into various structures for versatile applications.The design incorporates a combined structure of both internal and external TENG to optimize output performance via multiple energy harvesting strategies.The internal structure features a dual-electrode columnar-shaped LS-TENG,designed to harvest fluid kinetic energy from water droplets.By leveraging the back-and-forth motion of a small amount of water within the air column,mechanical energy can be readily collected,achieving a maximum mass power density of 9.02 W·Kg^(−1)and an energy conversion efficiency of 10.358%.The external component is a droplet-based LS-TENG,which utilizes a double-layer capacitor switch effect elucidated with an equivalent circuit model.Remarkably,without the need for pre-charging,a single droplet can generate over 140 V of high voltage,achieving a maximum power density of 7.35 W·m^(−2)and an energy conversion efficiency of 22.058%.The combined LS-TENG with a sophisticated inflatable columnar structure can simultaneously collect multiple types of energy with high efficacy,exhibiting great significance in potential applications such as TENG aeration rollers,inflatable lifejacket,wind energy harvesting,TENG tents,and green houses.展开更多
BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effective...BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated.AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients.METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this study.Patients were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over time.Assessments were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day 12.Family satisfaction was assessed using the Family Satisfaction ICU 24 ques-tionnaire.RESULTS No significant differences in baseline characteristics were observed between the two groups.In the intervention group,there were significant reductions in total PUSH scores over the assessment period.Specifically,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control group.Family satisfaction with care and decision-making was notably higher in the intervention group.Overall family satisfaction was significantly better in the intervention group.CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients.This approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.展开更多
Biological tests provide information on the medical analysis requested by both the patient and the prescriber. It is a communication link between the prescriber and the laboratory staff. The lack of some information o...Biological tests provide information on the medical analysis requested by both the patient and the prescriber. It is a communication link between the prescriber and the laboratory staff. The lack of some information on request forms not only affects the drafting quality of the test and patient care, but could also make thousands of data produced by healthcare centers unusable. The aim of this study was to assess the drafting quality of request forms submitted to the Malaria and Parasitology Units at the Institut Pasteur de Côte d’Ivoire. Methods: It was a descriptive cross-sectional study to assess the drafting quality of request forms of various prescribers received at the Institut Pasteur de Côte d’Ivoire. This study was conducted at the Malaria and Parasitology Units, department of Parasitology and Mycology (Institut Pasteur de Côte d’Ivoire), from 6<sup>th</sup> December 2020 to 6<sup>th</sup> December 2021. The information on each request forms was recorded on a data collection form designed for this purpose. Each data collection form corresponds to a request forms and each test to a patient. Results: Out of a total of 1990 request forms received, the patient’s age and sex were missing on 18% and 26.8% of the tests respectively. More than half (51.80%) of request forms did not indicate the patient’s place of residence. Clinical information was not provided on 45.90% of the tests. Prescribers omitting their signatures were 51%, stamps were 50.3% and contacts were 71.2%. Only 5.4% of request forms were of good drafting quality. Providing all the required information on the forms could facilitate the use and analysis of data and samples.展开更多
Boron−nitrogen doped multiple resonance(BN-MR)emitters,characterized by B−N covalent bonds,offer distinctive advantages as pivotal building blocks for facile access to novel MR emitters featuring narrowband spectra an...Boron−nitrogen doped multiple resonance(BN-MR)emitters,characterized by B−N covalent bonds,offer distinctive advantages as pivotal building blocks for facile access to novel MR emitters featuring narrowband spectra and high efficiency.However,there remains a scarcity of exploration concerning synthetic methods and structural derivations to expand the library of novel BN-MR emitters.Herein,we present the synthesis of a BN-MR emitter,tCz[B−N]N,through a one-pot borylation reaction directed by the amine group,achieving an impressive yield of 94%.The emitter is decorated by incorporating two 3,6-di-tbutylcarbazole(tCz)units into a B−N covalent bond doped BN-MR parent molecule via para-C−π−D and para-N−π−D conjugations.This peripheral decoration strategy enhances the reverse intersystem crossing process and shifts the emission band towards the pure green region,peaking at 526 nm with a narrowband full-width at half maximum(FWHM)of 41 nm.Consequently,organic light emitting diodes(OLEDs)employing this emitter achieved a maximum external quantum efficiency(EQEmax)value of 27.7%,with minimal efficiency roll-off.Even at a practical luminance of 1000 cd·m^(−2),the device maintains a high EQE value of 24.6%.展开更多
The present study, carried out in the forest (Daloa) and pre-forest (M’Bahiakro) zones of Cote d’Ivoire, aims to determine soil landscape units using the coding method. Geological maps and satellite images (SRTM and...The present study, carried out in the forest (Daloa) and pre-forest (M’Bahiakro) zones of Cote d’Ivoire, aims to determine soil landscape units using the coding method. Geological maps and satellite images (SRTM and Landsat) were used for this purpose. The methodological approach adopted consisted in producing maps of slope, geology, land use and topography using the codification method. These various maps, integrated into a GIS using the coding aggregation method, were used to generate soil landscape maps. Twenty-seven (27) soil landscapes have been identified for the pre-forest zone (M’Bahiakro), with a strong dominance of acid rock over a moderate relief under savannah, forest/degraded forest and crops/fallow. However, the forest zone (Daloa), with forty-one (41) soil landscapes identified over the entire zone, is characterized by a majority of mafic rocks on a medium altitude under forest/degraded forest, water and crops/fallow. The criteria used from the codification method (sum of aggregations) made it possible to predict the spatial distribution of soil map units according to agro-ecological environments in the humid intertropical zone. This is essential for the orientation and reinforcement of soil survey tools. However, a comparative evaluation of the different multicriteria analysis methods for coding and weighting soil landscape unit mapping would enable us to identify the most suitable and efficient method for drawing up base maps for soil surveys.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
Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the ...Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the Drâa Tafilalet region through a diagnostic study conducted by surveying 12 date-packing units. Interviews and surveys were conducted among 12 date packaging units provided by the State to Economic Interest Groups (EIG) in the Drâa-Tafilalet region. Data focused on general EIG information, unit identification, a four-year operational overview, and 2021 palm date processing activities. To streamline analysis, units were categorized into two groups based on packaging capacity: Group 1 (≥400 tons) and Group 2 (<400 tons). The assessment revealed that the packaging units had enhanced this crucial link in the dating industry and introduced a new dynamic in the date marketing chain. However, operational expertise and optimal equipment utilization often fall short, with over 50% of the EIG failing to use provided equipment, except for cold storage rooms. The chain involves a series of operations to preserve the stored product’s intrinsic and extrinsic quality. Evaluated practices include fumigation, meticulous sorting to eliminate visually anomalous dates, calibration during packaging, and storage at temperatures ranging from 0 to 4˚C with humidity levels between 50 and 80%, varying based on the date’s nature (soft, dry, or semi-dry). Expertise in this process mitigates the risk of desiccation or excessive rehydration, preventing date fermentation. Finally, to reduce their energy consumption and solve the balance sheet deficit issue, the government has equipped all the date packaging units from Group 1 and one from Group 2 in the Daraa Tafilalet region with photovoltaic energy. The date packaging infrastructure has boosted the value of Moroccan dates, benefiting small-scale agriculture. Despite improved packaging quality and job creation, suboptimal equipment usage by over 50% of EIGs emphasizes the need for enhanced operational efficiency.展开更多
Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use ...Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.展开更多
Since the beginning of the pandemic caused by the new Coronavirus (SARS- CoV-2), critically ill patients care has been challenging. It is necessary to perform the best available practice and protect the health team, p...Since the beginning of the pandemic caused by the new Coronavirus (SARS- CoV-2), critically ill patients care has been challenging. It is necessary to perform the best available practice and protect the health team, preserving human resources and rationalizing costs. Changes in tracheostomies institutional protocols are necessary according to each health care services reality. This is particular important in developing countries. The aim of this study is to establish a practical and sucint guideline to minimize controversies regarding the proper timing to perform elective tracheostomies in critically ill coronavirus infected patients.展开更多
The coronavirus disease 2019(COVID-19)pandemic has stretched our healthcare system to the brink,highlighting the importance of efficient resource utilization without compromising healthcare provider safety.While advan...The coronavirus disease 2019(COVID-19)pandemic has stretched our healthcare system to the brink,highlighting the importance of efficient resource utilization without compromising healthcare provider safety.While advanced imaging is a great resource for diagnostic purposes,the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport,healthcare provider safety,and post-imaging decontamination.This dilemma has necessitated the transition to more bedside imaging.More so than ever,during the current pandemic,the clinical utility and importance of point-of-care ultrasound(POCUS)cannot be overstressed.It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making.The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into“COVID-units.”In this article,we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology.Additionally,we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients.We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness,hemodynamic decompensation,renal failure,and gastrointestinal disorders experienced by many patients admitted to COVID-units.展开更多
Introduction: Critically ill patients can experience stress-induced hyperglycaemia. Glycaemic control therapy (GCT) is administered to control patients’ blood glycaemic levels and reduce the incidence of infection, m...Introduction: Critically ill patients can experience stress-induced hyperglycaemia. Glycaemic control therapy (GCT) is administered to control patients’ blood glycaemic levels and reduce the incidence of infection, myocardial infarctions and organ failure. However, there are many factors influencing the effectiveness of glycaemic control for patients. This investigation aimed to review the method of Glycaemic Control Therapy (GCT) used in two hospital settings, to assess the effectiveness of glycaemic control on patients’ blood glycaemic levels and examine any barriers that may be in place. Method: A retnrospective audit was carried out on patients’ case notes in Intensive Care Units (ICU) within the East Midlands, UK. This method prevents the study outcomes being swayed because GCT has already taken place. To reduce selection bias the most recent available case notes were selected. All the patients who were admitted to these adult ICU’s between March and April 2010 had their case notes examined, those who were administered GCT were included in the study, this involved 79 from Hospital A and 50 from Hospital B. The patients’ notes were retrospectively audited. Results: Different glycaemic control protocols were being implemented in each hospital, despite both belonging to the same ICU network. In most incidences, regardless of age, diabetes status or diagnosis, patients were administered the same sliding scale insulin (SSI). It was also found that GCT commenced for 41.9% (n = 52) of ICU patients (across both Hospitals) when glycaemic levels were below the established threshold of 10mmol/L. Additionally, a new glycaemic range has been discovered, where 88.3% (n = 113) of patients (across both Hospitals) receiving GCT were not controlled in hypoglycaemia, normoglycaemia or hyperglycaemia. They had mean blood glycaemic levels maintained between 5.6 - 9.9 mmol/L, now being described as medioglycaemia. Conclusions: The majority of patients receiving GCT were controlled in medioglycaemia and therefore a new comprehensive guideline needs to be developed incorporating this new range. Recommendations also need to be established to adapt the titration regimen to individual patients, to improve the effectiveness and safety of glycaemic control.展开更多
<strong>Introduction:</strong> Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovas...<strong>Introduction:</strong> Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovascular diseases in emergency units of Senegal, more precisely in Dakar, in order to know epidemiological profile of these patients. <strong>Methods:</strong> The study setting was the reception and emergency units of the Hôpital de Pikine and Hôpital Principal de Dakar. This was an observational, descriptive cross-sectional study with an analytical aim to search for factors associated with the occurrence of cardiovascular disease. The study ran from January 25th to February 5th, 2018 at the Hôpital de Pikine and from February 25th to March 5th, 2018 at Hôpital Principal de Dakar. The source population consisted of patients over 18 years of age and not in a state of pregnancy, who were been received there and had given their free and informed consent to participate in the survey. A representative sample had drawn and a consecutive recruitment of eligible patients were been carried out. The data collection tools were been based on the WHO STEPwise survey questionnaire. Data collection was been carried out in accordance with ethical rules. <strong>Results:</strong> The study involved 615 patients. The proportions of sedentary lifestyle, low daily consumption of fruits/vegetables, overweight and obesity were 72.4%, 96.4%, 22.7% and 17.3% respectively. This was 55.5% of women who had a waist circumference that corresponded to a high risk of a cardiovascular event and 10.2% for men. 38.9% of patients had blood pressure above 140/90mmhg and 32.2% said they had never controlled their blood pressure in their life. The use of a consultation in a health structure to control his blood pressure was by far the most frequent modality with 61.4%. The proportion of people with cardiovascular disease was 50.1%. Hypertensive flare-ups/hypertensive emergencies were the leading complications diagnosed with 33.33%. Factors associated with the occurrence of cardiovascular disease were sex, age, professional status and body mass index. <strong>Discussion & Conclusion:</strong> The risk factors for cardiovascular disease are highly represented in our emergency units. In addition to the available care offer, the identification of factors associated with the occurrence of cardiovascular diseases in patients who are been seen there will allow targeted preventive actions within this fragile and vulnerable population. All this to help achieve target 3.4 of the Sustainable Development Goals (SDGs) by 2030. Furthermore, according to the associated factors identified, it appears that achieving SDG 8 will greatly contribute to the prevention of cardiovascular disease. This proves the urgency and interest of an integrated multi-ministerial vision in our strategic plans for the prevention against major non-communicable diseases and cardiovascular diseases in particular.展开更多
Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH...Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.展开更多
Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing conse...Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations.B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago.Its application in the diagnosis of thoracic diseases has always been considered limited,due to the presence of air in the lung and the presence of the bones of the thoracic cage,which prevent the progression of the ultrasound beam.However,the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds.At the bedside,thoracic ultrasound is based primarily on the analysis of these artifacts,with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly"water-rich"or"air-rich".The indications,contraindications,advantages,disadvantages,and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.展开更多
Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is...Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is immediate cause for post-discharge medical problems in premature and neonates readmission to NICU. Hence, this study aims to evaluate mothers’ knowledge of caring for premature infants post-discharge from Neonatal Intensive Care Units in the Gaza strip. Methods: A Quantitative-based cross-sectional designs study was used to survey 120 mothers of preterm neonates at the time of preterm neonates discharge by face-to-face interview at Al-Shifa medical complex and Nasser hospital between February and June 2018. Results: The results showed that only about 58.4% of mothers of premature babies had good knowledge about health care needed for premature infants after discharge from NICU. Furthermore, there was no statistically significant difference between the level of knowledge and mother’s sociodemographic characteristics (P-values > 0.05). Conclusion: Mothers’ knowledge of premature infants care was not at the optimal level, which might put the newborns at risk. Therefore, the study emphasizes the necessity of thoughtful exchange of health information between team members and mothers and establishing pre- and post-discharge plans with mothers to start their healthy transition of preterm neonate to home and to ameliorate family concerns.展开更多
Floating Storage and Regasification Units(FSRU)form a rapidly expanding sector of LNG business.In many cases,FSRU now provide a more cost-effective and very flexible way to deliver natural gas to end users in comparis...Floating Storage and Regasification Units(FSRU)form a rapidly expanding sector of LNG business.In many cases,FSRU now provide a more cost-effective and very flexible way to deliver natural gas to end users in comparison with shore-based terminals.Due to enhanced operations FSRU are more complex compared to LNG carriers(LNGC).FSRU are essentially merge of the attributes of shore-based terminals and LNGC.The existing FSRU fleet is formed of new-build vessels and converted LNGC.Together with their advantages FSRU come with the inherent problems of handling and storing LNG.Here we focus on the rollover issues that occur on FSRU and suggest ways to improve handling to minimize the impacts of those events.Rollover is a physical mixing process in a single tank with two or more different parcels of LNG of different compositions,temperatures and densities that can manifest in large boil-off rates,beyond handling-equipment capacities,and large tank pressure increases culminating rapidly.If prevention/mitigation actions are not implemented,uncontrolled venting of boil off gas in vapor form to the atmosphere is a likely consequence involving flammability hazards and tank structure over-pressurization with potential damage.This study provides in-depth analysis of FSRU rollovers based on observations of more than twenty rollovers on many different FSRU.The analysis focuses on LNG saturated vapor pressure(SVP)rather than the traditional approach of focusing on boil-off rate(BOG).This approach allows efficient rollover management without any in-built rollover prevention means.Strategies are developed for managing a combination of FSRU tanks utilizing rollover prevention and mitigation actions,as well as efficient pre-planning for LNG stock management.Novel rules of thumb for predicting time to rollover onset,based on many observed FSRU rollovers provide operators with real-time insight to what rollover preventive and mitigating actions are effective in specific circumstances.展开更多
Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill pa...Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.展开更多
Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary a...Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.展开更多
An α-L-arabinofuranosidase (ARF) gene of 1503 bp was synthesized, subcloned into pET26b vector, and expressed in Escherichia coli. The enzyme was purified in active form, and consisted of 500 amino acid residues, cor...An α-L-arabinofuranosidase (ARF) gene of 1503 bp was synthesized, subcloned into pET26b vector, and expressed in Escherichia coli. The enzyme was purified in active form, and consisted of 500 amino acid residues, corresponding to 55 kD based on SDS-PAGE. The affinity-purified protein was characterized using arabinofuranosyl xylooligosaccharides (AXOS) as substrates. The pH effect was investigated showing an optimum at pH 5.5. XaARF catalyzed the cleavage of arabinose at C3 of the xylopyranosyl unit efficiently if the arabinofuranosyl substitution was at the terminal compared to internal xylose units. The enzyme was able to act on di-substituted xylopyranosyl units with the first cleavage at C3 followed by C2 linkages.展开更多
文摘Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.
基金supported by the National Key Research and Development Program of China(2023YFB3208102,2021YFB3200304)the National Natural Science Foundation of China(52073031)+2 种基金Beijing Nova Program(Z211100002121148)Fundamental Research Funds for the Central Universities(E0EG6801X2)the‘Hundred Talents Program’of the Chinese Academy of Sciences.
文摘The use of water resources for energy generation has become increasingly prevalent,encompassing the conversion of kinetic energy from streams,tides,and waves into renewable electrical power.Water energy sources offer numerous benefits,including widespread availability,stability,and the absence of carbon dioxide and other greenhouse gas emissions,making them a clean and environmentally friendly form of energy.In this work,we develop a droplet-based liquid-solid triboelectric nanogenerator(LS-TENG)using sophisticatedly designed inflatable columnar structures with inner and outer dual-electrodes.This device can be utilized to harvest both the internal droplet-rolling mechanical energy and the external droplet-falling mechanical energy,capable of being assembled into various structures for versatile applications.The design incorporates a combined structure of both internal and external TENG to optimize output performance via multiple energy harvesting strategies.The internal structure features a dual-electrode columnar-shaped LS-TENG,designed to harvest fluid kinetic energy from water droplets.By leveraging the back-and-forth motion of a small amount of water within the air column,mechanical energy can be readily collected,achieving a maximum mass power density of 9.02 W·Kg^(−1)and an energy conversion efficiency of 10.358%.The external component is a droplet-based LS-TENG,which utilizes a double-layer capacitor switch effect elucidated with an equivalent circuit model.Remarkably,without the need for pre-charging,a single droplet can generate over 140 V of high voltage,achieving a maximum power density of 7.35 W·m^(−2)and an energy conversion efficiency of 22.058%.The combined LS-TENG with a sophisticated inflatable columnar structure can simultaneously collect multiple types of energy with high efficacy,exhibiting great significance in potential applications such as TENG aeration rollers,inflatable lifejacket,wind energy harvesting,TENG tents,and green houses.
文摘BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated.AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients.METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this study.Patients were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over time.Assessments were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day 12.Family satisfaction was assessed using the Family Satisfaction ICU 24 ques-tionnaire.RESULTS No significant differences in baseline characteristics were observed between the two groups.In the intervention group,there were significant reductions in total PUSH scores over the assessment period.Specifically,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control group.Family satisfaction with care and decision-making was notably higher in the intervention group.Overall family satisfaction was significantly better in the intervention group.CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients.This approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.
文摘Biological tests provide information on the medical analysis requested by both the patient and the prescriber. It is a communication link between the prescriber and the laboratory staff. The lack of some information on request forms not only affects the drafting quality of the test and patient care, but could also make thousands of data produced by healthcare centers unusable. The aim of this study was to assess the drafting quality of request forms submitted to the Malaria and Parasitology Units at the Institut Pasteur de Côte d’Ivoire. Methods: It was a descriptive cross-sectional study to assess the drafting quality of request forms of various prescribers received at the Institut Pasteur de Côte d’Ivoire. This study was conducted at the Malaria and Parasitology Units, department of Parasitology and Mycology (Institut Pasteur de Côte d’Ivoire), from 6<sup>th</sup> December 2020 to 6<sup>th</sup> December 2021. The information on each request forms was recorded on a data collection form designed for this purpose. Each data collection form corresponds to a request forms and each test to a patient. Results: Out of a total of 1990 request forms received, the patient’s age and sex were missing on 18% and 26.8% of the tests respectively. More than half (51.80%) of request forms did not indicate the patient’s place of residence. Clinical information was not provided on 45.90% of the tests. Prescribers omitting their signatures were 51%, stamps were 50.3% and contacts were 71.2%. Only 5.4% of request forms were of good drafting quality. Providing all the required information on the forms could facilitate the use and analysis of data and samples.
基金financial support from the National Natural Science Foundation of China(Nos.52303253 and 52273198)Yunnan Fundamental Research Project(No.202301BF070001-008)the Yunling Scholar Project of"Yunnan Revitalization Talent Support Program".
文摘Boron−nitrogen doped multiple resonance(BN-MR)emitters,characterized by B−N covalent bonds,offer distinctive advantages as pivotal building blocks for facile access to novel MR emitters featuring narrowband spectra and high efficiency.However,there remains a scarcity of exploration concerning synthetic methods and structural derivations to expand the library of novel BN-MR emitters.Herein,we present the synthesis of a BN-MR emitter,tCz[B−N]N,through a one-pot borylation reaction directed by the amine group,achieving an impressive yield of 94%.The emitter is decorated by incorporating two 3,6-di-tbutylcarbazole(tCz)units into a B−N covalent bond doped BN-MR parent molecule via para-C−π−D and para-N−π−D conjugations.This peripheral decoration strategy enhances the reverse intersystem crossing process and shifts the emission band towards the pure green region,peaking at 526 nm with a narrowband full-width at half maximum(FWHM)of 41 nm.Consequently,organic light emitting diodes(OLEDs)employing this emitter achieved a maximum external quantum efficiency(EQEmax)value of 27.7%,with minimal efficiency roll-off.Even at a practical luminance of 1000 cd·m^(−2),the device maintains a high EQE value of 24.6%.
文摘The present study, carried out in the forest (Daloa) and pre-forest (M’Bahiakro) zones of Cote d’Ivoire, aims to determine soil landscape units using the coding method. Geological maps and satellite images (SRTM and Landsat) were used for this purpose. The methodological approach adopted consisted in producing maps of slope, geology, land use and topography using the codification method. These various maps, integrated into a GIS using the coding aggregation method, were used to generate soil landscape maps. Twenty-seven (27) soil landscapes have been identified for the pre-forest zone (M’Bahiakro), with a strong dominance of acid rock over a moderate relief under savannah, forest/degraded forest and crops/fallow. However, the forest zone (Daloa), with forty-one (41) soil landscapes identified over the entire zone, is characterized by a majority of mafic rocks on a medium altitude under forest/degraded forest, water and crops/fallow. The criteria used from the codification method (sum of aggregations) made it possible to predict the spatial distribution of soil map units according to agro-ecological environments in the humid intertropical zone. This is essential for the orientation and reinforcement of soil survey tools. However, a comparative evaluation of the different multicriteria analysis methods for coding and weighting soil landscape unit mapping would enable us to identify the most suitable and efficient method for drawing up base maps for soil surveys.
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Efficient storage and handling facilities play a pivotal role in ensuring the quality and longevity of date palm produce. This study aims to contribute to the assessment of the operation of refrigeration units in the Drâa Tafilalet region through a diagnostic study conducted by surveying 12 date-packing units. Interviews and surveys were conducted among 12 date packaging units provided by the State to Economic Interest Groups (EIG) in the Drâa-Tafilalet region. Data focused on general EIG information, unit identification, a four-year operational overview, and 2021 palm date processing activities. To streamline analysis, units were categorized into two groups based on packaging capacity: Group 1 (≥400 tons) and Group 2 (<400 tons). The assessment revealed that the packaging units had enhanced this crucial link in the dating industry and introduced a new dynamic in the date marketing chain. However, operational expertise and optimal equipment utilization often fall short, with over 50% of the EIG failing to use provided equipment, except for cold storage rooms. The chain involves a series of operations to preserve the stored product’s intrinsic and extrinsic quality. Evaluated practices include fumigation, meticulous sorting to eliminate visually anomalous dates, calibration during packaging, and storage at temperatures ranging from 0 to 4˚C with humidity levels between 50 and 80%, varying based on the date’s nature (soft, dry, or semi-dry). Expertise in this process mitigates the risk of desiccation or excessive rehydration, preventing date fermentation. Finally, to reduce their energy consumption and solve the balance sheet deficit issue, the government has equipped all the date packaging units from Group 1 and one from Group 2 in the Daraa Tafilalet region with photovoltaic energy. The date packaging infrastructure has boosted the value of Moroccan dates, benefiting small-scale agriculture. Despite improved packaging quality and job creation, suboptimal equipment usage by over 50% of EIGs emphasizes the need for enhanced operational efficiency.
文摘Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.
文摘Since the beginning of the pandemic caused by the new Coronavirus (SARS- CoV-2), critically ill patients care has been challenging. It is necessary to perform the best available practice and protect the health team, preserving human resources and rationalizing costs. Changes in tracheostomies institutional protocols are necessary according to each health care services reality. This is particular important in developing countries. The aim of this study is to establish a practical and sucint guideline to minimize controversies regarding the proper timing to perform elective tracheostomies in critically ill coronavirus infected patients.
文摘The coronavirus disease 2019(COVID-19)pandemic has stretched our healthcare system to the brink,highlighting the importance of efficient resource utilization without compromising healthcare provider safety.While advanced imaging is a great resource for diagnostic purposes,the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport,healthcare provider safety,and post-imaging decontamination.This dilemma has necessitated the transition to more bedside imaging.More so than ever,during the current pandemic,the clinical utility and importance of point-of-care ultrasound(POCUS)cannot be overstressed.It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making.The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into“COVID-units.”In this article,we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology.Additionally,we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients.We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness,hemodynamic decompensation,renal failure,and gastrointestinal disorders experienced by many patients admitted to COVID-units.
文摘Introduction: Critically ill patients can experience stress-induced hyperglycaemia. Glycaemic control therapy (GCT) is administered to control patients’ blood glycaemic levels and reduce the incidence of infection, myocardial infarctions and organ failure. However, there are many factors influencing the effectiveness of glycaemic control for patients. This investigation aimed to review the method of Glycaemic Control Therapy (GCT) used in two hospital settings, to assess the effectiveness of glycaemic control on patients’ blood glycaemic levels and examine any barriers that may be in place. Method: A retnrospective audit was carried out on patients’ case notes in Intensive Care Units (ICU) within the East Midlands, UK. This method prevents the study outcomes being swayed because GCT has already taken place. To reduce selection bias the most recent available case notes were selected. All the patients who were admitted to these adult ICU’s between March and April 2010 had their case notes examined, those who were administered GCT were included in the study, this involved 79 from Hospital A and 50 from Hospital B. The patients’ notes were retrospectively audited. Results: Different glycaemic control protocols were being implemented in each hospital, despite both belonging to the same ICU network. In most incidences, regardless of age, diabetes status or diagnosis, patients were administered the same sliding scale insulin (SSI). It was also found that GCT commenced for 41.9% (n = 52) of ICU patients (across both Hospitals) when glycaemic levels were below the established threshold of 10mmol/L. Additionally, a new glycaemic range has been discovered, where 88.3% (n = 113) of patients (across both Hospitals) receiving GCT were not controlled in hypoglycaemia, normoglycaemia or hyperglycaemia. They had mean blood glycaemic levels maintained between 5.6 - 9.9 mmol/L, now being described as medioglycaemia. Conclusions: The majority of patients receiving GCT were controlled in medioglycaemia and therefore a new comprehensive guideline needs to be developed incorporating this new range. Recommendations also need to be established to adapt the titration regimen to individual patients, to improve the effectiveness and safety of glycaemic control.
文摘<strong>Introduction:</strong> Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovascular diseases in emergency units of Senegal, more precisely in Dakar, in order to know epidemiological profile of these patients. <strong>Methods:</strong> The study setting was the reception and emergency units of the Hôpital de Pikine and Hôpital Principal de Dakar. This was an observational, descriptive cross-sectional study with an analytical aim to search for factors associated with the occurrence of cardiovascular disease. The study ran from January 25th to February 5th, 2018 at the Hôpital de Pikine and from February 25th to March 5th, 2018 at Hôpital Principal de Dakar. The source population consisted of patients over 18 years of age and not in a state of pregnancy, who were been received there and had given their free and informed consent to participate in the survey. A representative sample had drawn and a consecutive recruitment of eligible patients were been carried out. The data collection tools were been based on the WHO STEPwise survey questionnaire. Data collection was been carried out in accordance with ethical rules. <strong>Results:</strong> The study involved 615 patients. The proportions of sedentary lifestyle, low daily consumption of fruits/vegetables, overweight and obesity were 72.4%, 96.4%, 22.7% and 17.3% respectively. This was 55.5% of women who had a waist circumference that corresponded to a high risk of a cardiovascular event and 10.2% for men. 38.9% of patients had blood pressure above 140/90mmhg and 32.2% said they had never controlled their blood pressure in their life. The use of a consultation in a health structure to control his blood pressure was by far the most frequent modality with 61.4%. The proportion of people with cardiovascular disease was 50.1%. Hypertensive flare-ups/hypertensive emergencies were the leading complications diagnosed with 33.33%. Factors associated with the occurrence of cardiovascular disease were sex, age, professional status and body mass index. <strong>Discussion & Conclusion:</strong> The risk factors for cardiovascular disease are highly represented in our emergency units. In addition to the available care offer, the identification of factors associated with the occurrence of cardiovascular diseases in patients who are been seen there will allow targeted preventive actions within this fragile and vulnerable population. All this to help achieve target 3.4 of the Sustainable Development Goals (SDGs) by 2030. Furthermore, according to the associated factors identified, it appears that achieving SDG 8 will greatly contribute to the prevention of cardiovascular disease. This proves the urgency and interest of an integrated multi-ministerial vision in our strategic plans for the prevention against major non-communicable diseases and cardiovascular diseases in particular.
文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.
文摘Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations.B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago.Its application in the diagnosis of thoracic diseases has always been considered limited,due to the presence of air in the lung and the presence of the bones of the thoracic cage,which prevent the progression of the ultrasound beam.However,the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds.At the bedside,thoracic ultrasound is based primarily on the analysis of these artifacts,with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly"water-rich"or"air-rich".The indications,contraindications,advantages,disadvantages,and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.
文摘Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is immediate cause for post-discharge medical problems in premature and neonates readmission to NICU. Hence, this study aims to evaluate mothers’ knowledge of caring for premature infants post-discharge from Neonatal Intensive Care Units in the Gaza strip. Methods: A Quantitative-based cross-sectional designs study was used to survey 120 mothers of preterm neonates at the time of preterm neonates discharge by face-to-face interview at Al-Shifa medical complex and Nasser hospital between February and June 2018. Results: The results showed that only about 58.4% of mothers of premature babies had good knowledge about health care needed for premature infants after discharge from NICU. Furthermore, there was no statistically significant difference between the level of knowledge and mother’s sociodemographic characteristics (P-values > 0.05). Conclusion: Mothers’ knowledge of premature infants care was not at the optimal level, which might put the newborns at risk. Therefore, the study emphasizes the necessity of thoughtful exchange of health information between team members and mothers and establishing pre- and post-discharge plans with mothers to start their healthy transition of preterm neonate to home and to ameliorate family concerns.
文摘Floating Storage and Regasification Units(FSRU)form a rapidly expanding sector of LNG business.In many cases,FSRU now provide a more cost-effective and very flexible way to deliver natural gas to end users in comparison with shore-based terminals.Due to enhanced operations FSRU are more complex compared to LNG carriers(LNGC).FSRU are essentially merge of the attributes of shore-based terminals and LNGC.The existing FSRU fleet is formed of new-build vessels and converted LNGC.Together with their advantages FSRU come with the inherent problems of handling and storing LNG.Here we focus on the rollover issues that occur on FSRU and suggest ways to improve handling to minimize the impacts of those events.Rollover is a physical mixing process in a single tank with two or more different parcels of LNG of different compositions,temperatures and densities that can manifest in large boil-off rates,beyond handling-equipment capacities,and large tank pressure increases culminating rapidly.If prevention/mitigation actions are not implemented,uncontrolled venting of boil off gas in vapor form to the atmosphere is a likely consequence involving flammability hazards and tank structure over-pressurization with potential damage.This study provides in-depth analysis of FSRU rollovers based on observations of more than twenty rollovers on many different FSRU.The analysis focuses on LNG saturated vapor pressure(SVP)rather than the traditional approach of focusing on boil-off rate(BOG).This approach allows efficient rollover management without any in-built rollover prevention means.Strategies are developed for managing a combination of FSRU tanks utilizing rollover prevention and mitigation actions,as well as efficient pre-planning for LNG stock management.Novel rules of thumb for predicting time to rollover onset,based on many observed FSRU rollovers provide operators with real-time insight to what rollover preventive and mitigating actions are effective in specific circumstances.
文摘Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.
文摘Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.
文摘An α-L-arabinofuranosidase (ARF) gene of 1503 bp was synthesized, subcloned into pET26b vector, and expressed in Escherichia coli. The enzyme was purified in active form, and consisted of 500 amino acid residues, corresponding to 55 kD based on SDS-PAGE. The affinity-purified protein was characterized using arabinofuranosyl xylooligosaccharides (AXOS) as substrates. The pH effect was investigated showing an optimum at pH 5.5. XaARF catalyzed the cleavage of arabinose at C3 of the xylopyranosyl unit efficiently if the arabinofuranosyl substitution was at the terminal compared to internal xylose units. The enzyme was able to act on di-substituted xylopyranosyl units with the first cleavage at C3 followed by C2 linkages.
