Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on...Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on-site high-speed rail emergency disposal,basic principles for revising the regulations on railway technical management(RRTM)are proposed and suggestions and evaluation methods according to the main clauses are put forward.Findings–Basic principles for revising the RRTM are proposed,namely“to meet the actual needs of on-site high-speed railway emergency disposal,standardize the emergency disposal process,improve the efficiency of emergency disposal and keep the consistency between provisions of emergency disposal”.Existing provisions related to emergency disposal efficiency,scenarios,safety and service quality are made up for the deficiencies.To make up for the deficiencies of the existing provisions related to emergency disposal efficiency,improvement of emergency disposal scenarios and guarantee of emergency disposal safety and quality,this paper puts forward suggestions on revising 15 emergency disposal provisions of the RRTM with regard to earthquake monitoring and warning,in-station foreign body invasion warning,air conditioning failure of EMU trains and forced parking of trains in sections.A fuzzy comprehensive evaluation model based on the analytic hierarchy process(AHP)is constructed to evaluate the proposed revision scheme and suggestions,which has been highly recognized by experts.Originality/value–This study implements the goal of high-quality railway development.展开更多
Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offe...Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offer a comprehensive overview of the entire disposal framework for R-LIBs,encompassing a broad spectrum of activities,including screening,repurposing and recycling.Firstly,we delve deeply into a thorough examination of current screening technologies,shifting the focus from a mere enumeration of screening methods to the exploration of the strategies for enhancing screening efficiency.Secondly,we outline battery repurposing with associated key factors,summarizing stationary applications and sizing methods for R-LIBs in their second life.A particular light is shed on available reconditioning solutions,demonstrating their great potential in facilitating battery safety and lifetime in repurposing scenarios and identifying their techno-economic issues.In the realm of battery recycling,we present an extensive survey of pre-treatment options and subsequent material recovery technologies.Particularly,we introduce several global leading recyclers to illustrate their industrial processes and technical intricacies.Furthermore,relevant challenges and evolving trends are investigated in pursuit of a sustainable end-of-life management and disposal framework.We hope that this study can serve as a valuable resource for researchers,industry professionals and policymakers in this field,ultimately facilitating the adoption of proper disposal practices.展开更多
Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resista...Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.展开更多
A means to develop a comparative assessment of the risks of available wastewater effluent disposal options on a local scale needs to be developed to help local decision-makers make decisions on options such as direct ...A means to develop a comparative assessment of the risks of available wastewater effluent disposal options on a local scale needs to be developed to help local decision-makers make decisions on options such as direct or indirect potable reuse options. These options have garnered more interest as a result of water supply limitations in many urban areas. This risk assessment was developed from a risk assessment developed at the University of Miami in 2001 and Florida Atlantic University (FAU) in 2023. Direct potable reuse and injection wells were deemed to have the lowest risk in the most recent study by FAU. However, the injection well option may not be available everywhere. As a result, a more local means to assess exposure risk is needed. This paper outlines the process to evaluate the public health risks associated with available disposal alternatives which may be very limited in some areas. The development of exposure pathways can help local decision-makers define the challenges, and support later expert level analysis upon which public health decisions are based.展开更多
Safe emplacement of high-level nuclear waste(HLNW)arising from the utilization of nuclear power is a frequently en-countered and considerably challenging issue.The widely accepted and feasible approach for the permane...Safe emplacement of high-level nuclear waste(HLNW)arising from the utilization of nuclear power is a frequently en-countered and considerably challenging issue.The widely accepted and feasible approach for the permanent disposal of HLNW involves housing it in a corrosion-resistant container and subsequently burying it deep in a geologic repository.The focus lies on ensuring the dur-ability and integrity of the container in this process.This review introduces various techniques and strategies employed in controlling the corrosion of used fuel containers(UFCs)using copper(Cu)as corrosion barrier in the context of deep geological disposal.Overall,these corrosion prevention techniques and methods have been effectively implemented and employed to successfully mitigate the corrosion challenges encountered during the permanent disposal of Cu containers(e.g.,corrosion mechanisms and corrosion parameters)in deep geologic repositories.The primary objective of this review is to provide an extensive examination of the alteration in the corrosion envir-onment encountered by the UFCs when subjected to deep geologic repository conditions and focusing on addressing the potential corro-sion scenarios.展开更多
Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disp...Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disposed of. In Burkina Faso, there are as yet no guidelines for the disposal of unused medicines in households. The aim of this study was to estimate the extent of household possession of unused or expired medicines, and to describe attitudes and disposal practices. Methods: This was a descriptive cross-sectional study covering households in the Ouagadougou commune conducted from June to August 2021. Two-stage stratified sampling was used: selection of Enumeration Zones (EZs) and selection of households, with each EZ comprising several households. Data collection was based on direct interviews using a structured questionnaire. Data were processed using Epi Info software version 7.2.4.0. Results: In total, 417 household residents were surveyed out of the planned 423 households, corresponding to a completion rate of 98.58% compared with the initial sample. Among the respondents, 79.62% had unused and/or expired medicines in their household. A total of 2562 drug packaging units were counted, for a total weight of 121.90 kg. Nearly 75% were aware that improper disposal was a danger to the environment. Some respondents kept their unused medicines at home until they expired (43.41%), and disposed of them mainly by throwing them in the household garbage (75.58%). The majority (79%) were in favor of the government setting up a take-back program for these medicines. Conclusion: The introduction of a take-back program for unused or out-of-date medicines will ensure safer disposal of medicines, and better protection for households and the environment.展开更多
Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (...Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.展开更多
BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gather...BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.展开更多
BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)adm...BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to fi nd a light-weight,convenient prediction method through machine learning.METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation.RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the fi ve most important features were acuity,arrival transportation,age,shock index,and respiratory rate.CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.展开更多
Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP...Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
Introduction: Pediatric emergencies in developing countries are associated with high morbidity and mortality. The Maroua Regional Hospital (MRH) is one of the referral centers for pediatric emergencies in the Far nort...Introduction: Pediatric emergencies in developing countries are associated with high morbidity and mortality. The Maroua Regional Hospital (MRH) is one of the referral centers for pediatric emergencies in the Far north region of Cameroon. Pediatric emergencies are frequent in Maroua and are associated with significant mortality. The aim of our study is to determine the epidemiological, clinical, and evolutionary profile of children admitted to the pediatric emergency department of the HRM. Methods: We conducted an observational, descriptive, and retrospective study over a period from April 10, 2023 to April 10, 2024, focusing on the records of patients admitted to the pediatric emergency department of the MRH. The variables studied included epidemiological, clinical, and evolutionary characteristics. Data analysis was performed using CSPro version 8.01 and SPSS version 27.0. Results: We included 1027 patients;the sex ratio was 1.2 infants under 2 years represented 54.33%. The main reasons for consultation were fever (62.22%) and seizures (30.18%). The most frequently prescribed additional test was the Complete Blood Count (CBC), performed in 97.37% of cases. The most common pathologies were severe malaria (45.18%), broncho-pulmonary infections (15.48%), and bacterial meningitis (12.26%). At admission, 32.9% were transfused. There were 68 deaths, representing 6.67%, and 86% of the deaths occurred within 24 hours of admission. The leading cause of death was severe malaria, with 28 (41.17%) cases. Conclusion: Febrile illnesses were the main reason for consultation, and mortality was linked to severe malaria. Therefore, in addition to the other preventive methods already used against malaria, it is recommended to consider the use of the malaria vaccine.展开更多
With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of...With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.展开更多
Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the ...Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.展开更多
Introduction The main objective of any healthcare establishment must be to ensure the quality of patient care and customer satisfaction. It is necessary to regularly assess patient satisfaction. The aim of this study ...Introduction The main objective of any healthcare establishment must be to ensure the quality of patient care and customer satisfaction. It is necessary to regularly assess patient satisfaction. The aim of this study was to assess the level of satisfaction of customers aged over 18 years attending the emergency department of the health center. Methodology This was a descriptive and analytical cross-sectional study of patients aged 18 years and over, who attended the Samu Municipal emergency department between 02 and 30 May 2023. The satisfaction index was determined using the adapted 2009 SAPHORA-MCO questionnaire and the Likert satisfaction scale. Results A total of 400 patients were surveyed. The average age was 35 years, with a standard deviation of 14.7. Of those surveyed, 51% were women, 87% were educated, 50% lived in Grand Yoff and 59.5% were unemployed. Satisfaction levels linked to perception of the cost of care (72%), waiting time (64.3%), information given to patients (69.1%) and pain management (74 .5%) are fair. On the other hand, the levels of satisfaction linked to administrative procedures (82.5%), staff attitudes towards patients (84%), staff availability (86.4%), patient privacy (89.2%), general atmosphere (87.2%), staff competence (87.3%), and the effectiveness of care (89.4%) were satisfactory. The average waiting time was 38 minutes. However, 32% of patients waited less than 30 minutes and 92% less than an hour. The satisfaction index linked to administration and reception was 72.9% and 79.85%, respectively. The satisfaction index linked to the administration and technical quality of care is equal to 85.8% and 83.7%, respectively. The overall satisfaction index is equal to 80.6%;the level of satisfaction of users of the health structure is satisfactory. Conclusion Patient satisfaction is an essential part of quality care. Patient satisfaction must be based on effective communication from the healthcare team and the creation of a patient-caregiver relationship.展开更多
BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We per...BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.展开更多
Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients s...Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.展开更多
The post-earthquake emergency period,which is a sensitive time segment just after an event,mainly focuses on saving life and restoring social order.To improve the seismic resilience of city road networks,a resilience ...The post-earthquake emergency period,which is a sensitive time segment just after an event,mainly focuses on saving life and restoring social order.To improve the seismic resilience of city road networks,a resilience evaluation method used in the post-earthquake emergency period is proposed.The road seismic damage index of a city road network can consider the influence of roads,bridges and buildings along the roads,etc.on road capacity after an earthquake.A function index for a city road network is developed,which reflects the connectivity,redundancy,traffic demand and traffic function of the network.An optimization model for improving the road repair order in the post-earthquake emergency period is also developed according to the resilience evaluation,to enable decision support for city emergency management and achieve the best seismic resilience of the city road network.The optimization model is applied to a city road network and the results illustrate the feasibility of the resilience evaluation and optimization method for a city road network in the post-earthquake emergency period.展开更多
The disposal of contaminated water from Japan’s Fukushima nuclear power plant is a significant international nuclear safety issue with considerable cross-border implications.This matter requires compliance not only w...The disposal of contaminated water from Japan’s Fukushima nuclear power plant is a significant international nuclear safety issue with considerable cross-border implications.This matter requires compliance not only with the law of the sea but also with the principles of nuclear safety under international law.These principles serve as the overarching tenet of international and China’s domestic nuclear laws,applicable to nuclear facilities and activities.The principle of safety in nuclear activities is fully recognized in international and domestic laws,carrying broad legal binding force.Japan’s discharge of nuclear-contaminated water into the sea violates its obligations under the principle of safety in nuclear activities,including commitments to optimum protection,as low as reasonably practicable,and prevention.The Japanese government and the International Atomic Energy Agency(IAEA)have breached the obligation of optimum protection by restricting the scope of assessments,substituting core concepts,and shielding dissenting views.In the absence of clear radiation standards,they have acted unilaterally without fulfilling the obligation as low as reasonably practicable principle.The discharge of Fukushima nuclear-contaminated water poses an imminent and unpredictable risk to all countries worldwide,including Japanese residents.Japan and the IAEA should fulfill their obligations under international law regarding disposal,adhering to the principles of nuclear safety,including optimum protection,the obligation as low as reasonably practicable,and prevention through multilateral cooperation.Specifically,the obligation to provide optimum protection should be implemented by re-evaluating the most reliable disposal technologies and methods currently available and comprehensively assessing various options.The standard of the obligation as low as reasonably practicable requires that the minimization of negative impacts on human health,livelihoods,and the environment should not be subordinated to considerations of cutting costs and expenses.Multilateral cooperation should be promoted through the establishment of sound multilateral long-term monitoring mechanisms for the discharge of nuclear-contaminated water,notification and consultation obligations,and periodic assessments.These obligations under international law were fulfilled after the accidents at the Three Mile Island and Chernobyl nuclear power plants.The implications of the principles of nuclear safety align with the concept of building a community of shared future for nuclear safety advocated by China.In cases of violations of international law regarding the disposal of nuclear-contaminated water that jeopardize the concept of a community of a shared future for nuclear safety,China can also rely on its own strength to promote the implementation of due obligations through self-help.展开更多
Objective:To assess the correlation between atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City.Methods:Daily data on atmospheric pollutants,meteorolog...Objective:To assess the correlation between atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City.Methods:Daily data on atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City from 2018 to 2021 were collected.The Spearman rank correlation test was used to analyze the correlation,and a distributed lag non-linear model was employed to analyze the health effects and lag impacts of environmental factors.Subgroup analyses were conducted based on sex and age.Results:According to the criteria of International Classification of Diseases(ICD-10:J00-J99),a total of 221913 cases were included,accounting for 21.3%of the total emergency department visits in Haikou City.For every 1℃increase in temperature,the risk of emergency department visits increased by 1.029%(95%CI 1.016%-1.042%).Relative humidity greater than 80%reduced the risk of visits,while higher atmospheric pressure(>1010 hpa)also decreased the likelihood of daily emergency department visits.Higher concentrations of PM_(2.5)(30-50μg/m^(3)),PM10(>60μg/m^(3)),and O_(3)(75-125μg/m^(3))were associated with increased visits.Higher temperatures(>25℃)have a greater impact on females and children aged 0-14 years,while males are more sensitive to low atmospheric pressure.Individuals aged 65 and above exhibited increased sensitivity to O_(3)concentration,and the effects of PM2.5,PM10,and O_(3)are more pronounced in individuals over 14 years old.Conclusions:Short-term exposure to high temperatures,particulate matter pollutants(PM_(2.5)and PM_(10)),and ozone(O_(3))is associated with increased emergency department visits for respiratory diseases.展开更多
基金funded by Foundation of China Academy of Railway Sciences(No:AYF22Y143).
文摘Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on-site high-speed rail emergency disposal,basic principles for revising the regulations on railway technical management(RRTM)are proposed and suggestions and evaluation methods according to the main clauses are put forward.Findings–Basic principles for revising the RRTM are proposed,namely“to meet the actual needs of on-site high-speed railway emergency disposal,standardize the emergency disposal process,improve the efficiency of emergency disposal and keep the consistency between provisions of emergency disposal”.Existing provisions related to emergency disposal efficiency,scenarios,safety and service quality are made up for the deficiencies.To make up for the deficiencies of the existing provisions related to emergency disposal efficiency,improvement of emergency disposal scenarios and guarantee of emergency disposal safety and quality,this paper puts forward suggestions on revising 15 emergency disposal provisions of the RRTM with regard to earthquake monitoring and warning,in-station foreign body invasion warning,air conditioning failure of EMU trains and forced parking of trains in sections.A fuzzy comprehensive evaluation model based on the analytic hierarchy process(AHP)is constructed to evaluate the proposed revision scheme and suggestions,which has been highly recognized by experts.Originality/value–This study implements the goal of high-quality railway development.
基金supported by an Australian Government Research Training Program Scholarship offered to the first author of this study。
文摘Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offer a comprehensive overview of the entire disposal framework for R-LIBs,encompassing a broad spectrum of activities,including screening,repurposing and recycling.Firstly,we delve deeply into a thorough examination of current screening technologies,shifting the focus from a mere enumeration of screening methods to the exploration of the strategies for enhancing screening efficiency.Secondly,we outline battery repurposing with associated key factors,summarizing stationary applications and sizing methods for R-LIBs in their second life.A particular light is shed on available reconditioning solutions,demonstrating their great potential in facilitating battery safety and lifetime in repurposing scenarios and identifying their techno-economic issues.In the realm of battery recycling,we present an extensive survey of pre-treatment options and subsequent material recovery technologies.Particularly,we introduce several global leading recyclers to illustrate their industrial processes and technical intricacies.Furthermore,relevant challenges and evolving trends are investigated in pursuit of a sustainable end-of-life management and disposal framework.We hope that this study can serve as a valuable resource for researchers,industry professionals and policymakers in this field,ultimately facilitating the adoption of proper disposal practices.
基金funded by the Science and Technology Research and Development Plan of the China State Railway Group Company Limited(No.N2023J053).
文摘Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.
文摘A means to develop a comparative assessment of the risks of available wastewater effluent disposal options on a local scale needs to be developed to help local decision-makers make decisions on options such as direct or indirect potable reuse options. These options have garnered more interest as a result of water supply limitations in many urban areas. This risk assessment was developed from a risk assessment developed at the University of Miami in 2001 and Florida Atlantic University (FAU) in 2023. Direct potable reuse and injection wells were deemed to have the lowest risk in the most recent study by FAU. However, the injection well option may not be available everywhere. As a result, a more local means to assess exposure risk is needed. This paper outlines the process to evaluate the public health risks associated with available disposal alternatives which may be very limited in some areas. The development of exposure pathways can help local decision-makers define the challenges, and support later expert level analysis upon which public health decisions are based.
基金study received financial support from the National Natural Science Foundation of China(No.U22B2065),EditChecks(https://editchecks.com.cn/)for providing linguistic assistance during the preparation of this manuscript.
文摘Safe emplacement of high-level nuclear waste(HLNW)arising from the utilization of nuclear power is a frequently en-countered and considerably challenging issue.The widely accepted and feasible approach for the permanent disposal of HLNW involves housing it in a corrosion-resistant container and subsequently burying it deep in a geologic repository.The focus lies on ensuring the dur-ability and integrity of the container in this process.This review introduces various techniques and strategies employed in controlling the corrosion of used fuel containers(UFCs)using copper(Cu)as corrosion barrier in the context of deep geological disposal.Overall,these corrosion prevention techniques and methods have been effectively implemented and employed to successfully mitigate the corrosion challenges encountered during the permanent disposal of Cu containers(e.g.,corrosion mechanisms and corrosion parameters)in deep geologic repositories.The primary objective of this review is to provide an extensive examination of the alteration in the corrosion envir-onment encountered by the UFCs when subjected to deep geologic repository conditions and focusing on addressing the potential corro-sion scenarios.
文摘Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disposed of. In Burkina Faso, there are as yet no guidelines for the disposal of unused medicines in households. The aim of this study was to estimate the extent of household possession of unused or expired medicines, and to describe attitudes and disposal practices. Methods: This was a descriptive cross-sectional study covering households in the Ouagadougou commune conducted from June to August 2021. Two-stage stratified sampling was used: selection of Enumeration Zones (EZs) and selection of households, with each EZ comprising several households. Data collection was based on direct interviews using a structured questionnaire. Data were processed using Epi Info software version 7.2.4.0. Results: In total, 417 household residents were surveyed out of the planned 423 households, corresponding to a completion rate of 98.58% compared with the initial sample. Among the respondents, 79.62% had unused and/or expired medicines in their household. A total of 2562 drug packaging units were counted, for a total weight of 121.90 kg. Nearly 75% were aware that improper disposal was a danger to the environment. Some respondents kept their unused medicines at home until they expired (43.41%), and disposed of them mainly by throwing them in the household garbage (75.58%). The majority (79%) were in favor of the government setting up a take-back program for these medicines. Conclusion: The introduction of a take-back program for unused or out-of-date medicines will ensure safer disposal of medicines, and better protection for households and the environment.
文摘Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.
文摘BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.
基金supported by the National Key Research and Development Program of China(2021YFC2500803)the CAMS Innovation Fund for Medical Sciences(2021-I2M-1-056).
文摘BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to fi nd a light-weight,convenient prediction method through machine learning.METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation.RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the fi ve most important features were acuity,arrival transportation,age,shock index,and respiratory rate.CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.
文摘Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘Introduction: Pediatric emergencies in developing countries are associated with high morbidity and mortality. The Maroua Regional Hospital (MRH) is one of the referral centers for pediatric emergencies in the Far north region of Cameroon. Pediatric emergencies are frequent in Maroua and are associated with significant mortality. The aim of our study is to determine the epidemiological, clinical, and evolutionary profile of children admitted to the pediatric emergency department of the HRM. Methods: We conducted an observational, descriptive, and retrospective study over a period from April 10, 2023 to April 10, 2024, focusing on the records of patients admitted to the pediatric emergency department of the MRH. The variables studied included epidemiological, clinical, and evolutionary characteristics. Data analysis was performed using CSPro version 8.01 and SPSS version 27.0. Results: We included 1027 patients;the sex ratio was 1.2 infants under 2 years represented 54.33%. The main reasons for consultation were fever (62.22%) and seizures (30.18%). The most frequently prescribed additional test was the Complete Blood Count (CBC), performed in 97.37% of cases. The most common pathologies were severe malaria (45.18%), broncho-pulmonary infections (15.48%), and bacterial meningitis (12.26%). At admission, 32.9% were transfused. There were 68 deaths, representing 6.67%, and 86% of the deaths occurred within 24 hours of admission. The leading cause of death was severe malaria, with 28 (41.17%) cases. Conclusion: Febrile illnesses were the main reason for consultation, and mortality was linked to severe malaria. Therefore, in addition to the other preventive methods already used against malaria, it is recommended to consider the use of the malaria vaccine.
基金supported by the National Natural Science Foundation of China under Grant 62131012/61971261。
文摘With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.
文摘Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.
文摘Introduction The main objective of any healthcare establishment must be to ensure the quality of patient care and customer satisfaction. It is necessary to regularly assess patient satisfaction. The aim of this study was to assess the level of satisfaction of customers aged over 18 years attending the emergency department of the health center. Methodology This was a descriptive and analytical cross-sectional study of patients aged 18 years and over, who attended the Samu Municipal emergency department between 02 and 30 May 2023. The satisfaction index was determined using the adapted 2009 SAPHORA-MCO questionnaire and the Likert satisfaction scale. Results A total of 400 patients were surveyed. The average age was 35 years, with a standard deviation of 14.7. Of those surveyed, 51% were women, 87% were educated, 50% lived in Grand Yoff and 59.5% were unemployed. Satisfaction levels linked to perception of the cost of care (72%), waiting time (64.3%), information given to patients (69.1%) and pain management (74 .5%) are fair. On the other hand, the levels of satisfaction linked to administrative procedures (82.5%), staff attitudes towards patients (84%), staff availability (86.4%), patient privacy (89.2%), general atmosphere (87.2%), staff competence (87.3%), and the effectiveness of care (89.4%) were satisfactory. The average waiting time was 38 minutes. However, 32% of patients waited less than 30 minutes and 92% less than an hour. The satisfaction index linked to administration and reception was 72.9% and 79.85%, respectively. The satisfaction index linked to the administration and technical quality of care is equal to 85.8% and 83.7%, respectively. The overall satisfaction index is equal to 80.6%;the level of satisfaction of users of the health structure is satisfactory. Conclusion Patient satisfaction is an essential part of quality care. Patient satisfaction must be based on effective communication from the healthcare team and the creation of a patient-caregiver relationship.
基金supported by the Health and Medical Research Fund of the Food and Health Bureau of the Hong Kong Special Administrative Region(Project No.19201161)Seed Fund from the University of Hong Kong.
文摘BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.
文摘Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.
基金National Natural Science Foundation of China under Grant Nos.U1939210 and 51825801。
文摘The post-earthquake emergency period,which is a sensitive time segment just after an event,mainly focuses on saving life and restoring social order.To improve the seismic resilience of city road networks,a resilience evaluation method used in the post-earthquake emergency period is proposed.The road seismic damage index of a city road network can consider the influence of roads,bridges and buildings along the roads,etc.on road capacity after an earthquake.A function index for a city road network is developed,which reflects the connectivity,redundancy,traffic demand and traffic function of the network.An optimization model for improving the road repair order in the post-earthquake emergency period is also developed according to the resilience evaluation,to enable decision support for city emergency management and achieve the best seismic resilience of the city road network.The optimization model is applied to a city road network and the results illustrate the feasibility of the resilience evaluation and optimization method for a city road network in the post-earthquake emergency period.
基金funded by the Research on National Greenhouse Gas Emission Reduction Obligations under the Carbon Peak and Carbon Neutral Commitment,General Program of Humanities and Social Sciences,Ministry of Education of China[Grant No.21YJA820010].
文摘The disposal of contaminated water from Japan’s Fukushima nuclear power plant is a significant international nuclear safety issue with considerable cross-border implications.This matter requires compliance not only with the law of the sea but also with the principles of nuclear safety under international law.These principles serve as the overarching tenet of international and China’s domestic nuclear laws,applicable to nuclear facilities and activities.The principle of safety in nuclear activities is fully recognized in international and domestic laws,carrying broad legal binding force.Japan’s discharge of nuclear-contaminated water into the sea violates its obligations under the principle of safety in nuclear activities,including commitments to optimum protection,as low as reasonably practicable,and prevention.The Japanese government and the International Atomic Energy Agency(IAEA)have breached the obligation of optimum protection by restricting the scope of assessments,substituting core concepts,and shielding dissenting views.In the absence of clear radiation standards,they have acted unilaterally without fulfilling the obligation as low as reasonably practicable principle.The discharge of Fukushima nuclear-contaminated water poses an imminent and unpredictable risk to all countries worldwide,including Japanese residents.Japan and the IAEA should fulfill their obligations under international law regarding disposal,adhering to the principles of nuclear safety,including optimum protection,the obligation as low as reasonably practicable,and prevention through multilateral cooperation.Specifically,the obligation to provide optimum protection should be implemented by re-evaluating the most reliable disposal technologies and methods currently available and comprehensively assessing various options.The standard of the obligation as low as reasonably practicable requires that the minimization of negative impacts on human health,livelihoods,and the environment should not be subordinated to considerations of cutting costs and expenses.Multilateral cooperation should be promoted through the establishment of sound multilateral long-term monitoring mechanisms for the discharge of nuclear-contaminated water,notification and consultation obligations,and periodic assessments.These obligations under international law were fulfilled after the accidents at the Three Mile Island and Chernobyl nuclear power plants.The implications of the principles of nuclear safety align with the concept of building a community of shared future for nuclear safety advocated by China.In cases of violations of international law regarding the disposal of nuclear-contaminated water that jeopardize the concept of a community of a shared future for nuclear safety,China can also rely on its own strength to promote the implementation of due obligations through self-help.
基金the National Natural Science Foundation of China(No:81960351)Research Foundation for Advanced Talents of Hainan(No:822RC835)Province Natural Science Key Foundation of Hainan(No:ZDYF 2019125).
文摘Objective:To assess the correlation between atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City.Methods:Daily data on atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City from 2018 to 2021 were collected.The Spearman rank correlation test was used to analyze the correlation,and a distributed lag non-linear model was employed to analyze the health effects and lag impacts of environmental factors.Subgroup analyses were conducted based on sex and age.Results:According to the criteria of International Classification of Diseases(ICD-10:J00-J99),a total of 221913 cases were included,accounting for 21.3%of the total emergency department visits in Haikou City.For every 1℃increase in temperature,the risk of emergency department visits increased by 1.029%(95%CI 1.016%-1.042%).Relative humidity greater than 80%reduced the risk of visits,while higher atmospheric pressure(>1010 hpa)also decreased the likelihood of daily emergency department visits.Higher concentrations of PM_(2.5)(30-50μg/m^(3)),PM10(>60μg/m^(3)),and O_(3)(75-125μg/m^(3))were associated with increased visits.Higher temperatures(>25℃)have a greater impact on females and children aged 0-14 years,while males are more sensitive to low atmospheric pressure.Individuals aged 65 and above exhibited increased sensitivity to O_(3)concentration,and the effects of PM2.5,PM10,and O_(3)are more pronounced in individuals over 14 years old.Conclusions:Short-term exposure to high temperatures,particulate matter pollutants(PM_(2.5)and PM_(10)),and ozone(O_(3))is associated with increased emergency department visits for respiratory diseases.