First experience in laparoscopic surgery in low and middle income countries: A systematic review

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.

The Impact of Train Staff on the Customer Experience

The NS （Netherlands Railways） has developed an instrument which allows the measurement of both hard and less tangible quality aspects. This instrument, the so-called TEM （train experience monitor）, monitors the quality experiences of customers with an aim to influencing key areas and underlying aspects. The TEM is a measurement instrument based on scientific evidence and questions passengers on the most important aspects of the train and train journey. These can be either functional questions on, e.g., security, cleanliness and information provision, or more emotional questions on the atmosphere and comfort of the train, e.g., whether passengers find the train pleasant and they feel welcome, including the role of the staff. The experience of a train journey can be influenced in three dimensions： process, people and place. Our focus in this study is on the importance of the people dimension, and for this purpose, the train staff experimented with a number of scripts which varied in their approach to tannoy announcements, ticket control and service provision. The findings show that the script focusing on control in combination with a warm （instead of a rational/business-like） service provision generates the highest assessment of the staff. On scrutinizing the influence of the scripts on the general assessment of the train journey, it is quite clear that the aforementioned script has a significant and positive impact.

An Uploaded Experience Too many tourists are experiencing life through a lens

REMEMBER the days when people used to have a phone, a computer and a camera？ I do - simply because it wasn＇t that long ago. However, as technology hurtles along at the speed of light, it might have escaped some people＇s attention that all these three devices now come together in the form of a smartphone, There＇s no need to carry all three devices when visiting a tourist site or monument - your handy smartphone can take a picture, log on to the Internet to post your picture on social media, and then use the calling function to tell your friends about the pictures you＇ve just posted.

Experimental investigation of railway train-induced vibrations of surrounding ground and a nearby multi-story building

In this paper, a field experiment was carried out to study train-induced environmental vibrations. During the field experiment, velocity responses were measured at different locations of a six-story masonry structure near the Beijing- Guangzhou Railway and along a small road adjacent to the building. The results show that the velocity response levels of the environmental ground and the building floors increase with train speed, and attenuate with the distance to the railway track. Heavier freight trains induce greater vibrations than lighter passenger trains. In the multi-story building, the lateral velocity levels increase monotonically with floor elevation, while the vertical ones increase with floor elevation in a fluctuating manner. The indoor floor vibrations are much lower than the outdoor ground vibrations. The lateral vibration of the building along the direction of weak structural stiffness is greater than along the direction with stronger stiffness. A larger room produces greater floor vibrations than the staircase at the same elevation, and the vibration at the center of a room is greater than at its corner. The vibrations of the building were compared with the Federal Transportation Railroad Administration （FTA） criteria for acceptable ground-borne vibrations expressed in terms ofrms velocity levels in decibels. The results show that the train-induced building vibrations are serious, and some exceed the allowance given in relevant criterion.

NUMERICAL AND EXPERIMENTAL INVESTIGATION OF WAVE DYNAMIC PROCESSES IN HIGH-SPEED TRAIN/TUNNELS

Numerical and experimental investigation on wave dynamic processes induced by high-speed trains entering railway tunnels are presented. Experiments were conducted by using a 1:250 scaled train-tunnel simulator. Numerical simulations were carried out by solving the axisymmetric Euler equations with the dispersion-controlled scheme implemented with moving boundary conditions. Pressure histories at various positions inside the train-tunnel simulator at different distance measured from the entrance of the simulator are recorded both numerically and experimentally, and then compared with each other for two train speeds. After the validation of nonlinear wave phenomena, detailed numerical simulations were then conducted to account for the generation of compression waves near the entrance, the propagation of these waves along the train tunnel, and their gradual development into a weak shock wave. Four wave dynamic processes observed are interpreted by combining numerical results with experiments. They are: high-speed trains moving over a free terrain before entering railway tunnels; the abrupt-entering of high-speed trains into railway tunnels; the abrupt-entering of the tail of high-speed trains into railway tunnels; and the interaction of compression and expansion waves ahead of high-speed trains. The effects of train-tunnel configuration, such as the train length and the train-tunnel blockage ratio, on these wave processes have been investigated as well.

Numerical and experimental investigation on snow accumulation on bogies of high-speed trains

This paper reviews the current status of investigation on snow accumulation on the bogies of high-speed trains(HSTs) running in snowy region. First, the background of the snow issue occurring to the HST and the contra-measures for the snow issue proposed in the past decades are provided by reviewing previous studies. Next, the methodology for investigating the snow issue developed by High-Speed Train Research Center of Central South University is introduced, including the numerical simulation research platform and the experimental devices for two-phase flow wind tunnel tests. Then, effective anti-snow flow control schemes for guiding the underbody airflow and their impact on the motion and accretion of snow in the installation region of the bogies are presented. Finally, the remaining investigating challenge for the snow issue of HST and the future research with respect to the challenge are provided from an engineering application viewpoint.

CO_2 insufflation for potentially diffi cult colonoscopies: Effi cacy when used by less experienced colonoscopists

AIM： To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists. METHODS： One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insuffiation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist （EC） group and a less experienced colonoscopist （LEC） group. Study measurements included a 100-mm visual analogue scale （VAS） for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times. RESULTS： Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group （P〈 0.001, two-way ANOVA） from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group （P = 0.29）, however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group （P = 0.023） immediately after colonoscopies and up to 4 h afterwards. CONCLUSION： CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

Gastric endoscopic submucosal dissection in Western countries:Indications,applications,efficacy and training perspective

Endoscopic submucosal dissection was introduced in Japan for the mini-invasive treatment of early gastric cancer,as part of national screening program considering high prevalence of disease in these latitudes.This technique allows en-bloc curative oncological excision and to obtain in a single step R0-resection,characterization,histological staging and potential cure of the tumor with a very high cost-benefit balance.Over the years,Western endoscopists have adopted endoscopic submucosal dissection,achieving good rates of efficacy,long-term improved outcomes and safety,with low risk of local recurrence comparable to those obtained in Asian institutes.However,according to some authors,the excellent outcomes from East country could not be representative of the Western experience.Despite epidemiological differences of early gastric cancer,scant volume data and limitations in training opportunities between Western and Eastern countries,European Society of Gastrointestinal Endoscopy have adopted Japanese guidelines and developed a European core curriculum for endoscopic submucosal dissection training.Endoscopists should be able to estimate the probability of performing a curative resection by considering the benefit/risk relationship case-by-case in order to implement a correct decision-making process.

Experiments on Transformation and Run-Up of Wave Trains

This paper. details experiments undertaken in the UK Coastal Research Facility (CRF)at Hy draulies Research (HR), Wallingford, on transformation and run-up of wave trains. The purpose of these experiments is to provide verification data for numerical models of wave transformation in shoaling. surf and swash zones. This is the kind of data ih:lt flume experiments are unable to provide, and is collected in the highly controlled environment of CRF where extrinsic factors present in the field are not an issue. The experiments concerning wave trains are undertaken by use of existing wave generation software, and the run-up measurements are made with large experimental run-up gauges.

Enlightenment of the Talent Training Mode of Japan's Colleges and Universities to China's five-year Higher Vocational Education

Since Jimei navigation College of Fujian Province started five-year junior college education in 1984,five-year higher vocational education has become one of the important forms of Higher Vocational Education in China.In the 1960s,with the rapid development of Japan's economy,there was a shortage of technical personnel.In order to cultivate a large number of technical personnel in a short period of time,Japan's specialized colleges and universities recruited junior high school graduates,studied in school for five years,and obtained an associate's degree after graduation,which provided a large number of technical personnel for the development of Japan's basic industry manufacturing industry.By combing the development process of Japan's colleges and universities,this paper studies Japan's colleges and universities from the aspects of school running subjects,talent training objectives,training methods and evaluation methods.It can provide the basis and implementation methods for China to better promote the convergence of secondary and higher vocational education,strengthen the training of secondary and higher vocational education,and provide theoretical basis and practical experience for improving the quality of five-year higher vocational education.

Application of Functional Training in College Volleyball Teaching

Volleyball Teaching in Colleges and universities is faced with multiple challenges, such as the teaching content is simple, the training method is single, the students’ physical quality is poor, the physical condition of the physical condition is the guarantee of volleyball technology. This research is on body function training on volleyball teaching methods of this technology in the project, the function of training system into the volleyball technique teaching, through the method of experimental teaching method to verify the function of training to the technical level of the student volleyball has been effectively improved.

The Observation of Blood Biochemistry and HSP72 Expression Changing Rules in Peripheral Blood of Flying-saucer-athletes under High Temperature Training

Objective:To study the effect of training under high temperature on blood and heat shock protein 72(HSP72)expression of flying saucer athletes.Methods:The numbers of training group and control group are 30.Twenty-four flying saucer athletes in Zhejiang province were selected and randomly divided into training group and control group,15 in each group.Peripheral venous blood of each group was taken before and after the experiment.The HSP72 content of lymphocyte,blood routine and biochemical indexes were measured respectively.Results:There was significant difference in white blood cell in training group count before and after the experiment(P<0.05).The expression of HSP72 and the white blood cell in training group was higher than that control group(P<0.05).Conclusions:Organism could be affected and turned to stress state due to training under high temperature.It is necessary to provide the safeguard for the flying saucer athletes under high temperature in order to prevent the damage.

面向林学专业群的有机化学实验教学内容改革实践与探索

作为高等学校公共基础课,有机化学实验因教学资源不足,普遍存在教学内容千篇一律、与专业特色契合度低等问题,导致学生学习动力不足。本文结合西南林业大学实际,尝试将具有植物资源培养、开发、利用的相关专业组成林学专业群,并针对该专业群,构建了以天然产物提取、分离、纯化、鉴定为主线的有机化学实验教学体系。学生期末考试表现及问卷调查结果表明,新教学体系对提升学生学习兴趣、改善学生培养质量具有显著的推进作用,同时也为在教学体系中融入农林特质提供了思路。

项目驱动“新工科”背景下高分子化学实验的教学改革与探索

基于“新工科”大背景下对应用型人才的需求,我们结合高分子化学课程的培养目标,采用项目驱动课堂教学新模式,提出“赛教融合”、“挑战杯”、“互联网+”、科研开发、校企联培等典型项目来源助力高分子化学实验教学,提升学生兴趣及应用知识能力。我们结合具体实施路径,挖掘学生潜力,全方位提升学生的创新思维,激发学生主观能动性,以期培养高质量应用型高分子专业人才。

基于创新能力培养的高校实验教学体系构建

高校实验教学体系的构建,是教育体系改革中一个至关重要的部分,也是培养创新型人才的基石。该文分析创新实验层次的构建,研究创新型人才能力培养的途径,提出培养创新型人才的5种方式,推出将创新实验与社会实际有机结合的具体方案,最后,为推进高效实验教育体系的整体优化和创新改革,配备合适的创新实验教学效果评价方法。

新时代背景下的化学实验教学示范中心建设

化学国家级实验教学示范中心(南开大学)是2006年首批入选的国家级示范中心。十几年来,在“强化基础、注重综合、突出创新、培养能力、提高素质”的方针指导下,坚持以学生发展为中心,致力于培养具有扎实化学基础知识、精通化学实验技能、勤于思考善于创新的高水平化学人才。本文介绍该中心近五年来在实验教学体系建设、师资队伍教学能力提升及开放交流方面的改革举措,为高等院校实验教学提供参考。

基于旅游体验的观光列车设计研究

为了解决我国现有观光列车存在的问题,指导观光列车的设计实践。综合我国近年来在“交旅融合”方向的研究成果,调研分析国内外现有观光列车,发现我国观光列车设计还存在主题不鲜明、内容不丰富、地域特色不强的问题。基于旅游体验相关理论,对3个问题提出了解决方法。设计了“茶马古道”号观光列车作为实践验证。该方法可为多元化、地域化观光列车的设计提供参考。

天然植物种子制备水处理材料探索型实验设计

针对当前染料废水体量大、严重威胁人类健康和生态环境安全的现状,设计了以天然辣木籽为基体,制备过程绿色低碳且兼具吸附-降解双功能的复合材料,用于废水中染料的处理。实验应用于本科生探索型化学实验课程,通过文献调研、方案设计、实验操作、结果分析等一系列的实践环节,全面培养了学生的动手能力和科研素养,有助于培养兼具扎实知识基础和社会责任感的创新型人才。

以学习动机为驱动的基础化学实验课程教学改革与实践

课程是人才培养的核心要素,深化课程改革是推进我国高等教育高质量发展的重要内容之一。鉴于基础课程在人才培养方面的重要性,对基础化学实验课程普遍存在的共性问题进行了教学分析与思考,开展了以学习动机为驱动的基础化学实验课程教学改革研究与实践,为持续提升教学质量和人才培养质量提供了有效途径。

基于Kano模型的列车正性情感体验需求研究

目的遵照“以事实为依据”的设计原则,明确对列车样本展开设计分析的内容与标准,获得准确的体验需求。方法首先基于哈森扎尔在情感体验方面的研究,提出正性品质理论模型及其需求洞察路径,用于分析、提取列车乘客的情感体验需求;其次利用Kano模型对需求进行优先级排序;最后以享誉世界的儿童列车“阿苏男孩号”对方法进行了应用验证。结果获得了22项需求及其优先级排序,总结得出儿童列车体验设计的策略:空间设计优先考虑提供就餐场所,以及针对用户分层做空间分割;设施设计优先考虑亲子互动性;涂装设计优先考虑“列车外壳”;服务设计优先考虑为家长陪伴提供条件。结论该方法可以帮助设计师洞察样本列车的体验需求及其优先级排序,能够为优化列车自身体验与指导同类列车设计提供决策支持。