Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

A General Equation for Calculating the‘True’Height of Transfer Unit in Extraction Columns

Based on single drop mass transfer models and two phase flow equation,a general equationfor calculating the‘true’height of transfer unit of extraction columns was derived and tested withfour types of extraction columns with some different working systems.The calculated results fittedwell with those obtained by experiments.

Study on Commercial Application of FP-DSN Sulfur Transfer Additive in FCC Unit

The FCC unit with addition of various inventories of the FP-DSN type sulfur transfer additive was tested in a commercial scale. The effect of the sulfur transfer additive was analyzed by investigating the indicators related with the regenerator flue gas composition,the dry gas composition before desulfurization,the LPG composition before desulfurization,the acid gas,and the yield of gasoline and diesel. The test results indicated that the sulfur was trans ferred from the feed stream into the dry gas,LPG and acid gas,and the sulfur transfer effect was obvious only when the inventory of sulfur transfer additive exceeded over 2.0% of total FCC catalyst inventory.

Pressure control strategy for pump motor energy transfer unit

Multi-level pressure source system is a novel hydraulic system with distinct advantage of energy saving. In order to balance each pressure level of the multi-level pressure source system, a pump motor energy transfer unit is usually equipped. However, the pump motor energy transfer has the characteristics of poor starting and low response, which cause long time of pressure adjustment and large pressure jitter when the transformer is switched to system suddenly and the motor-side pressure has pressure impact when rail of the pump-side is switched. To address these problems, this paper proposes a compound control strategy of feedforward compensation control with Fuzzy-PID to improve the controllability of the multi-level pressure source system. A test rig of the pump motor energy transfer unit is built and the controllability of compound controller and PID controller are compared. The experiment results show that, compared with the traditional PID, the adjustment time and the pressure impact are reduced by 20% and 25% with the proposed compound control strategy. Therefore, the presented compound control strategy can be used to improve starting performance and robustness of the pump motor energy transfer unit control system.

Unveiling the highly disordered NbO_(6) units as electron‐transfer sites in Nb_(2)O_(5) photocatalysis with N‐hydroxyphthalimide under visible light irradiation

Although different NbO_(x) units are present in Nb_(2)O_(5)‐based catalysts,the correlations between these structures and activity remain unclear,which considerably hinders the further development of Nb_(2)O_(5) photocatalysis.Herein,we utilized N‐hydroxyphthalimide(NHPI)as the probe molecule to distinguish the role of different NbO_(x) units in the activation of C–H bond under visible light irradia‐tion.With the addition of NHPI,Nb_(2)O_(5) catalysts with highly disordered NbO_(6) units exhibited higher activities than that with slightly disordered NbO_(6) units(419‒495 vs.82μmol·g^(-1)·h^(-1))in photocata‐lytic selective oxidation of ethylbenzene.Revealed by Raman spectra,electron paramagnetic reso‐nance spectra,and transmission‐electron‐microscopy images,highly disordered NbO_(6) units were confirmed to act as the active sites for the transfer of photogenerated electrons from NHPI,pro‐moting the generation of phthalimide‐N‐oxyl(PINO)radicals for the enhanced conversion of ethylbenzene under visible light irradiation.This study provides guidance on the role of local NbO_(x) units in Nb_(2)O_(5) photocatalysis.

The theoretical study of one-carbon unit transfer with H_2O participation from imidazolidine to dUMP analogue

The ONIOM quantum mechanics method is used to study the reaction of one-carbon unit transfer from an imidazolidine to 6- aminouracil model with the participation of water molecules.The computation results show that in this reaction the participation of H_2O molecule makes the energy barrier lower because of the H-bond interaction.

The Study of One Carbon Unit Transfer from Imidazolidine to dUMP Analogue with ONIOM Theory

ONIOM quantum mechanics method is used in this paper to study one-carbon unit transfer from imidazolidine to 6-aminouracil derivates. The computation results show that this reaction can be completed via three paths owing to the three different proton transfer modes. By calculation and analysis, we can find the direct proton transfer is the preferable pathway.

DFT Study on One-carbon Unit Transfer from 1,10-CH^+- tetrahydroquinoxaline to Methylamine

Density Functional Theory (DFT) method was used in this paper to study one-carbon transfer from 1,10-tetrahydroquinoxaline, an analogue of tetrahydrofolic acid, to methylamine. This reaction can be completed via two paths. From the computation result we can conclude that a general-acid catalysis exists in this reaction. By computation we find DFT has its limitation in describing a newly incorporated structure with a unit charge.

Psychosocial Factors Associated with Transfer Anxiety among Open Heart Surgery Patients Transferred from the Intensive Care Unit to the General Ward

Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.

Carbon Price Forecasting Approach Based on Multi-Scale Decomposition and Transfer Learning

Accurate carbon price forecasting is essential to provide the guidance for production and investment.Current research is mainly dependent on plenty of historical samples of carbon prices,which is impractical for the newly launched carbon market due to its short history.Based on the idea of transfer learning,this paper proposes a novel price forecasting model,which utilizes the correlation between the new and mature markets.The model is firstly pretrained on large data of mature market by gated recurrent unit algorithm,and then fine-tuned by the target market samples.An integral framework,including complexity decomposition method for data pre-processing,sample entropy for feature selection,and support vector regression for result post-processing,is provided.In the empirical analysis of new Chinese market,the root mean square error,mean absolute error,mean absolute percentage error,and determination coefficient of the model are 0.529,0.476,0.717%and 0.501 respectively,proving its validity.

接纳与承诺疗法对重症监护病房转出患者创伤后应激障碍及创伤后成长的影响

目的探讨接纳与承诺疗法对重症监护病房(ICU)转出患者创伤后应激障碍(PTSD)及创伤后成长(PTG)的影响。方法选择2021年7月至2022年12月南通市第一人民医院综合ICU转出患者86例,采用随机数字表法分为观察组与对照组各43例。对照组给予ICU转出患者常规护理干预,观察组在此基础上联合应用接纳与承诺疗法。比较两组PTSD、PTG、重返ICU率。结果观察组患者回避/麻木、高警觉、再体验、PSTD总分均低于对照组(P<0.05);个人力量、人际关系、新可能性、精神变化、PTG总分高于对照组(P<0.05);重返ICU率低于对照组(χ^(2)=4.547,P<0.05)。结论接纳与承诺疗法能够缓解ICU转出患者创伤后应激障碍,促进创伤后成长,降低重返ICU发生率。

模块化公交系统车辆单元动态编组方案优化

为研究基于模块化公交系统的车辆单元路段运行动态编组方案优化问题,首先,构建车辆单元方向分配与位置调整的两阶段联合优化模型。第1阶段,构建以乘客换乘次数最少为目标的整数线性规划模型,实现车辆单元最佳方向分配与增补车辆单元数计算;第2阶段,构建以位置调整时间最小和车内换乘时间最小的双目标混合整数非线性规划模型,实现车辆单元动态编组方案优化。其次,构建模型的求解算法,利用CPLEX求解器求解第1阶段车辆单元分配模型,设计非支配排序遗传算法(NSGA-Ⅱ)求解第2阶段车辆编队位置调整模型。最后,算例验证构建模型及求解算法的有效性,并定量探究不同车辆单元容量下的车辆单元动态编组效率与公交载客率变化。算例结果表明:在模块化公交车辆单元容量一定增幅内,模块化公交车辆单元动态编组效率会随着车辆单元容量的增加而提高;而车辆单元容量增幅太大,不仅不会提高动态编组效率,反而会降低车辆编队的载客率,造成模块化公交车辆编队运力过剩。

三套管式加肋相变蓄热单元的强化传热特性

相变蓄热技术在利用工业余热、太阳能等解决热能与用户之间的供需不平衡问题方面起着重要的作用,然而受相变材料自身物性的限制,蓄热熔化时仍存在蓄热速度低、熔化不均匀等问题。本文以三套管式相变蓄热单元为基本结构,利用FLUENT软件模拟研究了在考虑自然对流情况下添加纵向肋片的不同参数(肋片数量、长度、厚度、偏心距及肋片排布方式)对三套管式相变蓄热单元蓄热性能的影响。结果表明,三套管式蓄热单元内外双壁面共同加热,与普通套管式蓄热单元相比,换热面积增大,相变材料全部熔化需要的时间缩短;加装纵向直肋片的三套管蓄热单元的熔化速度进一步加快,相同数量肋片下,肋片的长度和厚度是影响蓄热单元蓄热量与平均蓄热速率的主要因素,肋片长度占相变材料区域径向长度的50%时,蓄热单元的熔化速度加快幅度明显且蓄热量与平均蓄热速率较高。通过优化设计,发现内管向下偏移距离e对相变材料的熔化过程作用显著,偏心距离较短时相变材料完全熔化所需时间最少,相比光滑管蓄热单元,相变材料的熔化速率提升了48.5%,偏移距离过长则会延长蓄热时间;通过加密蓄热单元底部外层肋片的排布,蓄热单元的熔化进程有不同程度的加快,总体蓄热速率较原肋片结构有所提高。

相平衡关系在《化工原理》单元过程强化中的应用

相平衡条件是传质过程的热力学极限,借此可以确定分离级数、液气比等操作参数,设计和优化分离工艺,探索体系极限。本文列举了蒸馏、吸收、萃取单元操作中相平衡的内容,说明通过改变温度、压力、浓度或增加促进剂可以改善相平衡,调整传质过程的控制步骤,从而对化工过程实现精准设计和调控,是过程强化的重要手段。对于这些能源密集型单元过程,相平衡模型的准确预测或模拟是高效分离或纯化、减少能耗和原料损失的必要保障。

基于圆台波浪形换热管的潜热储热单元性能分析

为提高潜热储热单元(latent heat storage unit,LHSU)的储热性能,提出了三种优化换热管结构的新型LHSU,分别为圆台形换热管潜热储热单元、波浪形换热管潜热储热单元和圆台波浪形换热管潜热储热单元(frustum wavy heat transfer tube latent heat storage unit,FW-LHSU)。基于数值模拟方法,比较了传统圆柱形换热管潜热储热单元(cylindrical heat transfer tube latent heat storage unit,C-LHSU)和三种新型LHSU的储热性能。此外,针对FW-LHSU研究了换热管壁面倾斜角度对储热性能的影响。结果发现,所提出的三种新型换热管结构均能增强储热性能,其中FW-LHSU储热效果最好,与C-LHSU相比,FW-LHSU的熔化时间缩短了32.64%,储热速率密度提高了48.1%。当增加FW-LHSU的换热管壁面倾斜角度时,其储热性能可进一步提高。当换热管倾斜角度从2°增加到8°时,FW-LHSU的储热时间可缩短37.00%、储热速率密度可提高48.44%。

美国核科学长期规划及对中国的启示建议

深入分析了美国《探索发现的新时代:2023年核科学长期规划》,旨在为中国核科学发展提供借鉴。解读了美国核科学的优先研究方向,包括夸克与胶子、核结构与核反应、核天体物理、基本对称性、中子和中微子以及理论核物理等领域。研究了美国在大科学设施建设、人才培养、经费支持和国际合作等方面的策略。美国通过持续投入和战略规划,保持其核科学领域的领先地位。同时,提出了中国在核科学领域强化规划引领、加快大科学装置建设、提供运行费支持、加强国际合作和建立多层次教育体系等建议,以促进中国核科学的发展。

基于动态相量法的地铁牵引整流机组谐波传递研究

牵引整流机组在运行过程中具有非线性时变特性,对谐波扰动的传递作用导致其交直流侧的谐波交互影响,成为威胁地铁牵引供电系统安全稳定的潜在隐患。为揭示牵引整流机组交直流侧谐波传递的内在机理,采用基于动态相量表达的电压、电流开关函数描述牵引整流机组的非线性时变特性,分析整流变压器不同连接方式对开关函数的影响,给出开关函数的各阶动态相量计算式。以调制理论为框架,采用基于动态相量的矩阵运算进行牵引整流机组谐波传递计算,包括交流侧谐波电压传递和直流侧谐波电流传递,模拟牵引整流机组谐波传递过程,明确了谐波频率的变换关系。通过与PSCAD/EMTDC中详细电磁暂态仿真结果进行对比,验证了该方法的正确性和有效性,可为滤波装置参数设计与谐波抑制策略制定提供参考。

基于二次通用旋转组合设计的冷金属过渡电弧增材制造AZ31镁合金焊道截面尺寸研究

基于冷金属过渡的电弧增材制造技术制备了AZ31镁合金单道试样,测试了单道试样的焊道宽度和焊道高度。根据二次通用旋转组合试验设计与二次多项式逐步回归分析,建立了高度显著的焊道宽度和焊道高度与摆动宽度、焊接速度、送丝速度和基板温度等工艺参数间的关系式。结果表明,工艺参数对焊道宽度的影响主次顺序依次为摆动宽度、送丝速度、基板温度、焊接速度,对焊道高度的影响主次顺序依次为焊接速度、摆动宽度、基板温度、送丝速度。随摆动宽度的增大,焊道宽度逐渐增大,焊道高度逐渐减小;随焊接速度的提高,焊道宽度和焊道高度均逐渐减小;随送丝速度的提高,焊道宽度和焊道高度也随之同步增大;随基板温度升高,焊道宽度增大,焊道高度降低。

基于迁移学习的滚动轴承剩余使用寿命预测

为解决轴承剩余使用寿命预测模型预测泛化能力低,不能准确预测出未训练轴承剩余使用寿命的问题,本文提出了一种迁移轴承状态知识的剩余使用寿命的方法。利用计算时域、频域特征以及模糊熵作为预测特征,使用“3σ”准则将轴承全寿命过程划分为正常阶段、退化阶段,以实现对退化阶段轴承剩余使用寿命的预测。构建基于门控循环单元的轴承剩余使用寿命预测模型,并使用某一轴承的全寿命周期数据进行训练,使模型学习到新轴承的状态信息。研究表明:相较于未使用迁移学习的方法,其预测所有轴承的轴承剩余使用寿命平均均方根误差减小了52.53%,平均百分比误差减少了68.87%。本文提出的方法可以有效、准确地预测出轴承的轴承剩余使用寿命。

中国ICU转出患者家属迁移应激影响因素Meta分析

目的系统分析中国重症监护室(intensive care unit,ICU)转出患者家属迁移应激的影响因素,为减轻转出患者家属迁移应激水平提供循证依据。方法计算机检索中国知网、万方数据知识服务平台、维普、中国生物医学文献数据库、Web of Science、PubMed、the Cochrane Library、Embase中有关ICU转出患者家属迁移应激影响因素的队列研究、病例对照研究、横断面研究等观察性研究,检索时限为建库至2023年10月。由2名研究者按照纳入及排除标准单独进行文献筛选、质量评价和资料提取。采用RevMan5.4软件对数据结果进行Meta分析。结果最终纳入15篇研究,总样本量2558,共提取12个影响因素。将15篇文献根据测量结局指标的工具分为正向计分组(得分越高,迁移应激水平越高,共9篇文献)、反向计分组(得分越高,迁移应激水平越低,共6篇文献)。分析每个组别时,仅对组内提及≥2次的影响因素进行Meta分析。Meta分析结果显示:正向计分组内,家属文化程度、家属性别、患者意识、ICU治疗时间、家属疾病不确定感是ICU转出患者家属迁移应激的影响因素(P<0.05);反向计分组内,家属文化程度、家属性别、患者年龄、ICU治疗时间是ICU转出患者家属迁移应激的影响因素(P<0.05)。敏感度分析结果显示各个因素的结果均较为稳定。结论家属文化程度、家属性别、患者年龄、ICU治疗时间、家属疾病不确定感是中国ICU转出患者家属迁移应激的影响因素,家属宗教信仰、患者意识对其影响还需进一步论证。