Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

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.

Association between Meeting 24-Hour Movement Guidelines and Psychological Features of Chinese Emerging Adults

Background:Emerging adulthood is a pivotal life stage,presenting significant psychological and social changes,such as decreased sociability,depression,and other mental health problems.Previous studies have associated these changes with an unhealthy lifestyle.The 24-h movement guidelines for healthy lifestyles have been developed to promote appropriate health behaviors and improve individual wellness.However,the relationship between adherence to the 24-h movement guidelines and different characteristics of Chinese emerging adults is yet to be explored.This cross-sectional study aimed to investigate the association between adherence to the 24-h movement guidelines and four characteristics(self-exploration,instability,possibilities,and responsibility)of Chinese emerging adults.Methods:Overall,1,510 Chinese emerging adults aged 18–29 years were included in this study.Each participant completed a self-administered questionnaire that included questions on adherence to the 24-h movement guidelines(physical activity,sedentary behavior,and sleep)and the inventory of dimensions of emerging adulthood.Multivariable logistic regression analysis was employed to investigate the associations between adherence to the 24-h movement guidelines and each of the four characteristics.Results:The proportion of participants who adhered to the 24-h movement guidelines was 31.72%.Multiple regression analysis revealed a significantly negative relationship between adhering to more guidelines and instability(β=−0.51,p<0.001).A statistically significant association was observed between instability and meeting only sedentary behavior(β=−1.27,95%confidence interval[CI]:[−2.32,−0.24],p=0.02),sedentary behavior+sleep(β=−1.30,95%CI:[−2.24,−0.35],p<0.01),and physical activity+sedentary behavior(β=−1.08,95%CI:[1.94,−0.21],p=0.02)guidelines.Further,positive and significant associations were observed between possibilities and meeting the guidelines for only physical activity(β=0.70,95%CI:[0.14,1.27),p=0.01),only sleep(β=0.61,95%CI:[0.01,1.21],p=0.04),physical activity+sedentary behavior(β=0.56,95%CI:[0.04,1.07),p=0.01),and physical activity+sleep(β=0.76,95%CI:[0.23,1.27],p=0.01).Conclusions:These findings suggest that adherence to the 24-h movement guidelines was associated with instability in Chinese emerging adults.Future studies are warranted to verify our findings to highlight the importance of maintaining a heath lifestyle to promote health in emerging adulthood.

Ultrasonic enhancement of persulfate oxidation system governs emerging pollutants decontamination

Emerging contaminants (ECs) are widely present in aquatic environments, posing potential risks to both ecosystems and human health. Theultrasound-assisted persulfate oxidation process has attracted considerable attention in the degradation of ECs due to its ability to generate bothsulfate radicals and cavitation effects, enhancing degradation effects. In this paper, the principle of ultrasonic synergistic Fenton-like oxidationsystem for degrading organic pollutants was reviewed, divided into homogeneous system, non-homogeneous system, and single-atom system toexplore the synergistic effect of ultrasound-enhanced persulfate technology in three aspects, and the effects of environmental factors such asultrasonic frequency and power, system pH, temperature, and initial oxidant concentration on the system's decontamination performance werediscussed. Finally, future research on ultrasonically activated persulfate technology is summarized and prospected.

Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

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.

Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning

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.

Risk factors for postpartum posttraumatic stress disorder after emergency admission

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.

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

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.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Epidemiological, Clinical, and Evolutionary Profile of Children Admitted to the Pediatric Emergency Department of the Maroua Regional Hospital, Cameroon

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.

A Game-Theoretic Approach to Safe Crowd Evacuation in Emergencies

Obstacle removal in crowd evacuation is critical to safety and the evacuation system efficiency. Recently, manyresearchers proposed game theoreticmodels to avoid and remove obstacles for crowd evacuation. Game theoreticalmodels aim to study and analyze the strategic behaviors of individuals within a crowd and their interactionsduring the evacuation. Game theoretical models have some limitations in the context of crowd evacuation. Thesemodels consider a group of individuals as homogeneous objects with the same goals, involve complex mathematicalformulation, and cannot model real-world scenarios such as panic, environmental information, crowds that movedynamically, etc. The proposed work presents a game theoretic model integrating an agent-based model to removethe obstacles from exits. The proposed model considered the parameters named: (1) obstacle size, length, andwidth, (2) removal time, (3) evacuation time, (4) crowd density, (5) obstacle identification, and (6) route selection.The proposed work conducts various experiments considering different conditions, such as obstacle types, obstacleremoval, and several obstacles. Evaluation results show the proposed model’s effectiveness compared with existingliterature in reducing the overall evacuation time, cell selection, and obstacle removal. The study is potentially usefulfor public safety situations such as emergency evacuations during disasters and calamities.

Digestive Surgical Emergencies at the “Mother Child”Hospital Center Luxembourg in Mali

Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we set ourselves the objectives of: 1) Studying digestive surgical emergencies in the general surgery department of the “Mother Child” Le Luxembourg hospital in Bamako, Mali;2) Determine the frequency of digestive surgical emergencies, 3) Describe the clinical and therapeutic aspects, and 4) Analyze the results of treatment. From November 1, 2022 to October 31, 2023, the general surgery department of the “Mother Child” Luxembourg Hospital Center in Bamako, Mali, carried out 139 digestive surgical emergencies whose files were usable;75 men and 64 women, a sex ratio of 1.2. The 20 - 40 years old age group was the most represented, at 40.29%. The average age was 39 years;the extremes 16 years and 93 years with a standard deviation of 21.65 years. The reference concerned 51.08% of our patients. Abdominal pain was the main reason for consultation (100% of cases). In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain clinical cases, we requested ultrasound (109/139), ASP (46/139) and CT (15/139). The main etiology was acute appendicitis with 42.45% of cases. The frequency of digestive surgical emergencies was 10.71% of all activities in the general surgery department of the “Mère Enfant” Le Luxembourg hospital center in Bamako. All our patients were seen in consultation by an anesthesiologist before entering the operating room. The surgical consequences were complicated in 11.51% of cases with 7.91% deaths. Surgical site infections accounted for 12.5% of postoperative complications. Eleven deaths were noted, representing 68.75% of complications and 7.91% of our sample. Acute peritonitis was the cause of death in 100% of cases. The average cost of care was 329,000 FCFA.

Mega-Constellations Based TT&C Resource Sharing: Keep Reliable Aeronautical Communication in an Emergency

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.

Emergency Obstetric Hysterectomy in a Low Resources Country: An Eight-Year Retrospective Cohort Study from a Secondary Care Hospital in Niger

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.

Assessment of Satisfaction in the Reception and Emergency Department of a Health Center

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.

The Emergence of Time from Quantum Information Dynamics

This paper presents a novel framework for understanding time as an emergent phenomenon arising from quantum information dynamics. We propose that the flow of time and its directional arrow are intrinsically linked to the growth of quantum complexity and the evolution of entanglement entropy in physical systems. By integrating principles from quantum mechanics, information theory, and holography, we develop a comprehensive theory that explains how time can emerge from timeless quantum processes. Our approach unifies concepts from quantum mechanics, general relativity, and thermodynamics, providing new perspectives on longstanding puzzles such as the black hole information paradox and the arrow of time. We derive modified Friedmann equations that incorporate quantum information measures, offering novel insights into cosmic evolution and the nature of dark energy. The paper presents a series of experimental proposals to test key aspects of this theory, ranging from quantum simulations to cosmological observations. Our framework suggests a deeply information-theoretic view of the universe, challenging our understanding of the nature of reality and opening new avenues for technological applications in quantum computing and sensing. This work contributes to the ongoing quest for a unified theory of quantum gravity and information, potentially with far-reaching implications for our understanding of space, time, and the fundamental structure of the cosmos.

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

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.

REDISSE in Benin and Lessons Learned for the Management of Public Health Emergencies after Five Years of Implementation

Introduction: Benin was embarked on phase 3 of the REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) which began in 2018. The objectives were in five key components namely, Surveillance and health information;Laboratory capacity building;Emergency preparedness and response;Human resources management for effective disease surveillance and epidemic preparedness;and Institutional Capacity Building, Project Management, Coordination and Advocacy. After five years of implementation, this study aimed at the documentation of lessons learned and best practices. Methods: A descriptive cross-sectional study. Apart from individual semi-structured interviews, a thematic workshops bringing together the project’s main stakeholders recruited on an exhaustive way by component to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector. Criteria were set up and used to validate best practices and lessons learned. Results: A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five interviews. The good practices (33: 9 for animal health, 7 for human health and 17 crosscutting) and lessons learned (10: 3 for animal health and 7 for human health) have been identified and have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance. Discussion: The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

Factors Associated with Mortality in Diabetic Patients with End-Stage Renal Failure Starting Emergency Hemodialysis

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.

The surface electron transfer strategy promotes the hole of PDI release and enhances emerging organic pollutant degradation

In semiconductor photocatalysts,the easy recombination of photogenerated carriers seriously affects the application of photocatalytic materials in water treatment.To solve the serious problem of electron−hole pair recombination in perylene diimide(PDI)organic semiconductors,we loaded ferric hydroxyl oxide(FeOOH)on PDI materials,successfully prepared novel FeOOH@PDI photocatalytic materials,and constructed a photo-Fenton system.The system was able to achieve highly efficient degradation of BPA under visible light,with a degradation rate of 0.112 min^(−1)that was 20 times higher than the PDI system,and it also showed universal degradation performances for a variety of emerging organic pollutants and anti-interference ability.The mechanism research revealed that the FeOOH has the electron trapping property,which can capture the photogenerated electrons on the surface of PDI,effectively reducing the compounding rate of photogenerated carriers of PDI and accelerating the iron cycling and H2O2 activation on the surface of FeOOH at the same time.This work provides new insights and methods for solving the problem of easy recombination of carriers in semiconductor photocatalysts and degrading emerging organic pollutants.

Resilience assessment and optimization method of city road network in the post-earthquake emergency period

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.