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.

Computational Experiments for Complex Social Systems:Experiment Design and Generative Explanation

Powered by advanced information technology,more and more complex systems are exhibiting characteristics of the cyber-physical-social systems(CPSS).In this context,computational experiments method has emerged as a novel approach for the design,analysis,management,control,and integration of CPSS,which can realize the causal analysis of complex systems by means of“algorithmization”of“counterfactuals”.However,because CPSS involve human and social factors(e.g.,autonomy,initiative,and sociality),it is difficult for traditional design of experiment(DOE)methods to achieve the generative explanation of system emergence.To address this challenge,this paper proposes an integrated approach to the design of computational experiments,incorporating three key modules:1)Descriptive module:Determining the influencing factors and response variables of the system by means of the modeling of an artificial society;2)Interpretative module:Selecting factorial experimental design solution to identify the relationship between influencing factors and macro phenomena;3)Predictive module:Building a meta-model that is equivalent to artificial society to explore its operating laws.Finally,a case study of crowd-sourcing platforms is presented to illustrate the application process and effectiveness of the proposed approach,which can reveal the social impact of algorithmic behavior on“rider race”.

Expert Experience and Data-Driven Based Hybrid Fault Diagnosis for High-SpeedWire Rod Finishing Mills

The reliable operation of high-speed wire rod finishing mills is crucial in the steel production enterprise.As complex system-level equipment,it is difficult for high-speed wire rod finishing mills to realize fault location and real-time monitoring.To solve the above problems,an expert experience and data-driven-based hybrid fault diagnosis method for high-speed wire rod finishing mills is proposed in this paper.First,based on its mechanical structure,time and frequency domain analysis are improved in fault feature extraction.The approach of combining virtual value,peak value with kurtosis value index,is adopted in time domain analysis.Speed adjustment and side frequency analysis are proposed in frequency domain analysis to obtain accurate component characteristic frequency and its corresponding sideband.Then,according to time and frequency domain characteristics,fault location based on expert experience is proposed to get an accurate fault result.Finally,the proposed method is implemented in the equipment intelligent diagnosis system.By taking an equipment fault on site,for example,the effectiveness of the proposed method is illustrated in the system.

Optimal Control of Nonlinear Systems Using Experience Inference Human-Behavior Learning

Safety critical control is often trained in a simulated environment to mitigate risk.Subsequent migration of the biased controller requires further adjustments.In this paper,an experience inference human-behavior learning is proposed to solve the migration problem of optimal controllers applied to real-world nonlinear systems.The approach is inspired in the complementary properties that exhibits the hippocampus,the neocortex,and the striatum learning systems located in the brain.The hippocampus defines a physics informed reference model of the realworld nonlinear system for experience inference and the neocortex is the adaptive dynamic programming(ADP)or reinforcement learning(RL)algorithm that ensures optimal performance of the reference model.This optimal performance is inferred to the real-world nonlinear system by means of an adaptive neocortex/striatum control policy that forces the nonlinear system to behave as the reference model.Stability and convergence of the proposed approach is analyzed using Lyapunov stability theory.Simulation studies are carried out to verify the approach.

Role of CD36 in central nervous system diseases

CD36 is a highly glycosylated integral membrane protein that belongs to the scavenger receptor class B family and regulates the pathological progress of metabolic diseases.CD36 was recently found to be widely expressed in various cell types in the nervous system,including endothelial cells,pericytes,astrocytes,and microglia.CD36 mediates a number of regulatory processes,such as endothelial dysfunction,oxidative stress,mitochondrial dysfunction,and inflammatory responses,which are involved in many central nervous system diseases,such as stroke,Alzheimer’s disease,Parkinson’s disease,and spinal cord injury.CD36 antagonists can suppress CD36 expression or prevent CD36 binding to its ligand,thereby achieving inhibition of CD36-mediated pathways or functions.Here,we reviewed the mechanisms of action of CD36 antagonists,such as Salvianolic acid B,tanshinone IIA,curcumin,sulfosuccinimidyl oleate,antioxidants,and small-molecule compounds.Moreover,we predicted the structures of binding sites between CD36 and antagonists.These sites can provide targets for more efficient and safer CD36 antagonists for the treatment of central nervous system diseases.

Optimization of Interactive Videos Empowered the Experience of Learning Management System

The Learning management system(LMS)is now being used for uploading educational content in both distance and blended setups.LMS platform has two types of users:the educators who upload the content,and the students who have to access the content.The students,usually rely on text notes or books and video tutorials while their exams are conducted with formal methods.Formal assessments and examination criteria are ineffective with restricted learning space which makes the student tend only to read the educational contents and videos instead of interactive mode.The aim is to design an interactive LMS and examination video-based interface to cater the issues of educators and students.It is designed according to Human-computer interaction(HCI)principles to make the interactive User interface(UI)through User experience(UX).The interactive lectures in the form of annotated videos increase user engagement and improve the self-study context of users involved in LMS.The interface design defines how the design will interact with users and how the interface exchanges information.The findings show that interactive videos for LMS allow the users to have a more personalized learning experience by engaging in the educational content.The result shows a highly personalized learning experience due to the interactive video and quiz within the video.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

Thermal Experience in an Era of Low Exergy Domestic Heating Systems

Existing theories of thermal comfort are largely blind to the way heat is delivered to spaces.Field studies,however,show that people create and enjoy thermal conditions that lie outside conventional definitions of comfort-the thermal experience itself is valued-some of which are tied to particular ways of delivering heat.The concept“exergy”can be used to describe the quality of heat energy and its ability to provide warmth.A shift from fossil fuels towards renewable sources heralds a new era of space heating consisting mainly of low exergy sources,such as heat pumps.This marks a major turning point in the history of domestic heating.This paper begins by discussing variations in domestic thermal environments before considering new forms of low carbon heating.Later sections analyse the way in which these systems deliver heat within people’s homes and consider the implications for thermal experience,comfort and energy consumption.

Finding biomarkers of experience in animals

At a time when there is a growing public interest in animal welfare,it is critical to have objective means to assess the way that an animal experiences a situation.Objectivity is critical to ensure appropriate animal welfare outcomes.Existing behavioural,physiological,and neurobiological indicators that are used to assess animal welfare can verify the absence of extremely negative outcomes.But welfare is more than an absence of negative outcomes and an appropriate indicator should reflect the full spectrum of experience of an animal,from negative to positive.In this review,we draw from the knowledge of human biomedical science to propose a list of candidate biological markers(biomarkers)that should reflect the experiential state of non-human animals.The proposed biomarkers can be classified on their main function as endocrine,oxidative stress,non-coding molecular,and thermobiological markers.We also discuss practical challenges that must be addressed before any of these biomarkers can become useful to assess the experience of an animal in real-life.

UAV maneuvering decision-making algorithm based on deep reinforcement learning under the guidance of expert experience

Autonomous umanned aerial vehicle(UAV) manipulation is necessary for the defense department to execute tactical missions given by commanders in the future unmanned battlefield. A large amount of research has been devoted to improving the autonomous decision-making ability of UAV in an interactive environment, where finding the optimal maneuvering decisionmaking policy became one of the key issues for enabling the intelligence of UAV. In this paper, we propose a maneuvering decision-making algorithm for autonomous air-delivery based on deep reinforcement learning under the guidance of expert experience. Specifically, we refine the guidance towards area and guidance towards specific point tasks for the air-delivery process based on the traditional air-to-surface fire control methods.Moreover, we construct the UAV maneuvering decision-making model based on Markov decision processes(MDPs). Specifically, we present a reward shaping method for the guidance towards area and guidance towards specific point tasks using potential-based function and expert-guided advice. The proposed algorithm could accelerate the convergence of the maneuvering decision-making policy and increase the stability of the policy in terms of the output during the later stage of training process. The effectiveness of the proposed maneuvering decision-making policy is illustrated by the curves of training parameters and extensive experimental results for testing the trained policy.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

Research on Developing an Assessment Scale for Tourism Experience Elements of Ancient Shu Road Heritage Trail

Cultural ancient roads,known in Chinese as gudao,serve as heritage trails that carry historical exchanges across various regions in China.Due to their extensive preservation,wide geographical distribution,diverse thematic variations,and considerable tourist appeal,these paths have emerged as representative heritage trails,increasingly transforming into a novel tourism product experience that is highly favored by tourists and recognized by government authorities.However,research on ancient roads for tourism in China currently lacks a systematic theoretical framework,as well as relevant policies,regulations,and standards to guide their practical development.Therefore,there is a pressing need to draw upon international best practices and conduct foundational research to develop an experience element system that aligns with the perceptions,behaviors,and consumption characteristics of Chinese tourists,thereby advancing theoretical exploration in this field.This study focuses on the representative Ancient Shu Road as a case study and employs a mixed-method approach that integrates qualitative and quantitative research.It aims to construct a tourist-centric scale for the experience elements of ancient road tourism while analyzing the interactive relationship between these experience elements and tourist needs.This study addresses a significant gap in the development of indicator systems for domestic studies of ancient road tourism experiences.Ultimately,the study establishes a comprehensive scale that encompasses three core categories—trail resources and environment,facilities and services,and modes of tourism activities—along with eight primary dimensions:core resources,surrounding cultural environment,surrounding natural environment,tourism reception facilities and services,infrastructure and support services,information facilities and information services,and outdoor and recreational activities.This scale consists of thirty-two specific items,providing a robust reference for future research endeavors.Additionally,the study proposes specific development strategies related to key mechanisms,spatial configuration,and facility construction to enhance the overall development of ancient road tourism.

Predictability of the upper ocean heat content in a Community Earth System Model ensemble prediction system

Upper ocean heat content(OHC)has been widely recognized as a crucial precursor to high-impact climate variability,especially for that being indispensable to the long-term memory of the ocean.Assessing the predictability of OHC using state-of-the-art climate models is invaluable for improving and advancing climate forecasts.Recently developed retrospective forecast experiments,based on a Community Earth System Model ensemble prediction system,offer a great opportunity to comprehensively explore OHC predictability.Our results indicate that the skill of actual OHC predictions varies across different oceans and diminishes as the lead time of prediction extends.The spatial distribution of the actual prediction skill closely resembles the corresponding persistence skill,indicating that the persistence of OHC serves as the primary predictive signal for its predictability.The decline in actual prediction skill is more pronounced in the Indian and Atlantic oceans than in the Pacific Ocean,particularly within tropical regions.Additionally,notable seasonal variations in the actual prediction skills across different oceans align well with the phase-locking features of OHC variability.The potential predictability of OHC generally surpasses the actual prediction skill at all lead times,highlighting significant room for improvement in current OHC predictions,especially for the North Indian Ocean and the Atlantic Ocean.Achieving such improvements necessitates a collaborative effort to enhance the quality of ocean observations,develop effective data assimilation methods,and reduce model bias.

Citizens’Mental Health Issues and Psychological Trauma Experience due to a Crowd-Crush Disaster in Korea

This study evaluated the state of anxiety, depression, post-traumatic stress disorder, general mental health, and mental well-beingamong citizens after a crowd-crush disaster in Korea. Individuals who experienced the crowd crush had significantly higheranxiety, depression, and post-traumatic stress disorder (PTSD) scores than those who did not (p < 0.001). Additionally,people who avoided the disaster area had significantly higher depression and PTSD scores than those who did not avoid thearea (p < 0.001). Those who directly witnessed the Seoul Halloween crowd crush had a significant difference in PTSD levels ineither group than those who experienced it indirectly (p = 0.005). There was a significant difference in PTSD scores in cases ofdirect damage or death of an acquaintance (p < 0.001). The Seoul Halloween crowd crush caused psychological damagethrough indiscriminate exposure to the public, and symptoms of PTSD appeared over a long period. It is crucial to provideessential resources for ongoing treatment and case management.

Unexpected Diversity in Ecosystem Nutrient Responses to Experimental Drought in Temperate Grasslands

The responses of ecosystem nitrogen (N) and phosphorus (P) to drought are an important component of globalchange studies. However, previous studies were more often based on site-specific experiments, introducing a significantuncertainty to synthesis and site comparisons. We investigated the responses of vegetation and soil nutrientsto drought using a network experiment of temperate grasslands in Northern China. Drought treatment (66%reduction in growing season precipitation) was imposed by erecting rainout shelters, respectively, at the driest,intermediate, and wettest sites. We found that vegetation nutrient concentrations increased but soil nutrient concentrationsdecreased along the aridity gradient. Differential responses were observed under experimentaldrought among the three grassland sites. Specifically, the experimental drought did not change vegetation andsoil nutrient status at the driest site, while strongly reduced vegetation but increased soil nutrient concentrationsat the site with intermediate precipitation. On the contrary, experimental drought increased vegetation N concentrationsbut did not change vegetation P and soil nutrient concentrations at the wettest site. In general, the differentialeffects of drought on ecosystem nutrients were observed between manipulative and observationalexperiments as well as between sites. Our research findings suggest that conducting large-scale, consistent, andcontrolled network experiments is essential to accurately evaluate the effects of global climate change on terrestrialecosystem bio-geochemistry.

Psychological experience of breastfeeding among primiparous women with lactating mastitis:A qualitative research

Objective:The objective of this study is to comprehensively understand the psychological experience of primiparous women during breastfeeding while dealing with lactating mastitis and to establish a reliable foundation for tailored support measures.Methods:Twenty primiparous mothers from a tertiary hospital in Beijing between January and March 2023 were chosen using purposive sampling for semi-structured interviews.After conducting 20 interviews,data saturation was achieved.The Colaizzi’s seven-step analytical approach was employed to analyze,summarize,and refine the identified themes.Results:Among primiparous women afflicted by lactating mastitis,the primary themes regarding breastfeeding attitudes included three key aspects:(1)uncertainty during the initial diagnosis phase,(2)intricate emotional journey during treatment,and(3)positive psychological outlook during the recovery stage.Conclusion:Primiparous women undergoing lactating mastitis experience substantial physical and psychological strain.It is crucial for medical personnel,family caregivers,and society at large to be attuned to the emotions of these patients.Tailored support measures should be offered to enhance patients’physical and mental well-being and facilitate disease recovery.

Chemical simulation teaching system based on virtual reality and gesture interaction

Background Most existing chemical experiment teaching systems lack solid immersive experiences,making it difficult to engage students.To address these challenges,we propose a chemical simulation teaching system based on virtual reality and gesture interaction.Methods The parameters of the models were obtained through actual investigation,whereby Blender and 3DS MAX were used to model and import these parameters into a physics engine.By establishing an interface for the physics engine,gesture interaction hardware,and virtual reality(VR)helmet,a highly realistic chemical experiment environment was created.Using code script logic,particle systems,as well as other systems,chemical phenomena were simulated.Furthermore,we created an online teaching platform using streaming media and databases to address the problems of distance teaching.Results The proposed system was evaluated against two mainstream products in the market.In the experiments,the proposed system outperformed the other products in terms of fidelity and practicality.Conclusions The proposed system which offers realistic simulations and practicability,can help improve the high school chemistry experimental education.

Screening and field application of microbial-flooding activator systems

This study aims to further enhance the oil recovery of reservoirs in the Zhong-2 Block of the Gudao Oilfield by identifying the most effective microbial-flooding activator systems and applying them in the field.We began by analyzing the structure of the reservoirs'endogenous microbial communities to understand the potential impact of microbial flooding.This was followed by determining commonly used activator systems based on their abilities to stimulate oil-displacement functional bacteria.Through laboratory experiments on oil displacement efficiency and sweep characteristics,we determined the optimal activator injection method(injection ratio)and the requisite bacterial concentration for maximal microbial-flooding efficacy.Finally,we selected the optimal activator systems and applied them to field tests.Our findings suggest the target block is highly receptive to microbial-flooding.In terms of performance,the activator systems ranked as No.3>No.4>No.1>No.2.Interestingly,a deep activator system,when compared to the top-performing No.3 system,exhibited a higher bacterial concentration peak and longer peaking duration.Optimal oil displacement effects were observed at a 1:4 vol ratio between the No.3 activator and deep activator systems,with bacterial concentrations of up to 106 cells/mL or above.Field tests with the selected activator systems,following a specific injection protocol,demonstrated a notable increase in oil production and a reduction in water cut.

How Sense of Ritual in Tourism Impacts Tourists’Co-Creation of Tourism Experience Values:A Study Based on the Theory of Value Co-Creation

Establishing a sense of ritual within tourism consumption scenarios offers tourists the opportunity for interactive engagement.Drawing upon the value co-creation theory,this study constructed an influence mechanism model to examine tourists'active engagement in the process of co-creating tourism experience values.It employed Partial Least Squares Structural Equation Modeling(PLS-SEM)to empirically test the proposed hypotheses.The findings demonstrate that the model constructed in the present study exhibits robust reliability,validity,and explanatory power.The perception of the sense of ritual in tourism exerts a significant positive influence on tourists’co-creation of tourism experience values,thereby significantly enhancing both the communitas and flow experienced by tourists during their travels.Moreover,such communitas and flow can mediate the influence of the sense of ritual in tourism on tourists’co-creation of tourism experience values.This study contributes to advancing the current research on tourists’co-creation of tourism experience values and the sense of ritual in tourism,thereby providing theoretical foundations for cultivating a sense of ritual within tourism consumption scenarios.

The Tenth Anniversary of Free Trade Pilot Zones in China:Fundamental Experiences and Enhancement Strategies

Since the 18th National Congress of the Communist Party of China,the country has established 21 Free Trade Pilot Zones(FTZs),achieving significant pioneering results in reform and opening up and creating a strong demonstrative effect nationwide.The basic experience from a decade of FTZs includes:adhering to the centralized and unified leadership of the CPC Central Committee;combining top-level design with encouragement of grassroots innovation;leveraging the distinct characteristics and strengths of FTZs to form a differentiated development pattern;maintaining the integration of opening up with domestic reforms;using openness to drive reforms;and organically combining openness with national security assurance.Under the current and future new circumstances,China’s FTZs face new challenges and tasks.In accordance with the directives of the 20th National Congress of the Communist Party of China,an enhancement strategy for the FTZs needs to be implemented.This involves the following:First,accurately understanding and responding to the changing situation to create strategic opportunities.Second,shifting paradigms to implement innovation-driven strategies,using the new development pattern concept to guide the reform experiments and construction of the FTZs.Third,granting more autonomy to FTZs for reforms,pursuing progress while maintaining stability,and solidly advancing the reform experiments in the FTZs.Fourth,orderly expanding the opening up of the service sector and cautiously advancing the internationalization of the renminbi.Fifth,promoting innovative development in trade to build a strong trade nation.Sixth,establishing synergy with bilateral FTZs,Belt and Road cooperation,and national diplomatic strategies to enhance the linkage effect.