人工法off-line HDF对血液透析充分性和高同型半胱氨酸血症的影响

目的探究人工法off-line HDF对维持性血液透析(MHD)患者透析充分性、高同型半胱氨酸血症(HHcy)的影响。方法随机选取2021至2023年于南昌大学第一附属高新医院血液透析中心稳定透析6个月以上的MHD患者30例,进行单中心自身对照研究,时长6个月。前3个月维持每周2次高通量血液透析(HFHD)联合1次on-line HDF,后3个月维持每周2次人工法off-line HDF联合1次on-line HDF。于研究第3个月、第6个月时用全自动生化分析仪检测透析前后血尿素氮(BUN)、血肌酐(SCr)、β2-微球蛋白(β2MG)、同型半胱氨酸(Hcy)、白蛋白(Alb)、C反应蛋白(CRP)、血红蛋白(Hb)、甲状旁腺素(iPTH)、磷(P)、钾(K)水平;计算血清尿素清除指数(Kt/V)、尿素下降率(URR)和β2MG清除率。结果人工法off-line HDF模式透析的Kt/V、URR及β2MG清除率均较显著高于HFHD模式透析(P<0.05);人工法off-lineHDF模式透析Kt/V、URR及β2MG清除率达到透析充分的百分率分别为83.33%、83.33%和93.33%,均显著高于HFHD模式透析(P<0.05)。与HFHD模式透析时相比,人工法off-lineHDF模式透析结束后,患者透析前Hcy水平降低,Alb水平升高(P<0.05)。结论人工法off-line HDF模式透析可显著增加Kt/V、URR和β2MG清除率,提高MHD患者的透析充分性达标率,且对HHcy具有改善作用。

Hydrogeochemical Characterization of Groundwater from Fissured Aquifers in the Angovia Mine Operating Permit Area (Central-West Côte d’Ivoire)

The main objective of this study is to determine the hydrogeochemical specificities of the groundwater of the Angovia mine operating permit, located in the Yaouré mountains in the center-west of Côte d’Ivoire. To do so, descriptive and multivariate statistical analysis methods with the SOM (Self Organizing Maps) algorithm were applied to the physicochemical parameters of 17 boreholes using the calcite (ISC) and dolomite (ISD) saturation indices. The results obtained have shown that the groundwater in the Angovia mine operating permit area has an average temperature of 27.52°C (long rainy season) and 27.87&degC (long dry season) and has an average pH of 7.09 ± 0.35 during the main rainy season and 7.32 ± 0.35 during the main dry season. They are mineralized with an average electrical conductivity of 505.98 ± 302.85 μS/cm during the long rainy season and with 450.33 ± 233.74 μS/cm as average during the long dry season. The main phenomena at the origin of groundwater mineralization are water residence time, oxidation-reduction and surface inflow. The study of the relative age of the water shows that the groundwater in the Angovia mine operating permit area is mainly undersaturated with respect to calcite and dolomite. They are therefore very old in the aquifer with a slow circulation speed during the long rainy season and the long dry season.

Enhancing Patient Safety in the Operating Room: A Comprehensive Guide from a Nurse’s Perspective

Ensuring patient safety within the operating room is a paramount concern in contemporary healthcare, and this guide aims to provide an in-depth exploration of this crucial aspect from the perspective of nurses. Nurses play a pivotal role in supporting surgeons and maintaining a safe environment for patients undergoing various medical procedures.

Finite Element Method Simulation of Wellbore Stability under Different Operating and Geomechanical Conditions

The variation of the principal stress of formations with the working and geo-mechanical conditions can trigger wellbore instabilities and adversely affect the well completion.A finite element model,based on the theory of poro-elasticity and the Mohr-Coulomb rock damage criterion,is used here to analyze such a risk.The changes in wellbore stability before and after reservoir acidification are simulated for different pressure differences.The results indicate that the risk of wellbore instability grows with an increase in the production-pressure difference regardless of whether acidification is completed or not;the same is true for the instability area.After acidizing,the changes in the main geomechanical parameters(i.e.,elastic modulus,Poisson’s ratio,and rock strength)cause the maximum wellbore instability coefficient to increase.

Experimental investigation of the polarityswitching process with different bipolar ionic liquid thruster operating frequencies

The bipolar ionic liquid thruster employs ionic liquid as a propellant to discharge positively and negatively charged high-energy particles under an alternating current(AC)power source,effectively suppressing electrochemical reaction and ensuring charge neutrality.Determining an optimal AC supply power source frequency is critical for sustained stable thruster operation.This study focuses on the emission characteristics of the ionic liquid thruster under varied AC conditions.The AC power supply was set within the frequency range of 0.5-64 Hz,with eight specific frequency conditions selected for experimentation.The experimental results indicate that the thruster operates steadily within a voltage range of±1470 to±1920 V,with corresponding positive polarity current ranging from 0.41 to 4.91μA and negative polarity current ranging from−0.49 to−4.10μA.During voltage polarity switching,an emission delay occurs,manifested as a prominent peak signal caused by circuit capacitance characteristics and a minor peak signal resulting from liquid droplets.Extended emission test was conducted at 16 Hz,demonstrating approximately 1 h and 50 min of consistent emission before intermittent discharge.These findings underscore the favorable impact of AC conditions within the 8-16 Hz range on the self-neutralization capability of the ionic liquid thruster.

Prospective randomized study to evaluate and compare the post-procedural sexual function in patients undergoing semi-rigid ureterorenoscopy for distal ureteric stones in three different operating room settings

Objective:To evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings.Methods:In this prospective randomized study,consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups,with three different operating room settings.Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory(in males)and Female Sexual Function Index-6(in females),respectively.All the participants were stented following the procedure,and the stent was removed after 3 weeks.Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week,3 weeks,and 12 weeks.The effect of surgery-related anxiety,preoperative sexual function,age,and general discomfort(including stent-related discomfort)on post-procedural sexual function were analyzed using multiple regression analysis.A p-value of less than 0.05 was considered statistically significant.Results:Totally,327 eligible patients were randomized into three groups.The group of patients who underwent the procedural with a screen separating the operating area from the patient vision,while the patient could watch the endoscopy through a separate monitor,had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked.This difference was statistically significant.This post-procedural reduction in sexual function could not be attributed to in situ stent alone.Conclusions:Our study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function,which can be reduced with proper preoperative counseling and an ideal operating room settings.

A hierarchical enhanced data-driven battery pack capacity estimation framework for real-world operating conditions with fewer labeled data

Battery pack capacity estimation under real-world operating conditions is important for battery performance optimization and health management,contributing to the reliability and longevity of batterypowered systems.However,complex operating conditions,coupling cell-to-cell inconsistency,and limited labeled data pose great challenges to accurate and robust battery pack capacity estimation.To address these issues,this paper proposes a hierarchical data-driven framework aimed at enhancing the training of machine learning models with fewer labeled data.Unlike traditional data-driven methods that lack interpretability,the hierarchical data-driven framework unveils the“mechanism”of the black box inside the data-driven framework by splitting the final estimation target into cell-level and pack-level intermediate targets.A generalized feature matrix is devised without requiring all cell voltages,significantly reducing the computational cost and memory resources.The generated intermediate target labels and the corresponding features are hierarchically employed to enhance the training of two machine learning models,effectively alleviating the difficulty of learning the relationship from all features due to fewer labeled data and addressing the dilemma of requiring extensive labeled data for accurate estimation.Using only 10%of degradation data,the proposed framework outperforms the state-of-the-art battery pack capacity estimation methods,achieving mean absolute percentage errors of 0.608%,0.601%,and 1.128%for three battery packs whose degradation load profiles represent real-world operating conditions.Its high accuracy,adaptability,and robustness indicate the potential in different application scenarios,which is promising for reducing laborious and expensive aging experiments at the pack level and facilitating the development of battery technology.

The Impact of Optimizing Details in the Operating Room on the Level of Knowledge, Attitude, and Practice of Hospital Infection Prevention and Control by Surgeons, as Well as the Effectiveness of Infection Control

Objective: This paper aims to explore the impact of optimizing details in the operating room on the level of knowledge, attitude, and practice of hospital infection prevention and control by surgeons, as well as the effectiveness of infection control. Methods: From January 2022 to June 2023, a total of 120 patients were screened and randomly divided into a control group (routine care and hospital infection management) and a study group (optimizing details in the operating room). Results: Significant differences were found between the two groups in the data of surgeons’ level of knowledge, attitude, and practice in hospital infection prevention and control, infection rates, and nursing satisfaction, with the study group showing better results (P Conclusion: The use of optimizing details in the operating room among surgeons can effectively improve surgeons’ level of knowledge, attitude, and practice in hospital infection prevention and control, reduce infection occurrence, and is worth promoting.

Aero-Hydro-Elastic-Servo Modeling and Dynamic Response Analysis of A Monopile Offshore Wind Turbine Under Different Operating Scenarios

This paper constructs a coupled aero-hydro-elastic-servo simulation framework for a monopile offshore wind turbine(OWT).In this framework,a detailed multi-body dynamics model of the monopile OWT including the gearbox,blades,tower and other components(nacelle,hub,bedplate,etc.)has been explicitly established.The effects of pile−soil interaction,controller and operational conditions on the turbine dynamic responses are studied systematically in time domain and frequency domain.The results show that(1)a comprehensive drivetrain model has the capability to provide a more precise representation of the complex dynamic characteristics exhibited by drivetrain components,which can be used as the basis for further study on the dynamic characteristics of the drivetrain.(2)The pile−soil interaction can influence the wind turbine dynamic responses,particularly under the parked condition.(3)The effect of the pile−soil interaction on tower responses is more significant than that on blade responses.(4)The use of the controller can substantially affect the rotor characteristics,which in turn influences the turbine dynamic responses.(5)The tower and blade displacements under the operational condition are much larger than those under the parked condition.The model and methodology presented in this study demonstrate potential for examining complex dynamic behaviors of the monopile OWTs.To ensure accuracy and precision,it is imperative to construct a detailed model of the wind turbine system,while also taking into account simulation efficiency.

Impact of Sedation Protocols on Elderly Patients Undergoing Mechanical Ventilation and Off-Line Weaning

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

Correlation between critical thinking and emotional intelligence:a national crosssectional study on operating room nursing students in Iran

Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.

Operating Parameters of the District Heating Substation Cooperating With the Installation of Technological Air Conditioning With High Efficiency of Heat Recovery

The article analyses the problem of determining the operating parameters of the district heating substation cooperating with the air heating system in technological air conditioning systems equipped with heat exchangers with high efficiency of heat recovery.Attention was paid to the correct selection of heat exchangers for the heat output balance depending on the heat recovery protection algorithms against a drop in the temperature of the heat transfer surface below 0℃.Critical parameters were determined in Polish climatic conditions,at which the operation of the heat recovery exchanger in the air conditioning system is switched off or limited.It has been proven that the proper functioning of the district heating substation cooperating with the installation of air conditioning with high heat recovery efficiency requires the use of two heat exchangers with different characteristics,equipped with properly selected temperature control systems.The optimal model of cooperation between the technological air conditioning system and the heating substation was also indicated.

Operating Room Nurses’ Role in Multidisciplinary Surgical Coordination for a Patient with a Large Abdominal Tumor and Multiple Pelvic Fractures

In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.

Application of Nursing Cooperation Path in Operating Room and Analysis of Complication Rate During Laparoscopic Hysterectomy

Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided into groups according to the order of admission.The control group received routine perioperative care.The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group.The two groups’physiological responses,stimulus indicators,anxiety,and complication rates were compared.Results:The heart rate,blood pressure 0.5 hours after surgery,anxiety scores 1 day before and 3 days after surgery,and the total number of complications in the observation group were all lower than those in the control group(P<0.05).Conclusion:The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate,blood pressure,stress responses,and the risk of complications,and is worthy of promotion.

Effect of simulating training of the fundamentals of laparoscopic surgery on the attitude of operating room nurses students:an intervention study

Objective:Clinical education plays a key role in preparing students for patient care.Laparoscopy is one of the most important minimally invasive surgeries(MISs)wherein surgical technologists are responsible for camera navigation and assistant surgeons are responsible for peg transfer.Therefore,it is necessary to improve the attitude of the operating room students toward these skills during their study period.The present study was conducted to determine the effect of simulating training in the fundamentals of laparoscopic surgery(FLS)on the attitude of the operating room students.Methods:This interventional study was conducted on 28 operating room students of Iran University of Medical Sciences in 2019.The census sampling method was used.The data-collection tool included the“Intrinsic motivation inventory(IMI)questionnaire.”The educational intervention was carried out in theoretical(booklet design)and practical(simulation)sections.Data analysis was carried out using descriptive and inferential analyses including the paired t-test,Mann–Whitney U test,and independent t-test.The collected data were analyzed using R and SPSS software.P-value<0.05 was considered as the significant level.Results:The mean±SD of the participants'age was 22.93±2.14 years,and the majority of them were women(67.9%).There was a significant difference in the mean scores of students'attitudes toward the FLS before and after the educational intervention(P<0.001)in all dimensions(interest,perceived competence,perceived choice,and tension).There was also a significant correlation between gender and interest dimension(P=0.005).Conclusions:The results of the present study showed that simulating the training FLS curriculum positively affects students'attitudes.Therefore,the researchers suggest that for creating a positive attitude,increasing students'interest in laparoscopic surgery,and ensuring a more effective presence in the operating room,this training should be considered in the operating room curriculum.

Liquid Metal-Based Self-Healable and Elastic Conductive Fiber in Complex Operating Conditions

Flexible conductive fibers are essential for wearable electronics and smart electronic textiles.However,in complex operating conditions,conductive fibers will inevitably fracture or damage.Herein,we have developed an elastic conductive self-healable fiber(C-SHF),of which the electrical and mechanical properties can efficiently heal in a wide operating range,including room temperature,underwater,and low temperature.This advantage can be owed to the combination of reversible covalent imine bond and disulfide bond,as well as the instantaneous self-healing ability of liquid metal.The C-SHF,with stretchability,conductivity stability,and universal self-healing properties,can be used as an electrical signal transmission line at high strain and under different operating conditions.Besides,C-SHF was assembled into a double-layer capacitor structure to construct a self-healable sensor,which can effectively respond to pressure as a wearable motion detector.

Evaluation of Operating Room Noise by Different Medical Specialists

Noise pollution is in an increasing trend in the operating rooms, as has been the case in various other domains in life. It has been shown in studies that the main cause of this noise pollution consist of the behavior related to the operating room personel and the surgical equipment. These higher than normal noise levels may increase stress and decrease communication and performance, apart from the negative health effects on the operating team. In this study, we aimed to explore the sources of noise pollution and the place of music on these effects on anesthesiology and surgical doctors. Questions formulated through a questionnaire have been asked to the anesthesiology and surgical department physicians on a voluntary basis, and their approach to the concept of noise has been assessed. The study was planned as a descriptive study. In total, highest impact from noise pollution was found to be the aspirator (74.3%), chatting (55.4%), noises from the monitors (54.8%), alarms (48.6%), surgical material (25.9%) and music (23.8%). Noise had the most impact on the concentration of the doctors with a rate of 61.9%. Anesthesiologists, when compared to other surgical department physicians, were found to be impacted most by music with 37.2%. It is not realistic to eliminate all the noise and distraction. On the other hand, it can be minimalized through sufficient measures. Yet, general measures to keep the silence isn’t too likely to keep the noise down during long operations. Whereas music stays as a matter of personal choice. Controlled studies on whether to keep or not the music in the operating rooms aren’t yet sufficient, due to which, general recommendations do not apply. As a result of this study, we have found that while music might have performance increasing effects, it still has a potential as a distraction and interfere with the communication in the operating room.

Influence of Robot-Assisted Tumor Surgery Nursing on Patient Rehabilitation in Operating Room and Discussion on Nursing Strategies

Objective: To evaluate the effect of operating room nursing on the outcome of patients undergoing robot-assisted tumor surgery. Methods: This research starts from October 2021 to October 2022. The number of patients with robot-assisted tumor surgery included in our hospital is 769. The patients are treated in the operating room, and the prognosis of the patients is summarized. Results: The intraoperative blood loss in patients undergoing robot-assisted tumor surgery was (57.51 ± 12.01) ml;the operation time was (3.57 ± 0.66) h;and the hospital stay was (6.04 ± 0.53) d. There were 21 cases of complications after robot-assisted tumor surgery, accounting for 2.73%. After surgery, all robot-assisted tumor surgery patients recovered and were discharged smoothly after being checked by doctors. Conclusion: Robot-assisted tumor surgery nursing has a definite effect on patients’ rehabilitation in the operating room.

Fractal Fractional Order Operators in Computational Techniques for Mathematical Models in Epidemiology

New fractional operators, the COVID-19 model has been studied in this paper. By using different numericaltechniques and the time fractional parameters, the mechanical characteristics of the fractional order model areidentified. The uniqueness and existence have been established. Themodel’sUlam-Hyers stability analysis has beenfound. In order to justify the theoretical results, numerical simulations are carried out for the presented methodin the range of fractional order to show the implications of fractional and fractal orders.We applied very effectivenumerical techniques to obtain the solutions of themodel and simulations. Also, we present conditions of existencefor a solution to the proposed epidemicmodel and to calculate the reproduction number in certain state conditionsof the analyzed dynamic system. COVID-19 fractional order model for the case of Wuhan, China, is offered foranalysis with simulations in order to determine the possible efficacy of Coronavirus disease transmission in theCommunity. For this reason, we employed the COVID-19 fractal fractional derivative model in the example ofWuhan, China, with the given beginning conditions. In conclusion, again the mathematical models with fractionaloperators can facilitate the improvement of decision-making for measures to be taken in the management of anepidemic situation.

Operating room black box:Scrutinizer of theatre practices

Objective:Adverse surgical events are a major cause of morbidity,mortality,and disability worldw ide.The cause of many such events can be attributed to interruptions in the operating room(OR),muli-tasking by surgeons,etc.The objective of this study was to observe the types and frequency of intra-operative wor kflow interruptions in our ORs.Method:This ccoss-sectional study was conducted from March Do April of 2023.An observational approach using an audio-video recording device was employed to record OR flow disr uptions.One elective OR and one emergency OR under the Department of General Surgery were selected for the study.All open and laparoscopic surger ies conducted in the selected ORs were included.An Internet Protocol camera'was installed in the selec ted ORS with a view of the entire room,including the anesthesia station.Audio-video recording was started after the first indsion and stopped after closure of the surgical site.Result:Of the 51 cases that were studied,45(88.2%)were elective,and 18(35.3%)were laparoscopic cases.They could be classified into 8 types of open procedures and 4 types of lapar oscopic procedures.The mean maximum headcount inside the OR was 15.5土3.6 and doors opened on average of 15.8土6.0 times during a procedure.Other interruptions were surgeons attending phone calls(24,47.1%),leaving the sterile area(21,41.2%),technical disturbances(32,62.7%),anesthetic interruptions(18,35.3%),and faulty instruments(29,56.9%)Elective procedures had a signifcandy higher average number of in-terruptions per operating hour than emergency procedures(175±8.6vs.7.1±2.9,p<0.01).Condusion:Preventable factors such as faulty instruments,anesthetic interruption,and attending phone calls by the surgeon are commonly observed in ORs.They need to be addressed by timely surgical audits or the adoption of continued sureillance methods that can help take measures to minimize their occurrence.