Assessment of Acute Poisoning Cases in Emergency Department of the Provincial General Reference Hospital in Bukavu, DR-Congo

Background: Acute intoxications result from intentionally or accidentally taking a relatively significant amount of a chemical substance which triggers disturbances in the level of psychophysiological functions, the complications of which may lead to mental disorders, physical causalities, and death. Any acute intoxication mostly requires emergency care. Objective: To highlight the prevalence, history, clinical features, emergency treatment, and prediction of acute intoxication cases referred to the emergency services at the Provincial General Reference Hospital in Bukavu, DR-Congo. Methods: A retrospective cross-sectional study was conducted from January 2021 to October 2022 based on an analysis of patients’ medical files. Triage was performed among all-type of patient files recorded in the computerized hospital database Ebale-Sante to sort cases of intoxication. Results: During the observational period, 3966 emergency admissions were counted, of which 321 (8.09%) patients were identified as having acute intoxication. Among these, 100 files that containing sufficient information fit the quality criteria for this study’s analysis. The victims were infants, adolescents and adults aged 1 - 45 years, and 52% were female and 48% were male. Most cases were accidental and, occurred at home, and the victims were driven to the hospital within 2 - 24 hours. The substances consumed included household products, drugs, and herbs. Resuscitation care, antidotes and supportive symptomatic medications ensured that 85% were healed and 10% experienced sequelae;however, 5% died. Conclusion: Acute intoxication occurs in infants mostly accidentally though the ingestion of household products and medicines. Furthermore, suicide cases may occur in traumatized adolescents and discordant couples. People should be informed about how to store hazardous products (e.g.: drugs, household products and pesticides), which should not be available to children, to avoid unintentional poisoning. Special training in clinical toxicology is required to reduce treatment failure.

Self-Sustaining of Critical Park Microgrids Integrating Mobile Emergency Generators Subjective to Major Outage

In the event of a major power outage,critical park microgrids(PMGs)could be self-sustaining if mobile emergency generators(MEGs)are stationed to share energy.However,the need for privacy protection and the value of flexible power support on minute-time scales have not been given enough attention.To address the problem,this paper proposes a new self-sustaining strategy for critical PMGs integrating MEGs.First,to promote the cooperation between PMG and MEG,a bi-level benefit distribution mechanism is designed,where the participants'multiple roles and contributions are identified,and good behaviors are also awarded.Additionally,to increase the alliance benefits,three loss coordination modes are presented to guide the power exchange at the minute level between the MEG and PMG,considering the volatility of renewable generation and load.On this basis,a multi-time scale power-energy scheduling strategy is formulated via the alternating direction method of multipliers(ADMM)to coordinate the PMG and MEG.Finally,a dimensionality reduction technology is designed to equivalently simplify the optimization problem to facilitate the adaptive-step-based ADMM solution.Simulation studies indicate that the proposed strategy achieves the self-sustaining of PMGs integrating MEGs while increasing the economy by no less than 3.1%.

The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

Effects of a general practitioner cooperative co-located with an emergency department on patient throughput

BACKGROUND:In 2013 a General Practitioner Cooperative(GPC) was introduced at the Emergency Department(ED) of our hospital.One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED.To determine the change in patient flow,we assessed the number of self-referrals,redirection of self-referrals to the GPC and back to the ED,as well as ward and ICU admission rates and length of stay of the remaining ED population.METHODS:We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands.RESULTS:More than half of our ED patients were self-referrals.At triage,54.5%of these selfreferrals were redirected to the GPC.After assessment at the GPC,8.5%of them were referred back to the ED.The number of patients treated at the ED declined with 20.3%after the introduction of the GPC.In the remaining ED population,there was a significant increase of highly urgent patients(P<0.001),regular admissions(P<0.001),and ICU admissions(P<0.001).Despite the decline of the number of patients at the ED,the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period,a total increase of 270 hours in two months(P<0.001).CONCLUSION:Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

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.

风格迁移、指令设计与“世界模拟器”——兼论Sora模型产出艺术杰作的可能

随着生成式人工智能技术在机器监督学习和对抗神经网络的推动下不断升级,程序化算法对当代艺术创作的影响也逐渐加大。回溯人工智能技术在作品生成方面的路径与方法,有助于理解人工智能艺术不同于传统艺术的新特征。通过细审艺术风格迁移的技术迭代现象,可以发现人机交互界面上隐形存在的深层指令设计问题。围绕指令文本做出的无休止调整,在增强艺术创作的游戏化体验时,迎来了动态的涌现现象。作为世界模拟器之一的Sora模型,能够部分地呈现运动中的物理世界,却无法模拟情感动态,艺术杰作难以产出。

生成性学习策略在急危重症护理学课程思政教学中的应用

目的探讨生成性学习策略在急危重症护理学课程思政教学中的应用效果。方法便利选取我校2020级本科助产专业三年级163名学生为研究对象,在急危重症护理学课程思政教学中应用生成式学习策略。课前结合学情特点准备思政素材,设计教学方案;课中找准切入点引入思政案例,进行互动、思辨、交流、体验、探究、共情等多种生成性学习活动;课后抽查了解教学效果与存在的问题,反思、总结需改进的方面。通过出勤率、课堂表现、生成性活动与作业完成情况、操作考试评价学习效果,并让学生进行教学效果评价。结果学生出勤率为98.2%,出勤得分(9.97±0.01)分;课堂表现得分(9.85±0.04)分;生成性活动与作业得分为(25.80±0.61)分,46名(28.2%)学生主动报名参与案例作品的表演,117名(71.8%)学生用文字形式参与了案例作品的评论;操作成绩得分为(46.09±0.09)分。87.1%及以上的学生认为在急危重症护理学课程思政教学中应用生成性学习策略能增强家国情怀、科研精神、职业素养价值观。结论基于生成性学习策略的课程思政教学在急危重症护理学中能顺利开展,学生乐于接受,能够达到提升价值引领的教学效果。

新兴技术视域下的人工智能善治——发展现状、风险挑战与治理思路

人工智能正在引发一场远超乎于技术场域的时代变革,以大模型为代表的生成式人工智能塑造着未来的主要技术进路。尽管我国已成为一个人工智能大国,但在核心理论创新、基础底座建设、关键软硬件和生态方面还有待提升,迈向人工智能强国还有很长的路要走。在此情况下,如何在保障人工智能有力、有序、有益发展的同时,实现对人工智能的善治是亟需回应的关键问题。因此,平衡好发展与治理之间的关系,践行价值对齐的伦理思路,吸收人工智能国际治理有益经验,探索一条理念开放、主体多元、对象分层、工具灵活的治理新思路,成为探索人工智能善治路径的核心命题。

通识教育在口腔急诊住院医师规范化培训医患沟通教学中的价值探究

目的探究通识教育在口腔急诊住院医师规范化培训医患沟通教学中的价值。方法选取2021年3—10月中山大学附属口腔医院急诊综合科进行口腔急诊住院医师规范化培训的58名住院医师为研究对象,根据不同的教学方法分为对照组和研究组,各29名。对照组进行常规医患沟通教学,研究组在对照组基础上增加10学时的通识教育培训。比较两组的SEGUE量表评分、教师住院医师的评分及教学满意度。结果研究组在教师评价得分、沟通能力得分与教学满意度均优于对照组,差异有统计学意义(P均<0.05)。结论通识教育在口腔急诊住院医师规范化培训医患沟通教学中具有正面作用,可提高住院医师的医患沟通能力。

融合交通态势修正的台风灾害后多维度智能调拨策略

针对台风灾害后交通信息不确定、调拨策略考虑维度不足等问题,提出融合交通态势修正的台风灾害后多维度智能调拨策略。采用历史交通态势数据拟合道路通行时间概率分布,并基于拉丁超立方采样对交通态势进行随机抽样,以计算更准确的道路通行时间。考虑交通、电网、用户等多维度,以抢修队伍、抢修物资、应急发电车等作为调拨主体进行台风灾害后抢修调拨,提出考虑调拨距离、恢复时间、失负荷量最优的多维智能调拨策略,利用模糊隶属度函数求取帕累托前沿最优调拨方案。根据2018年台风“山竹”下的珠海市数据验证调拨策略的有效性。算例结果表明所提多维度智能调拨策略能有效缩短台风灾害后恢复进程,提升电网防灾减灾能力。

低空经济的背景、内涵与全球格局

低空经济作为新质生产力的典型代表,是航空业技术与市场深刻变革的重要内容,也是我国发挥后发优势、产业链优势,构建航空业又一个百年全新格局的重要机遇。全球航空业陷入寡头垄断、创新减缓、应用受限、规模萎缩的被动局面多年,数字经济、人工智能、新能源新材料等的大幅进步与深刻影响,创造了航空业百年一遇的低空经济新赛道。低空经济通过颠覆性创新孕育了新一代航空技术体系,展现了全新航空性能与应用场景,带动航空业深度转型,从而可实现航空业生产力跃升,构建立体交通新模式、新优势。当前国际低空经济在制度体系、产业链基础、创新战略等领域呈现不同格局,就我国而言,迫切需要建立有关低空经济的战略共识、技术共识与市场路径共识,为我国在全球航空业发展中贡献变革性推动力量创造条件。

新一代信息技术产业高质量发展研究

作为战略性新兴产业的重要组成部分,新一代信息技术产业对经济社会全局和长远发展具有重大的引领带动作用;它是培育新质生产力的基石,是开辟发展新领域新赛道、塑造发展新动能新优势的重要依托。本文从新一代信息技术产业的内涵出发,系统梳理了新一代信息技术产业典型领域的全球发展态势,总结了我国新一代信息技术产业的整体发展现状和典型领域发展态势,分析了新一代信息技术产业发展面临的机遇与挑战。着眼于高质量发展的要求,提出了新一代信息技术产业发展的对策建议:坚持运用体系工程思维,巩固提高一体化战略体系和能力;加强关键核心技术攻关,强化产业基础能力;构建产业融合集群发展,突出以企业为主体;以场景驱动的创新为牵引,促进开放式创新生态构建;推动“产学研用金”协调发展,培育高水平人才队伍。

三级综合医院护士突发公共卫生事件应急能力的影响因素分析

目的调查三级综合医院护士突发公共卫生事件应急能力现状,并探讨相关影响因素。方法选取2021年1月14日至1月30日重庆市6所三级综合医院护士1102名,采用护士突发公共卫生事件应急能力问卷、职业韧性量表进行调查分析。结果不同科室、年龄、职称、能级、工龄及是否参加过突发公共卫生事件应急培训、应急救援的护士应急能力评分比较,差异均有统计学意义(P<0.05)。护士突发公共卫生事件应急能力评分为(146.76±15.77)分,条目均分为(3.97±0.42)分。护士职业韧性评分为(90.78±7.63)分。护士突发公共卫生事件应急能力评分与职业韧性评分呈正相关(r=0.581,P<0.001)。能级、科室、参加过突发公共卫生事件应急培训和应急救援、职业韧性是护士突发公共卫生事件应急能力的影响因素(P<0.05)。结论三级综合医院护士突发公共卫生事件应急能力处于中等偏上水平,且受能级、科室、职业韧性及是否参加过突发公共卫生事件应急培训和应急救援影响。

无人机集群任务分配技术研究综述

任务分配是无人机集群实现高效遂行作战任务的关键技术。随着无人机集群技术的发展和作战样式的转变,无人机集群的作战任务领域不断拓展,任务分配所涵盖的范围不断扩大,任务分配问题的规模和复杂性不断增加,这都对无人机集群任务分配技术提出了新的挑战。本文对无人机集群作战理论、任务分配建模、任务预重分配算法、异构无人系统联合应用下任务分配的研究现状进行了全面的总结,凝练了目前无人机集群任务分配技术面临的通用化建模、面向多任务的任务预分配算法最优解求解、有限时间下面向突发事件的任务重分配算法寻优、路径规划紧耦合下面向大规模异构无人系统的协同任务分配等问题,并针对性地论述了未来无人机集群任务分配技术的若干发展方向,为提升无人机集群任务分配的求解质量和求解速度提供新的研究思路和解决途径,对于全面了解无人机集群任务分配技术具有重要参考意义。

儿童阻塞性睡眠呼吸暂停综合征全麻苏醒期躁动风险预测模型的构建与验证

目的:构建并验证儿童阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)术后苏醒期躁动(emergence agitation,EA)的风险预测模型。方法:选择665例全麻下行OSAS手术的3~12岁患儿为研究对象,随机分为建模组(n=499)和验证组(n=166)。建模组根据是否发生苏醒期躁动,分为EA组和非EA组,采用logistic回归分析筛选儿童OSAS术后EA的危险因素,以此建立风险预测列线图模型,并通过C-index、校准曲线和受试者工作特征曲线(ROC)下面积验证模型的预测效能,并用该风险模型进行内部验证。采用SPSS 26.0软件包和R软件(V4.1.2)对数据进行统计学分析。结果:OSAS手术后患儿苏醒期躁动发生率为38.68%。Logistic回归分析显示,年龄(OR:0.494,95%CI:0.313~0.778)、拔管时间(OR:0.971,95%CI:0.953~0.990)、术后疼痛(OR:1.530,95%CI:1.378~1.699)是儿童OSAS手术后苏醒期躁动的独立危险因素(P<0.05)。据此建立风险预测模型,ROC曲线下面积为0.782(95%CI:0.741~0.823),灵敏度为0.599,特异度为0.837。验证组的ROC曲线下面积为0.773(95%CI:0.697~0.849),灵敏度0.676,特异度为0.814。结论:年龄、拔管时间、术后疼痛是OSAS儿童术后苏醒期躁动的独立危险因素,以此构建的列线图模型对此类患儿术后苏醒期躁动的发生有较好的预测效能。

基于MBI-GS量表调查急诊科医务人员职业倦怠现状及影响因素

目的:当前急诊科医务人员的职业倦怠发生率高,其职业健康值得关注,医疗机构建立完善的职业健康体系至关重要。本研究旨在了解急诊科医务人员的职业倦怠现状,分析其影响因素,为预防急诊科医务人员职业倦怠提供参考。方法:采取便利抽样的方法,通过问卷星平台,于2022年12月至2023年1月对急诊科医务人员进行横断面调查。采用马斯拉克倦怠调查普适(Maslach Burnout Inventory-General Survey,MBI-GS)量表评价医务人员的职业倦怠水平,采用单因素分析及二元Logistic回归分析探索急诊科医务人员发生职业倦怠的影响因素。结果:回收有效问卷1173份,其中职业倦怠者946人(80.65%),轻中度和重度职业倦怠者的比例分别为73.57%和7.08%。急诊医务人员职业倦怠3个维度得分:情感耗竭(emotional exhaustion,EE)为2.33±0.31;去人格化(depersonalization,DP)为1.88±0.28;低个人成就感(low personal accomplishment,LPA)为3.20±0.39。总均分为2.46±0.22。急诊科医务人员职业倦怠与是否独生子女(OR=1.362,95%CI-0.707~-0.058)、平均每月晚夜班数量(OR=1.167,95%CI 0.091~0.272)、工作中亲身经历过职场暴力事件(OR=1.094,95%CI 0.027~0.195)有关(均P<0.05)。结论:急诊科医务人员职业倦怠发生率高,管理者需采取有效的措施及时干预,以降低急诊科医务人员的职业倦怠,保障急诊科医务工作的顺利开展。

语言模型与人工智能

本文按照自然语言处理学术发展的时间顺序,分析了人工智能与基于规则的语言模型、统计语言模型、神经语言模型、预训练语言模型、大语言模型之间的关系。研究指出,构建一个能够理解世界的模型将是人工智能未来的发展方向。

极端天气下考虑分布式电源可用程度的配电网多源协同恢复策略

为了提升配电网对极端天气的抵御及恢复能力,需要充分发挥分布式电源、储能系统、移动电源等海量配电网弹性资源的应用潜力,通过资源调度为配电网供电恢复提供支撑,最大限度保证配电网在极端天气下的功能完整性。为此,针对台风过境后的配电网和交通网故障状态,提出一种考虑台风影响下分布式电源可用程度的配电网多源协同恢复策略,建立计及分布式电源、自备储能和移动应急电源等多种灵活资源的配电网多时段故障恢复模型,实现台风过境后配电网故障负荷的快速恢复。首先,分析台风过境后的分布式电源可用程度;其次,针对交通网的故障状态,分析移动资源的最短行驶时间与路径;最后,采用IEEE 33节点配电系统与33节点交通网对所提策略进行验证,利用MATLAB+YALMIP+CPLEX工具箱创建优化模型并求解。结果表明,所提策略能够有效地利用多种灵活资源之间的时序配合,对负荷恢复起到良好的支撑作用。

基于知识融合和深度强化学习的智能紧急切机决策

紧急控制是在严重故障后维持电力系统暂态安全稳定的重要手段。目前常用的“人在环路”离线紧急控制决策制定方式存在效率不高、严重依赖专家经验等问题,该文提出一种基于知识融合和深度强化学习(deep reinforcement learning,DRL)的智能紧急切机决策制定方法。首先,构建基于DRL的紧急切机决策制定框架。然后,在智能体处理多个发电机决策时,由于产生的高维决策空间使得智能体训练困难,提出决策空间压缩和应用分支竞争Q(branching dueling Q,BDQ)网络的两种解决方法。接着,为了进一步提高智能体的探索效率和决策质量,在智能体训练中融合紧急切机控制相关知识经验。最后,在10机39节点系统中的仿真结果表明,所提方法可以在多发电机决策时快速给出有效的紧急切机决策,应用BDQ网络比决策空间压缩的决策性能更好,知识融合策略可引导智能体减少无效决策探索从而提升决策性能。