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.

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%.

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.

建设健康社会的催化剂:健康社会工作者与全科医生在基层的合作

以“健康中国”战略为导向,从优势互补专业知识、共同连接医院社区、拓展研究社会健康三个方面去探讨健康社会工作者与全科医生在基层卫生环境中的合作价值,尤其在完善公共卫生应急体系和构建医联体上,健康社会工作者与全科医生的合作可以发挥必不可少的作用,能有效推动健康社会的建设进程。同时文章也指明了目前健康社会工作面临的主要挑战,并提出相应的对策。

Acute Peritonitis Generalized at the Koutiala Reference Health Center, Mali: Epidemiological, Etiological and Therapeutic Aspects

History: In Mali, several studies have been carried out on acute peritonitis but in the Koutiala circle it is a first. Aim: To evaluate the epidemiological, etiological and therapeutic aspects of generalized acute peritonitis at the Koutiala reference health center. Method: This was a 14-month prospective and descriptive study from August 1, 2017 to November 30, 2019, covering all patients admitted and operated for generalized acute peritonitis. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and postoperative operations. Result: The number was 93 cases, 72 men and 21 women. The average age was 34.2 years (Extremes: 2 - 75 years). The hospital frequency was 2.0%. The incidence rate of generalized acute peritonitis in the circle was 12.4 cases per 100,000 population. The clinical picture was still of peritonitis. The Widal-Félix serology was positive in 19 cases. Perioperative bacteriological sampling was systematic. The etiologies were dominated by digestive perforations in 81 cases (87%) of which 33 were located at the ileal level, postoperative peritonitis (6 cases) and ruptured pyocholecyst (2 cases). There were also 3 cases of primary peritonitis and 1 case of gynecological peritonitis. Excision-suturing was the most used surgical technique with 35.5% (n = 33). Postoperatively, we identified 10 cases of parietal suppuration (10.8%), 6 cases of postoperative peritonitis (6.5%), 2 cases of external digestive fistula (2.2%) and 7 cases of death (7.5%). Conclusion: Acute peritonitis occupies second place in abdominal surgical emergencies in the Koutiala circle. The etiologies are multiple and varied and are dominated by the ileal perforation which is secondary to typhoid fever more often. In most cases the surgical treatment is done by excision-suturing of the perforation. Mortality and morbidity remain high.

A method of parsing based on improving the electricity behavior and regulating excitation system of the diesel generating set in the nuclear power plant

This paper introduces an applicable test plan for emergency diesel generator in nuclear power plant. It advances improvement approaches with problems found during field commissioning test and its trouble-shooting processes. The method is based on the integration of complementary through, the extension theory of matter-element model and neural network theory combine to overcome a neural network to learn shelters, and other defects. The purpose of this paper is to provide the better running and commissioning experience for the similar emergency generator unit.

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。

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。

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。

Digestive Surgical Emergencies at the Commune II Reference Health Centre in the District of Bamako

We conducted a prospective descriptive study from January 1 to December 31, 2018 with the objectives of determining the frequency of digestive surgical emergencies, describing the clinical and para-clinical aspects of the management of digestive surgical emergencies, evaluating the therapeutic aspect of digestive surgical emergencies and analysing the post-operative follow-up of patients operated on in emergencies. We counted 120 patients operated on for digestive surgical emergencies, which corresponds to 5.80% of all consultations and 44.80% of all surgical interventions. The male sex was the most represented with a ratio of 1.80. The average age was 27.5 years. The majority of patients were from Bamako. Abdominal pain was the reason for consultation in 80% of cases. The diagnosis was essentially clinical and paraclinical in doubtful cases. These included ultrasound, unprepared abdomen and sometimes abdominal CT scans. Acute appendicitis was the most common pathology with 42.5%. General anaesthesia and spinal anaesthesia were used with 50% each. The majority of patients were operated on between 30 minutes and 12 hours after their admission to the department (71.7%). Acute peritonitis accounted for 67% of deaths from sepsis. The surgical technique was decided according to the pathology and the surgeon’s choice. The postoperative course was simple in the majority of cases. The prognosis is good when the management is early. The treatment is medical-surgical.

Emergent Gravity, Violated Relativity and Dark Matter

The nonlinear affine Goldstone model of the emergent gravity, built on the nonlinearly realized/ hidden affine symmetry, is concisely revisited. Beyond General Relativity, the explicit violation of general invariance/relativity, under preserving general covariance, is exposed. Dependent on a nondynamical affine connection, a generally covariant second-order effective Lagrangian for metric gravity is worked out, with the general relativity violation and the gravitational dark matter serving as the signatures of emergence.

G-CPT Symmetry of Quantum Emergence and Submergence—An Information Conservational Multiagent Cellular Automata Unification of CPT Symmetry and CP Violation for Equilibrium-Based Many-World Causal Analysis of Quantum Coherence and Decoherence

An equilibrium-based YinYang bipolar dynamic Generalization of CPT (G-CPT) symmetry is introduced based on energy/information conservational quantum emergence-submergence. As a bottleneck of quantum computing, quantum decoherence or collapse has been plaguing quantum mechanics for decades. It is suggested that the crux of the problem can trace its origin back to the incompleteness of CPT symmetry due to the lack of holistic representation for equilibrium-based bipolar coexistence. In this work, the notion of quantum emergence-submergence is coined as two opposite processes with bipolar energy/information conservation. The new notion leads to G-CPT symmetry supported by a Bipolar Quantum Cellular Automata (BQCA) interpretation of quantum mechanics. It is shown that the new interpretation further leads to the unification of electromagnetic particle-antiparticle bipolarity and gravitational action-reaction bipolarity as well as CPT symmetry and CP violation into a philosophically, geometrically and logically different quantum gravity theory. On one hand, G-CPT symmetry enables a Bipolar Quantum Agent (BQA) to emerge as a bipolar quantum superposition or entanglement coupled to a globally coherent BQCA;on the other hand, G-CP violation supports a causal theory of BQA submergence or decoupling from the global coherence. In turn, BQAs can submerge from one world but emerge in another within YinYang bipolar quantum geometry. It is suggested that all logical, physical, social, biological and mental worlds are bipolar quantum entangled under G-CPT symmetry. It is contended that G-CPT symmetry constitutes an analytical paradigm of quantum mechanics and quantum gravity—a fundamental departure from “what goes around comes around”. The new paradigm leads to a number of predictions and challenges.

AIGC在应急情报服务中的应用研究

文章指出生成式人工智能(AIGC)应用于应急情报服务具有降低应急情报感知难度、打破应急情报信息壁垒、化解应急情报监管困境、克服危机模拟演练瓶颈的优势,基于AIGC应用于应急情报服务的核心组件,分析其在应急情报感知与采集、组织与存储、分析与研判、决策与评价等工作流程中的作用,并提出AIGC在应急情报服务中的应用策略,即立足总体国家安全观,强化顶层设计;兼具技术理性和人文关怀,推进人机协作;加强情报可靠性评估,注重风险溯源;夯实数据运行机制,确保数据安全。

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。

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。