Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.

Comparison of water resources management between China and the United States

As the world’s top two economies,the United States(U.S.)and China face a number of similar water resources problems.Yet,few studies have been done to systematically compare policies and approaches on water resources management between China and the U.S.This study compares water resources policies of China and the U.S.in the areas of national authority,water supply,water quality,and ecosystem use of the water to draw lessons learned and shed light on water resources management in China,the U.S.,and the rest of the world.The lessons learned from the comparison include six aspects.1)New paradigms of people-water harmony and a water-saving society are urgently needed to address the pressing water crisis and achieve the United Nations Sustainable Development Goals(UN SDGs).2)A comprehensive,consistent,forward-looking national policy is necessary to achieve sustainable use of water resources.3)Empowerment of river basin commissions with comprehensive authority over the integrative management of air,land,water,and biological resources in the river basin could significantly enhance the benefits and effectiveness of economic development and environmental protection.4)Expansion of water exchange through market mechanisms among water users promotes efficient and beneficial water uses.5)Use of water for ecosystem services should be an integral part of water resources management.China has set up a national blueprint for achieving ecological civilization;maintaining appropriate amounts of flow in rivers and lakes for maintenance of wildlife and fisheries and ecosystems should be institutionalized as part of this national strategy as well.6)By sharing their rich experiences and lessons in water resources management,economic development,and ecological protection with other countries,China and the U.S.can help the world to achieve global human-water harmony and the UN SDGs.

Power management unit chip design for automobile active-matrix organic light-emitting diode display module

A power management unit （PMU） chip supplying dual panel supply voltage, which has a low electro-magnetic interference （EMI） characteristic and is favorable for miniaturization, is designed. A two-phase charge pump circuit using external pumping capacitor increases its pumping current and works out the charge-loss problem by using bulk-potential biasing circuit. A low-power start-up circuit is also proposed to reduce the power consumption of the band-gap reference voltage generator. And the ring oscillator used in the ELVSS power circuit is designed with logic devices by supplying the logic power supply to reduce the layout area. The PMU chip is designed with MagnaChip＇s 0.25 μ high-voltage process. The driving currents of ELVDD and ELVSS are more than 50 mA when a SPICE simulation is done.

Management of procedural pain in the intensive care unit

Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Statistical Safety Analysis of Maintenance Management Process of Excavator Units

Within this paper, the process of statistical safety analysis has been presented, which involves the following steps： formulation of basic principles of statistical safety analysis, initial events analysis, accident sceneries progress analysis, risk calculation, and risk calculation results analysis. On this basis, it has been concluded that the bucket wheel excavator SRs 1200×24/4×0（400 kW）＋VR safety criteria is the mechanism for the hoist of rotor＇s arrow failure modes, because in that case whole bucket wheel excavator failure would necessarily happen （excavator falling down on counterweight）. Therefore, excavator units statistical safety analysis is accomplished preventively to obtain its effective maintenance management.

Characteristics and management strategy of the devices configured in Baosteel's domestically-integrated 60000 m^3/h air separation unit

Baosteel＇ s No. 8 air separation unit（ASU） is the first domestically-integrated 60 000 m^3/h ASU. This paper describes the mechanical equipment, the design and the configuration characteristics of this unit. The potential failure modes of the mechanical devices are deduced via analyses on the failure history of similar devices in other ASUs. Finally, this paper also brings up suggestions on daily maintenance, overhaul and purchases of spare parts.

Responding to fire in an intensive care unit: Management and lessons learned

Healthcare institutions are vulnerable to disruptionfrom events such as earthquakes, fires, and floods, andthe damage incurred can endanger the lives of patientsin the hospital.[1] In this type of scenario hospital staffhave primary responsibility for the hospitalized patients＇safety, since patients are neither fit to respond to sucha disaster, nor do they know how to respond.[2,3] Thesituation becomes more difficult and challenging if thedisaster occurs in critical care areas such as intensivecare units （ICUs） and operating rooms.

Developing GIS-Based Unit Hydrographs for Flood Management in Makkah Metropolitan Area, Saudi Arabia

Unit hydrographs (UH) are either determined from gauged data or derived using empirically-based synthetic unit hydrograph procedures. In Saudi Arabia, the discharge records may not be available either for several locations or for long time scales, and therefore synthetic unit hydrographs are crucial in flood and water resources management. Available metrological, geological, and land use datasets have been utilized in order to apply the US National Resources Conservative Services (NRCS) methodology in a Geographic Information Systems (GIS) environment. Furthermore, NRCS unit hydrographs have been developed for six watersheds within Makkah metropolitan area, southwest Saudi Arabia. The accomplished results show that the UH time to peak discharge vary from 1.15 hours to 4.47 hours, and the UH peak discharge quantities range from 10.14 m3/s to 16.74 m3/s. It is concluded that the third basin in Makkah city may be considered as the most hazardous catchment. Hence, it is recommended that careful flood protection procedures should be taken in this area within Makkah city.

Mapping regional forest management units:a road-based framework in Southeastern Coastal Plain and Piedmont

Management practices are one of the most important factors affecting forest structure and function.Landowners in southern United States manage forests using appropriately sized areas,to meet management objectives that include economic return,sustainability,and esthetic enjoyment.Road networks spatially designate the socioenvironmental elements for the forests,which represented and aggregated as forest management units.Road networks are widely used for managing forests by setting logging roads and firebreaks.We propose that common types of forest management are practiced in road-delineated units that can be determined by remote sensing satellite imagery coupled with crowd-sourced road network datasets.Satellite sensors do not always capture roadcaused canopy openings,so it is difficult to delineate ecologically relevant units based only on satellite data.By integrating citizen-based road networks with the National Land Cover Database,we mapped road-delineated management units across the regional landscape and analyzed the size frequency distribution of management units.We found the road-delineated units smaller than 0.5 ha comprised 64%of the number of units,but only0.98%of the total forest area.We also applied a statistical similarity test(Warren's Index)to access the equivalency of road-delineated units with forest disturbances by simulating a serious of neutral landscapes.The outputs showed that the whole southeastern U.S.has the probability of road-delineated unit of 0.44 and production forests overlapped significantly with disturbance areas with an average probability of 0.50.

Information Management in Disaster and Humanitarian Response: A Case in United Nations Office for the Coordination of Humanitarian Affairs

To guarantee a unified response to disasters, humanitarian organizations work together via the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Although the OCHA has made great strides to improve its information management and increase the availability of accurate, real-time data for disaster and humanitarian response teams, significant gaps persist. There are inefficiencies in the emergency management of data at every stage of its lifecycle: collection, processing, analysis, distribution, storage, and retrieval. Disaster risk reduction and disaster risk management are the two main tenets of the United Nations’ worldwide plan for disaster management. Information systems are crucial because of the crucial roles they play in capturing, processing, and transmitting data. The management of information is seldom discussed in published works. The goal of this study is to employ qualitative research methods to provide insight by facilitating an expanded comprehension of relevant contexts, phenomena, and individual experiences. Humanitarian workers and OCHA staffers will take part in the research. The study subjects will be chosen using a random selection procedure. Online surveys with both closed- and open-ended questions will be used to compile the data. UN OCHA offers a structure for the handling of information via which all humanitarian actors may contribute to the overall response. This research will enable the UN Office for OCHA better gather, process, analyze, disseminate, store, and retrieve data in the event of a catastrophe or humanitarian crisis.

The Poorly Known Northeast Atlantic Regional Management Unit for Loggerhead (Caretta caretta)

Loggerheads are distributed by ten Regional Management Units (RMUs) worldwide. The Atlantic Ocean houses three of these: the Northwest, Southwest and Northeast RMUs. The most studied is, so far, the Northwest RMU, but the other two have focused attention of researchers. In contrast, marine turtles from the African Atlantic region (Southeast) belong to a complex but little-known region. What is their role in the Atlantic? Are these RMUs connected? To understand these questions, research was made of reports and publications concerning the Northeast Atlantic (NEA) RMU. The asymmetry in information and available knowledge about NEA is high when compared to other RMUs. This demonstrates that there is still a lack of conservation programs besides Cape Verde, and that there is difficulty in transforming data (nesting ecology, molecular, telemetry, etc.) into publications. However, this issue is evident for other marine turtle species of East African Atlantic. There is a need for better scientific support, to enable local conservation programs to deliver data in reports, and even scientific publications. There are so many aspects of loggerhead’s life cycle that will only be unravelled by more and better supported studies. This is a paper that, by analysing the available information of the NEA loggerhead RMU, reflects the following steps to address in loggerhead conservation for the African Atlantic coast.

Rational Analysis of Management Accounting Implementation in China＇s Government Units

The implementation of management accounting in China＇s government units is an inevitable requirement of economic development and the important deployment of efficient government establishment. Up to now, China has made a lot of theoretical explorations and tried about management accounting practice in government units. But in practice, there are still some shortcomings. Therefore, based on the thought of Accounting Research Methodology written by Professor Lu Yonghua, this article carries out a comprehensive, systematic, in-depth and concrete study on the implementation of management accounting in China＇s government units. This paper argues that there are some deficiencies in management accounting practice, including lack of a complete government management accounting system, the failure of combining management accounting implementation with specific national conditions, limitations of government management accounting itself, resistance existing in government management accounting implementation, and the low quality of management accounting practitioners. In this regard, this research paper learns from foreign experience and puts forward some corresponding improvement suggestions from the perspective of legislation, empirical research, information construction, education investment and so on.

Inter-Professional-Compassionate pain management during endotracheal suctioning: a valuable lesson from a Chinese surgical intensive care unit

Objective:To compare the effects of a pain management program and routine suctioning methods on the level of pain presence and agitation in Chinese adults admitted to the intensive care unit.To disseminate the results from the implementation of the evidence-informed pain management interventions for reducing pain presence and agitation during endotracheal tube suctioning(ETS)and translate the key finding to clinical nursing practice.Methods:A quasi-experimental study of a two-group post-test design was conducted in adults admitted after surgery to a surgical intensive care unit(SICU)of the Second Affiliated Hospital of Kunming Medical University,Yunnan,China in 2018.Fifty-two adults who met the study eligibility were included after consent,26 in each group.Patients in the control group received usual care while patients in the intervention group received interventions to reduce agitation and pain-related ETS.The impacts of the intervention on the level of pain presence and agitation were measured at 5 measuring time points using the Chinese versions of Critical-Care Pain Observation Tool(CPOT)and Richmond Agitation Sedation Scale(RASS).Results:The level of pain presence in the intervention group statistically significantly decreased during,immediately after,and 5 min after suctioning.The level of agitation in the intervention group significantly decreased during and immediately after suctioning.Conclusions:The findings provide support for the positive pain-relieving effects of the evidence-informed pain-related ETS management interventions when compared with the usual ETS practice.The study interventions were sufficiently effective and safe to maintain patent airway clean and patent as standardized suctioning and helps pain relief.So,evidence-based pain-related ETS management intervention is worthy of recommending to utilize in SICU patients as well as other patients who required suctioning.It is worth noting that integrating pre-emptive analgesia prescription and administration with non-pharmacological intervention plays a critical role in achieving pain relief.

Regeneration Potential of Woody Species at the Side of Secondary Roads Post-Logging of Loundoungou-Toukoulaka Forest Management Unit, Republic of the Congo

Natural regeneration is the basis of a dynamic and demographic balance of plant populations. The objective of this study was to assess the natural regeneration potential of woody species along secondary roads post-logging abandoned since 2008 and 2018. In the two Annual Allowable Cuts (AAC 2008 and AAC 2018), 24 regenerating sub-plots (i.e. 12 sub-plots for AAC 2008 and 12 sub-plots for AAC 2018) with a unit area of 5 m × 5 m were delimited with a total area of 0.06 ha (i.e. 0.03 ha for each AAC). The abundance and diversity of woody species were respectively inventoried and estimated. Two estimators of the specific richness were used to estimate the floristic diversity of each Annual Allowable Cuts (AAC). The results reveal globally 88 woody species in the AAC 2008 and 241 woody species in the AAC 2018, with respective average densities of 2933 stem/ha and 8033 stem/ha. There was a very highly significant difference between the mean densities of the two AAC (Kruskal-Wallis test;H = 2.36, p-value < 0.000). The results also highlight a great diversity and a relatively high abundance of woody species in the 2018 AAC compared to the 2008 AAC. Also, the spatial structuring of the sub-plots on the basis of Principal Component Analysis (PCA) demonstrates that the floristic composition of the two AAC is globally different. The study suggests silvicultural interventions and the long-term assessment of regenerating woody species along abandoned secondary roads in order to guarantee the sustainable management of their population.

Characteristics and trends of integrated ocean management under the framework of the United Nations Convention on the Law of the Sea

As the international community place high value on the ocean,protecting the marine environment and promoting the sustainable development of the ocean have become the consensus of all countries around the world.Integrated ocean management,as an important part of the ocean governance mechanism within the framework of the United Nations,have approached to the scene view of human gradually.Taking the United Nations Convention on the Law of the Sea as the framework,the current international integrated ocean management is summarized and the future development trend of ocean management is analyzed,providing reference for China to build a maritime power and a maritime community with shared future.

Study on the Management of Chronic Diseases in American and British Community Pharmacy

Objective To provide a reference for promoting the construction of chronic disease management in community pharmacies in China.Methods Literature research and comparative research methods were used to analyze the management of chronic disease carried out by community pharmacies in the United States and the United Kingdom.Results and Conclusion The management of chronic diseases in American and British community pharmacies has formed retail health clinic and online chronic disease mode.It is recommended that Chinese government should issue measures and supporting guidelines for the management of chronic diseases in community pharmacies as soon as possible.Community pharmacies should be encouraged to carry out chronic disease management with the concept of prudent inclusion and gradual progression.Meanwhile,the concentration of drug retail industry should be improved to carry out the systematic construction of chronic disease management and build a standardized chronic disease service process.Besides,community pharmacies should make full use of new technologies such as the Internet,cloud computing and big data,smart wearable devices,and chronic disease management Apps to explore and carry out online professional chronic disease management mode.

The Trend of Scientific and Refinement of Financial Management in Business Units

In the new era,financial management has become increasingly sophisticated and has had a significant impact and change on various industries and fields.This paper analyzes the key significance of performance appraisal in institutions and proposes ways to enhance performance appraisal innovation,which will prevail in financial management innovation in institutions and upgrade the value of its applications.

System Safety Management of Whole Life Cycle of Chemical Process Unit

Guaranteeing the safety performance of chemical process units is the premise for the safety production of chemical enterprises.Only to have the system safety management of the whole life cycle of the process units can operate the process systems under the state of controllable risk.