Knowledge, attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey

Objectives:To explore the knowledge,attitude and practice of Chinese nurses regarding nursing interruptions and related factors.Methods:A total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge,Attitude and Practice(KAP)Questionnaire of Nursing Interruptions.The questionnaire consists of three dimensions,knowledge,attitude and practice,containing 10,9 and 7 items,with full score of 50,45 and 28,respectively.Results:The mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05±16.65(range:26-123),with scores for the knowledge,attitude,and practice component being 21.74±9.80,34.83±6.98,and 17.49±4.97,respectively.Among the nurses,70.8%of them experienced an average level of KAP toward nursing interruptions while 15.5%were at a poor level.The knowledge,attitude,and practice of nursing interruptions were better in chief nurses,managers,nurses with a master degree or above,nurses ever received training,and nurses with a strong agreement to leadership compared to nurses in other groups(P<0.05).In addition,employment type,professional title,position,standardized training and leaders'attention were predictors of KAP in nurses.Conclusion:Chinese nurses have a moderate level of KAP regarding nursing interruptions.Leaders'attention,standardized training,position,professional title and employment type could predict nurses'KAP state of nursing interruptions.Thus,a targeted training program should be implemented for clinical nurses by nursing leaders,with a particular focus on feasibility and professionalism.

An Optimal Control Approach to Structured Treatment Interruptions for HIV Patients: A Personalized Medicine Perspective

Highly Active Antiretroviral Therapy (HAART) has changed the course of human immunodeficiency virus (HIV) treatments since its introduction. However, for many patients, long term continuous HAART is expensive and can include problems with drug toxicity and side effects, as well as increased drug resistance. Because of these reasons, some HIV infected patients will voluntarily terminate HAART. Some of these patients will also interrupt the continuous prescribed therapies for short or long periods. After discontinuing HAART, patients will usually experience a rapid increase in viral load coupled with an immediate decline in CD4+ counts. The canonical example of a patient undergoing unsupervised breaks in HAART is that of the “Berlin patient”. In this case, the patient was able to control viral load in the absence of treatment by cycling HAART on and off due to non-related infections. Due to this patient, interest in the use of structured treatment interruptions (STI) as a mechanism to regulate an HIV infection piqued. This paper describes an optimal control approach to determine STI regimen for HIV patients. The optimal STI was implemented in the context of the receding horizon control (RHC) using a mathematical model for the in-vivo dynamics of an HIV type 1 infection. Using available clinical data, we calibrate the model by estimating on a patient specific basis, a best estimable set of parameters using sensitivity analysis and subset selection. We demonstrate how customized STI protocols can be designed through the variation of control parameters on a patient specific basis.

Proposed Measures to Mitigate Energy Interruptions in Residential Sector

This study investigates and analyzes the electric energy interruptions impact upon the residential sector in Riyadh city, the capital of the Kingdom of Saudi Arabia (KSA) resulting from severe power outages. The study results show that this sector which constitutes about 54% of the Saudi Electric Company in the Central Operating Area (SEC-COA) will suffer enormous tangible and intangible losses should occur in specific times, seasons and last for longer durations. The results obtained for the costs of these energy interruptions reveal a time-dependent non-linear outage cost variation. In order to reduce these energy interruptions and hence mitigate their adverse effects and consequences, the study proposes proper practical measures and solutions without compromising the consumers’ needs and convenience.

Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions

Background: Sufficient coronary perfusion pressure (CPP) to provide myocardial reperfusion is required for defibrillation success after prolonged ventricular fibrillation (VF) cardiac arrest. Chest compression interruptions cause a precipitous drop in CPP. Objective: To quantify the ex- tent to which CPP recovers to pre-pause levels following chest compression interruptions. Me- thods: This was a secondary analysis of data from two similar IACUC approved protocols. A total of 105 Yorkshire swine were included and VF was electrically induced. After 10 minutes of untreated VF in the first study (n = 52) and 12 minutes of untreated VF in the second (n = 53), CPR began and epinephrine was administered approximately 2 minutes prior to a planned 10-second pause to record an artifact-free ECG waveform segment. Following this pause, CPR was resumed for 20- seconds prior to defibrillation. CPP data were extracted from three time points: 2 minutes after epinephrine delivery (CPP1);following the chest compression pause (CPP2);and immediately before defibrillation (CPP3). Our primary outcome was defined as the ratio of CPP recovery (CPP3- CPP2) to the drop in CPP (CPP1-CPP2). Results: Interrupting compressions resulted in a significant drop in CPP (29.8 mmHg [95%CI: 26.2, 33.4] to 6.8 mmHg [95%CI: 5.4, 8.2]). Resuming CPR for restored 83% (95%CI: 78%, 86%) of the CPP lost. Conclusion: This study demonstrates that 83% of the decline in CPP values during a planned 10-second interruption in CPR can be restored with a short period of precordial compressions prior to defibrillation.

An Analysis on Functions of Interruptions in Specific Conversational Situations

The functional analysis of interruption is of great necessity in carrying out a smooth conversation.By exemplifying interruptions in specific conversational situations identified in Friends,the paper has explored the relative,interactive,pluralistic and situational characteristics of functions of interruptions.

Performance analysis of the stop-and-wait automatic repeat request protocol under Markovian interruptions

The performance of an integrated packet voice/data multiplexer using a stop-and-wait(SW)automatic repeat request(ARQ)protocol is discussed.We assume that the input for the data traffic is exponentially distributed in increments via the Poisson process,with each data packet transmitted within an individual slot time.Another assumption is that there is only a single voice signal,which has a higher priority over the data packet,and whose traffic is given via an on-off Markov process.Whenever the voice signal is active,the output link is used and will be blocked for the data packet.We introduce the concept of buffer occupancy to simplify the analysis,and discover that data multiplexers using the SW ARQ protocol exhibit a behavior of queueing delay and buffering when the interruption signal is given via a Markov process.Simulation results verify the validity of the analytical results.

Mastering air combat game with deep reinforcement learning

Reinforcement learning has been applied to air combat problems in recent years,and the idea of curriculum learning is often used for reinforcement learning,but traditional curriculum learning suffers from the problem of plasticity loss in neural networks.Plasticity loss is the difficulty of learning new knowledge after the network has converged.To this end,we propose a motivational curriculum learning distributed proximal policy optimization(MCLDPPO)algorithm,through which trained agents can significantly outperform the predictive game tree and mainstream reinforcement learning methods.The motivational curriculum learning is designed to help the agent gradually improve its combat ability by observing the agent's unsatisfactory performance and providing appropriate rewards as a guide.Furthermore,a complete tactical maneuver is encapsulated based on the existing air combat knowledge,and through the flexible use of these maneuvers,some tactics beyond human knowledge can be realized.In addition,we designed an interruption mechanism for the agent to increase the frequency of decisionmaking when the agent faces an emergency.When the number of threats received by the agent changes,the current action is interrupted in order to reacquire observations and make decisions again.Using the interruption mechanism can significantly improve the performance of the agent.To simulate actual air combat better,we use digital twin technology to simulate real air battles and propose a parallel battlefield mechanism that can run multiple simulation environments simultaneously,effectively improving data throughput.The experimental results demonstrate that the agent can fully utilize the situational information to make reasonable decisions and provide tactical adaptation in the air combat,verifying the effectiveness of the algorithmic framework proposed in this paper.

Modulated-ISRJ rejection using online dictionary learning for synthetic aperture radar imagery

In electromagnetic countermeasures circumstances,synthetic aperture radar(SAR)imagery usually suffers from severe quality degradation from modulated interrupt sampling repeater jamming(MISRJ),which usually owes considerable coherence with the SAR transmission waveform together with periodical modulation patterns.This paper develops an MISRJ suppression algorithm for SAR imagery with online dictionary learning.In the algorithm,the jamming modulation temporal properties are exploited with extracting and sorting MISRJ slices using fast-time autocorrelation.Online dictionary learning is followed to separate real signals from jamming slices.Under the learned representation,time-varying MISRJs are suppressed effectively.Both simulated and real-measured SAR data are also used to confirm advantages in suppressing time-varying MISRJs over traditional methods.

Pulsatile gonadotropin-releasing hormone therapy induces spermatogenesis in pituitary stalk interruption syndrome:A case report and review of the literature

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare anatomical defect of the pituitary gland falling under the spectrum of holoprosencephaly phenotypes.It is characterized by a deficiency in anterior pituitary hormones,such as growth hormone,gonadotropins,and thyroid hormones.Due to the syndrome's rarity and nonspecific manifestations,there is a lack of standardized treatment strategies.Consequently,early diagnosis through imaging and on-time intervention are crucial for improving patients’outcomes.CASE SUMMARY A 30-year-old man presented with absent secondary sexual characteristics and azoospermia.Laboratory evaluation revealed a deficiency in gonadotropins,while thyroid function was mostly within normal ranges.Magnetic resonance imaging of the pituitary gland showed pituitary stalk agenesis,hypoplasia of the anterior pituitary,and ectopic posterior pituitary,leading to the diagnosis of PSIS.Initially,the patient underwent 6 mo of gonadotropin therapy without significant changes in hormone levels and secondary sexual characteristics.Pulsatile gonadotropin-releasing hormone therapy was then administered,resulting in the detection of sperm in the semen analysis within 3 mo.After 6 mo,routine semen tests showed normal semen quality.The couple faced challenges in conceiving due to abstinence and underwent three cycles of artificial insemination,which was unsuccessful.They also attempted in vitro fertilization,but unfortunately,the woman experienced a miscarriage 10 wk after the embryo transfer.CONCLUSION Early detection,accurate diagnosis,and timely treatment are crucial in improving the quality of life and fertility of PSIS patients.

Safeguarding The Mother River China’s comprehensive measures to protect and manage the Yellow River

One of two mother rivers of the Chinese nation,the Yellow River has supported the development of Chinese civilization and nurtured the Chinese people for millennia.However,the great river has been suffering from severe crises of interrupted flow and water pollution in recent decades.

THE M/M/1 QUEUE WITH WORKING VACATIONS AND VACATION INTERRUPTIONS

In this paper, we study the M/M/1 queue with working vacations and vacation interruptions. The working vacation is introduced recently, during which the server can still provide service on the original ongoing work at a lower rate. Meanwhile, we introduce a new policy：, the server can come back from the vacation to the normal working level once some indices of the system, such as the number of customers, achieve a certain value in the vacation period. The server may come back from the vacation without completing the vacation. Such policy is called vacation interruption. We connect the above mentioned two policies and assume that if there are customers in the system after a service completion during the vacation period, the server will come back to the normal working level. In terms of the quasi birth and death process and matrix-geometric solution method, we obtain the distributions and the stochastic decomposition structures for the number of customers and the waiting time and provide some indices of systems.

Transient Behavior of a Single-Server Markovian Queue with Balking and Working Vacation Interruptions

This paper studies the time-dependent analysis of an M/M/1 queueing model with single,multiple working vacation,balking and vacation interruptions.Whenever the system becomes empty,the server commences working vacation.During the working vacation period,if the queue length reaches a positive threshold value‘k’,the working vacation of the server is interrupted and it immediately starts the service in an exhaustive manner.During working vacations,the customers become discouraged due to the slow service and possess balking behavior.The transient system size probabilities of the proposed model are derived explicitly using the method of generating function and continued fraction.The performance indices such as average and variance of system size are also obtained.Further,numerical simulations are presented to analyze the impact of system parameters.

Feasibility and clinical benefits of the double-ProGlide technique for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants

OBJECTIVE To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants(OAC),and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study.METHODS Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing,China from May 2019 to May 2021 were enrolled in this study.From October 2020,double-ProGlide technique was consistently used for hemostasis(ProGlide group),and before that conventional manual compression was utilized(manual compression group).The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up.RESULTS A total of 140 participants(69.30%of male,mean age:59.21±10.29 years)were evaluated,70 participants being in each group.Immediate hemostasis was achieved in all the patients with ProGlide closure.No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group.The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices(15.71%vs.2.86%,P=0.009).In addition,compared with the manual compression group,the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory[112.0(93.3–128.8)min vs.123.5(107.3–158.3)min,P=0.006],time from sheath removal until venous site hemostasis[3.8(3.4–4.2)min vs.8.0(7.6–8.5)min,P<0.001],bed rest time[8.0(7.6–8.0)h vs.14.1(12.0–17.6)h,P<0.001]and hospital stay after the procedure[13.8(12.5–17.8)h vs.38.0(21.5–41.0)h,P<0.001].CONCLUSIONS Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe,which has the clinical benefit in reducing the total electrophysiology laboratory time and the hospital stay length after the procedure.

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.

Game and Dynamic Communication Path-Based Pricing Strategies for Microgrids Under Communication Interruption

Nowadays,the microgrid cluster is an important application scenario for energy trading.In trading,one of the most important research directions is the issue of pricing.To determine reasonable pricing for the microgrid cluster,data communication is used to create the cyber-physical system(CPS),which can improve the observability of microgrids.Then,the following works are carried out in the CPS.In the physical layer:1)Regarding trading between microgrids and the load,based on the generalized game theory,an optimal pricing strategy is proposed,which takes into account the interactive relationships among microgrids and transforms the pricing problem into a Nikaido-Isoda function to obtain the optimal prices conveniently;2)Regarding peer-to-peer trading between two microgrids,based on evolutionary game theory and the penalty mechanism,the optimal sale price of the seller is selected with boundary rationality.In the cyber layer,regarding the communication interruption issue existing in pricing(i.e.,the game process),based on the principle of matching the performance of the path with the importance degree of the data,a dynamic regulating method of paths is proposed,i.e.,adopting a new path to re-transmit the interrupted data to the destination.Finally,the effect of the proposed strategies is verified by case studies.

Interrupted Time Series Analysis of Military and Civilian Regimes in Nigeria: A Statistical Evidence from Gross Domestic Product (GDP)

Governments influence the economy by changing the level and types of taxes, the extent and composition of spending, and the degree and form of borrowing. Governments directly and indirectly influence the way resources are used in the economy. Higher taxes, fees, and greater regulations can stymie businesses or entire industries and the resulting impact is reflected on the country’s economy status (strong or weak). The growth rate of GDP is often used as an indicator of the general health of the economy. In broad terms, an increase in real GDP is interpreted as a sign that the economy is doing well. So it is important to study and pay more attention to country’s GDP growth rate. In this paper, an intervention analysis approach was applied to Nigeria GDP data in order to evaluate the performances of military and civilian rules in the country. Data on Nigeria GDP were collected and subjected to interrupted (intervention) time series model. Based on the Alkaike Information Criterion (AIC), Bayesian Information Criterion (BIC) and sigma2 values, the interrupted time series model ARIMA (1, 1, 0) with exogenous variables (per capita per capita GDP, intervention, year and yearAfter) was identified as the best model amongst other competing models. It was observed that the intervention (civilian rule) was significant at the 10% level of significance in increasing the Nigeria GDP by 10B US$ on the average since 2005 till 2021 while controlling for the effects of other determinants. Also, the ARIMA (1, 1, 0) forecasts indicate that the Nigeria GDP will continue increasing during the civilian rule. As a result, changing from military rule to civilian rule in Nigeria significantly increased the GDP of the country.

Interrupted Time Series Analysis of Military and Civilian Regimes in Nigeria: A Statistical Evidence from Gross Domestic Product (GDP)

Governments influence the economy by changing the level and types of taxes, the extent and composition of spending, and the degree and form of borrowing. Governments directly and indirectly influence the way resources are used in the economy. Higher taxes, fees, and greater regulations can stymie businesses or entire industries and the resulting impact is reflected on the country’s economy status (strong or weak). The growth rate of GDP is often used as an indicator of the general health of the economy. In broad terms, an increase in real GDP is interpreted as a sign that the economy is doing well. So it is important to study and pay more attention to country’s GDP growth rate. In this paper, an intervention analysis approach was applied to Nigeria GDP data in order to evaluate the performances of military and civilian rules in the country. Data on Nigeria GDP were collected and subjected to interrupted (intervention) time series model. Based on the Alkaike Information Criterion (AIC), Bayesian Information Criterion (BIC) and sigma2 values, the interrupted time series model ARIMA (1, 1, 0) with exogenous variables (per capita per capita GDP, intervention, year and yearAfter) was identified as the best model amongst other competing models. It was observed that the intervention (civilian rule) was significant at the 10% level of significance in increasing the Nigeria GDP by 10B US$ on the average since 2005 till 2021 while controlling for the effects of other determinants. Also, the ARIMA (1, 1, 0) forecasts indicate that the Nigeria GDP will continue increasing during the civilian rule. As a result, changing from military rule to civilian rule in Nigeria significantly increased the GDP of the country.

常州市各级医院带量采购政策实施效果差异研究

目的评价第二批国家集中带量采购(以下简称“集采”)政策在常州市不同等级医院的实施效果。方法基于双组间断时间序列模型和描述性统计,依托江苏省常州市医疗机构药品采购数据,分析第二批国家集采政策实施对江苏省常州市二级及以上医院和基层医疗卫生机构用药影响差异。结果第二批国家集采政策实施后,常州市二级及以上医院和基层医疗卫生机构集采品种均呈现不同程度药品使用频度(defined drug dose numbers,DDDs)上升、采购金额下降和药品日均费用(defined daily dose cost,DDDc)下降的现象,其中对于基层医疗卫生机构集采中选品种使用增长效果更明显,在具体药物种类上,心血管系统类、消化系统类药物受政策影响更明显。结论政府应该根据不同医院的用药特点制定更为灵活、有针对性的集采品种使用考核标准,并将考核细化到不同种类药品的使用情况。此外,政府相关部门应持续性检测各级医院的合理用药情况,并通过奖惩制度提高医疗机构使用集采品种的积极性。

Using Interrupted Time Series Design to Analyze Changes in Hand, Foot, and Mouth Disease Incidence during the Declining Incidence Periods of 2008-2010 in China

Objective To identify patterns of hand, foot and mouth disease （HFMD） incidence in China during declining incidence periods of 2008, 2009, and 2010. Methods Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System （NDRS） and analyzed. An interrupted time series （ITS） technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Results Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level （P〈0.0001） when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 （all P〈O.O05）, but not 2009 to 2008. Conclusion Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.

MEASUREMENT OF ANODIC OVERVOLTAGE BY AMODIFIED CURRENT INTERRUPTION METHOD IN CRYOLITE-ALUMINA MELTS

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