Enhanced Deep Reinforcement Learning Strategy for Energy Management in Plug-in Hybrid Electric Vehicles with Entropy Regularization and Prioritized Experience Replay

Plug-in Hybrid Electric Vehicles(PHEVs)represent an innovative breed of transportation,harnessing diverse power sources for enhanced performance.Energy management strategies(EMSs)that coordinate and control different energy sources is a critical component of PHEV control technology,directly impacting overall vehicle performance.This study proposes an improved deep reinforcement learning(DRL)-based EMSthat optimizes realtime energy allocation and coordinates the operation of multiple power sources.Conventional DRL algorithms struggle to effectively explore all possible state-action combinations within high-dimensional state and action spaces.They often fail to strike an optimal balance between exploration and exploitation,and their assumption of a static environment limits their ability to adapt to changing conditions.Moreover,these algorithms suffer from low sample efficiency.Collectively,these factors contribute to convergence difficulties,low learning efficiency,and instability.To address these challenges,the Deep Deterministic Policy Gradient(DDPG)algorithm is enhanced using entropy regularization and a summation tree-based Prioritized Experience Replay(PER)method,aiming to improve exploration performance and learning efficiency from experience samples.Additionally,the correspondingMarkovDecision Process(MDP)is established.Finally,an EMSbased on the improvedDRLmodel is presented.Comparative simulation experiments are conducted against rule-based,optimization-based,andDRL-based EMSs.The proposed strategy exhibitsminimal deviation fromthe optimal solution obtained by the dynamic programming(DP)strategy that requires global information.In the typical driving scenarios based onWorld Light Vehicle Test Cycle(WLTC)and New European Driving Cycle(NEDC),the proposed method achieved a fuel consumption of 2698.65 g and an Equivalent Fuel Consumption(EFC)of 2696.77 g.Compared to the DP strategy baseline,the proposed method improved the fuel efficiency variances(FEV)by 18.13%,15.1%,and 8.37%over the Deep QNetwork(DQN),Double DRL(DDRL),and original DDPG methods,respectively.The observational outcomes demonstrate that the proposed EMS based on improved DRL framework possesses good real-time performance,stability,and reliability,effectively optimizing vehicle economy and fuel consumption.

Practical Experience of Management of Urban Parks at Home and Abroad

By systematically reviewing the practical experience of management of urban parks at home and abroad,the advanced experience in organization,management system,operation mechanism and social participation were summarized,and the optimization and improvement measures for the construction and management of urban parks in Chengdu were proposed to provide reference for the high-level construction,high-quality experience and efficient management of urban parks in the construction of park city demonstration zone in Chengdu.

Experience on the Management of Priapism at the Yaounde Central Hospital

Introduction: Priapism is a urological emergency defined as a prolonged penile erection for more than 6 hours, painful and sustained, occurring without any sexual stimulation. The diagnosis is essentially clinical. However, the management is often late because of the delay in consultation, which is characteristic in our context. The purpose of our study is to describe the clinical and therapeutic aspects of patients who presented with priapism at the Yaoundé Central Hospital as well as to propose a present synthesis concerning the management of priapism. Methodology: We conducted a descriptive cross-sectional study with a retrospective recruitment method in the urology department of the YCH. It extended over a period of 6 months from January 2022 to June 2022. We reviewed the files of patients seen within a period spanning 10 years from January 1st, 2011 to January 31st, December 2021. The study population consisted of patients who had been hospitalized and treated for priapism. We carried out consecutive and non-exhaustive sampling. Results: During the study, we collected data from the medical files of 13 patients. The median age was 25 years, with extremes of 12 and 82 years. Most of the patients were between 20 and 30 years old (38.5%). Most of the patients were single (69.2%). Sickle cell disease was the main comorbidity encountered during the study (76.9%). The median time from onset of symptoms to consultation was 10 [6 - 20.5] hours, with extremes of 1 and 264 hours. All patients presented with painful penile erection (100%). There was concomitant multifocal pain in 38.5% of cases suggestive of vaso-occlusive crises (VOC). The symptoms occurred in a non-traumatic context in the majority of cases (92.3%). The T-shunt was the most used surgical technique (84.6%). The median duration of surgery was 36 [35 - 40] minutes with extremes of 25 and 60 minutes, the majority being operated in less than 45 minutes (84.6%). The frequency of postoperative complications was 46.2%, dominated by weak erections/loss of erections (38.5%). The median duration of hospitalisation was 4 [3 - 5.5] days, with extremes 2 and 20 days of hospitalisation. Resumption of sexual activity was reported in 8 patients (61.5%). The time to recovery was mostly greater than 6 weeks (62.5%). Conclusion: Priapism remains a urological emergency. The prognosis depends on the patients’ promptness in consulting. The T-Shunt is an effective surgical technique in the event of failure of medical treatment.

Nurse anesthetists’perceptions and experiences of managing emergence delirium:A qualitative study

BACKGROUND This study employs a descriptive phenomenological approach to investigate the challenges anesthesia nurses face in managing emergence delirium(ED),a common and complex postoperative complication in the post-anesthesia care unit.The role of nurses in managing ED is critical,yet research on their understanding and management strategies for ED is lacking.AIM To investigate anesthetic nurses’cognition and management experiences of ED in hopes of developing a standardized management protocol.METHODS This study employed a descriptive phenomenological approach from qualitative research methodologies.Purposeful sampling was utilized to select 12 anesthetic nurses from a tertiary hospital in Shanghai as research subjects.Semi-structured interviews were conducted,and the data were organized and analyzed using Colaizzi’s seven-step analysis method,from which the final themes were extracted.RESULTS After analyzing the interview content,four main themes and eight subthemes were distilled:Inefficient cognition hinders the identification of ED(conceptual ambiguity,empirical identification),managing diversity and challenges(patientcentered safe care,low level of medical-nursing collaboration),work responsibilities and pressure coexist(heavy work responsibilities,occupational risks and stress),demand for high-quality management(expecting the construction of predictive assessment tools and prevention strategies,and pursuing standardized management processes to enhance management effectiveness).CONCLUSION Nursing managers should prioritize the needs and suggestions of nurses in order to enhance their nursing capabilities and provide guidance for standardized management processes.

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.

Effectiveness of Comprehensive Nursing Management in Enhancing Blood Donation Outcomes and Donor Experience: A Comparative Study

Objective:To assess the management effect of comprehensive nursing management on blood donation services in blood stations.Methods:Sixty-four individuals who donated blood at a blood station between September 2021 and September 2023 were selected and randomly assigned into two groups of 32 each.The first group received comprehensive nursing management,while the second group received routine nursing management.Blood donation indexes and observational indexes such as adverse reactions were compared between the groups.Results:The total blood donation volume and qualified blood donation volume were higher in the first group than in the second group.The amount of discarded blood and the rate of blood discards were lower in the first group compared to the second group(P<0.05).Additionally,the adverse reaction rate in the first group was lower,the blood donation comfort scores were higher,the psychological state scores were lower,and the quality of care scores were higher than those in the second group(P<0.05).Conclusion:Comprehensive nursing management can improve the efficiency of blood donation,reduce the rate of blood discards,decrease the incidence of adverse reactions,alleviate negative psychological states of blood donors,and enhance both the comfort level of blood donation and the quality of care provided.

Physicians＇ and Managers＇ Approach to Quality --Experience in Italian Hospitals

Literature provides many contributions about quality management and quality improvement. A few authors investigated the kind and strength of contribution to quality from physicians and managers. This study investigates the different approaches of physicians and managers towards managing and improving quality within healthcare organizations. Research questions are focused on the existence of any kind of correlation between physicians＇ and quality managers＇ skills as regards quality management. Do they work independently or is it possible to find out some relationship between their effort in enforcing service quality. In addition to that, the paper investigates if there is a correlation between organization＇s characteristic （dimension, ownership, teaching/not-teaching hospital） and quality of services. The study investigates an Italian regional-wide external assessment program （performed by Joint Commission International） focusing on a selection of item/standard related to physicians and quality managers＇ behaviours. The study did not found significant correlation between behaviours and hospitals＇ structural characteristics as well as between physicians＇ managerial behaviours and managers＇ behaviours as regards to quality. Physicians＇ and managers＇ contributions are independent to each other. The influence of managers on clinical behaviours is weak. Quality management depends mainly on people, not on structural elements.

Managers and Information Society： A Croatian Experience

In modem society information has become one of the most important resources, playing a crucial role in everyday life. As a result, information technology （IT） is now an indispensable tool in the business world, which has a direct impact on company competitiveness and performance. With all the changes in business environment there is also a dramatic shift in the way the management functions. In order to efficiently perform their tasks and thus rise up to the challenges of the information society, managers need not only to master appropriate IT skills, but also to understand the processes launched by the information revolution. The aim of this paper was to determine the extent to which Croatian managers are prepared for the information society. In addition to the data regarding the level of IT equipment at managers＇ disposal, the paper presents the results on computer usage, self-assessment of IT competencies, and the level of acceptance of modern technologies. Although satisfactory attainment has been recorded in some areas, the results of the analysis reveal that additional effort should be devoted to further improve computer and information literacy of Croatian managers.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

Expert Experience and Data-Driven Based Hybrid Fault Diagnosis for High-SpeedWire Rod Finishing Mills

The reliable operation of high-speed wire rod finishing mills is crucial in the steel production enterprise.As complex system-level equipment,it is difficult for high-speed wire rod finishing mills to realize fault location and real-time monitoring.To solve the above problems,an expert experience and data-driven-based hybrid fault diagnosis method for high-speed wire rod finishing mills is proposed in this paper.First,based on its mechanical structure,time and frequency domain analysis are improved in fault feature extraction.The approach of combining virtual value,peak value with kurtosis value index,is adopted in time domain analysis.Speed adjustment and side frequency analysis are proposed in frequency domain analysis to obtain accurate component characteristic frequency and its corresponding sideband.Then,according to time and frequency domain characteristics,fault location based on expert experience is proposed to get an accurate fault result.Finally,the proposed method is implemented in the equipment intelligent diagnosis system.By taking an equipment fault on site,for example,the effectiveness of the proposed method is illustrated in the system.

Incidence and management of colonoscopic perforations: 8 years' experience

AIM： To review the experience of a major medical teaching center with diagnostic and therapeutic colonoscopies and to assess the incidence and management of related colonic perforations. METHODS： All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed. RESULTS： A total of 12 067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations （4 females, 3 males） were diagnosed （0.058%）. Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4 patients. No deaths were reported. CONCLUSION： Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option.

Experience of Clinical Management for Pregnant Women and Newborns with Novel Coronavirus Pneumonia in Tongji Hospital,China

Based on the New Diagnosis and Treatment Scheme for Novel Coronavirus Infected Pneumonia(Trial Edition 5),combined with our current clinical treatment experience,we recently proposed a revision of the first edition of“Guidance for maternal and fctal management during pneumonia epidemics of novel coronavirus infection in the Wuhan Tongji Hospital".This article focused on the issues of greatest concern of pregnant women including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection diagnostic criteria,inspection precautions,drug treatment options,indications and methods of termination of pregnancy,postpartum fever,breastfeeding considerations,mode of mother-to-child transmission,neonatal isolation and advice on nconatal nursing,to provide valuable experience for better management of SARS-CoV-2 infection in pregnant women and newborns.

Anorectal malignant melanomas: Retrospective experience with surgical management

AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences. METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis. RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate. CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.

Acceptance and Experience of HIV-Infected Adolescents in Two Hospitals in Yaoundé

Introduction: Access to antiretroviral drugs has improved the survival of children infected with the Human Immunodeficiency Virus (HIV). As they reach adolescence, they are confronted with various constraints related to the infection and its treatment, in addition to those of the growth period they are going through. The main aim of the study was to assess the acceptance and describe the experience of HIV infection by infected adolescents but also to investigate the factors associated with good acceptance and a positive experience. Methodology: The cross-sectional analytic study concerned HIV-infected adolescents aged 15 to 19 followed up at the Chantal Biya Foundation-Mother and Child Centre (CME-FCB) and the Yaoundé University Hospital Centre (CHUY) between February 2020 and June 2020. The study saw participants complete a questionnaire containing socio-demographic data and assessing acceptance and experience with the infection. Data analysis was accomplished using Epi info software version 7.2.2.6. Results: One hundred and thirteen HIV-infected adolescents were included in the study. The sex ratio was 0.68 and the mean age was 17 years. More than half of the adolescents had a good acceptance and positive experience with the infection. Related factors were the adolescent’s perception of good health and participation in an association with other infected adolescents. Conclusion: Emphasizing the psychological and educational follow-up of infected adolescents and encouraging their participation in associations for adolescents living with HIV could reduce the consequences of poor acceptance and ensure a better transition to adulthood. .

Finding biomarkers of experience in animals

At a time when there is a growing public interest in animal welfare,it is critical to have objective means to assess the way that an animal experiences a situation.Objectivity is critical to ensure appropriate animal welfare outcomes.Existing behavioural,physiological,and neurobiological indicators that are used to assess animal welfare can verify the absence of extremely negative outcomes.But welfare is more than an absence of negative outcomes and an appropriate indicator should reflect the full spectrum of experience of an animal,from negative to positive.In this review,we draw from the knowledge of human biomedical science to propose a list of candidate biological markers(biomarkers)that should reflect the experiential state of non-human animals.The proposed biomarkers can be classified on their main function as endocrine,oxidative stress,non-coding molecular,and thermobiological markers.We also discuss practical challenges that must be addressed before any of these biomarkers can become useful to assess the experience of an animal in real-life.

What are the self-management experiences of the elderly with diabetes?A systematic review of qualitative research

BACKGROUND The number of elderly individuals with diabetes is dramatically increasing.Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management.Understanding of self-management from the patients’perspectives is important to nurses,healthcare providers,and researchers and benefits people by improving their self-management skills.AIM To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.METHODS Electronic databases were searched,including MEDLINE,CINAH,PsycINFO,PubMed,CNKI,and WANFADATA.Relevant research was identified by manually searching reference lists and gray literature.Only English and Chinese publications were included.The Critical Appraisal Skills Program was used to assess the quality of the research.The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.RESULTS A total of 10 qualitative studies were included,and content analysis was performed.Five themes were identified:The need for knowledge about diabetes care,support systems,functional decline,attitudes toward diabetes,and healthy lifestyle challenges.CONCLUSION This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Psychological experience of breastfeeding among primiparous women with lactating mastitis:A qualitative research

Objective:The objective of this study is to comprehensively understand the psychological experience of primiparous women during breastfeeding while dealing with lactating mastitis and to establish a reliable foundation for tailored support measures.Methods:Twenty primiparous mothers from a tertiary hospital in Beijing between January and March 2023 were chosen using purposive sampling for semi-structured interviews.After conducting 20 interviews,data saturation was achieved.The Colaizzi’s seven-step analytical approach was employed to analyze,summarize,and refine the identified themes.Results:Among primiparous women afflicted by lactating mastitis,the primary themes regarding breastfeeding attitudes included three key aspects:(1)uncertainty during the initial diagnosis phase,(2)intricate emotional journey during treatment,and(3)positive psychological outlook during the recovery stage.Conclusion:Primiparous women undergoing lactating mastitis experience substantial physical and psychological strain.It is crucial for medical personnel,family caregivers,and society at large to be attuned to the emotions of these patients.Tailored support measures should be offered to enhance patients’physical and mental well-being and facilitate disease recovery.

Pre-Hospital Management of Craniocerebral Trauma in South Saharan Africa: Cotonou Experience

The management of craniocerebral trauma begins at the site of the accident. This is one of the diseases for which pre-hospital care is well codified. The objective of this study is to report the experience of the Emergency Aid Medical Service (EMAS) of BENIN in the pre-hospital management of craniocerebral trauma. 146 head injuries were cared for. 116 were male. The mean age was 32 years with extremes ranging from 2 to 77 years. Etiology in 68% of patients was a public road accident. And the request for the use of the EMAS was made by highway users for 41% of the injuries. About 5.5% were severe cranio-brain injuries, more than 75% of which had died in intensive care. In 77% of the EMAS interventions, there was an intensive care physician in the team. 34 wounded had been transported in a vacuum mattress. The rigid cervical collar was used in 8 major traumas. All the wounded were transported by ambulance. The duration of hospitalization varied from a few hours in the emergency department to 90 days in the hospital ward. 9 patients died. One of them, who died in an ambulance, was a woman. The prehospital medical care of head trauma in BENIN is still progressing.

Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.