Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Pre-hospital application of REBOA for life-threatening hemorrhage

Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Parental Knowledge of Pre-Hospital Management of Avulsed Permanent Tooth in Children at Kath

BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.

Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Factors Influencing Pre-hospital Patient Delay in Patients with Acute Myocardial Infarction

Acute myocardial infarction （AMI） is a dangerous disease with a high mortality rate. For AMI patients, the outcome of the patients depends on time to beginning of effective treatment in addition to other factors such as severity of disease and involved vessels etc. The key is whether reperfusion therapy is started early enough after the onset of symptoms, and the benefit of reperfusion therapy depends on the time, too. The delay of AMI treatment is divided into pre-hospital delay and in-hospital delay. In-hospital delay, Door-to-Balloon Time, has been well controlled. Pre-hospital delay, accounting for 75% of the total delay time, is the most important factor affect- ing AMI treatment. Patient delay （PD） time for AMI patients is summarised in this study.

Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran

Background Acute myocardial infarction （AMI） is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran. Methods Between August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction （STEMI） admitted to Cardiac Care Unit （CCU） of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P 〈 0.05 using SPSS 16. Results Mean age was （60.11±12.29） years in all patients. Majority of patients （65.4%） were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours （±16.25 hours）. Regression analysis showed that admission in weekend （P 〈0.04, 0R=1.033, 95% Cl=1.187-2.006） and misinterpretation of symptoms as cardiac origin （P 〈0.002, OR=1.986, 95% Cl=1.254-3.155） and perceiving symptoms to not be so serious （P 〈0.003, OR=3.264, 95% Cl=1.492-7.142） were factors influencing pre-hospital delay 〉 2 hours. Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

Diagnostic delay in inflammatory bowel diseases in a German population

BACKGROUND Early diagnosis is key to prevent bowel damage in inflammatory bowel disease(IBD).Risk factor analyses linked with delayed diagnosis in European IBD patients are scarce and no data in German IBD patients exists.AIM To identify risk factors leading to prolonged diagnostic time in a German IBD cohort.METHODS Between 2012 and 2022,430 IBD patients from four Berlin hospitals were enrolled in a prospective study and asked to complete a 16-item questionnaire to determine features of the path leading to IBD diagnosis.Total diagnostic time was defined as the time from symptom onset to consulting a physician(patient waiting time)and from first consultation to IBD diagnosis(physician diagnostic time).Univariate and multivariate analyses were performed to identify risk factors for each time period.RESULTS The total diagnostic time was significantly longer in Crohn’s disease(CD)compared to ulcerative colitis(UC)patients(12.0 vs 4.0 mo;P<0.001),mainly due to increased physician diagnostic time(5.5 vs 1.0 mo;P<0.001).In a multivariate analysis,the predominant symptoms diarrhea(P=0.012)and skin lesions(P=0.028)as well as performed gastroscopy(P=0.042)were associated with longer physician diagnostic time in CD patients.In UC,fever was correlated(P=0.020)with shorter physician diagnostic time,while fatigue(P=0.011)and positive family history(P=0.046)were correlated with longer physician diagnostic time.CONCLUSION We demonstrated that CD patients compared to UC are at risk of long diagnostic delay.Future efforts should focus on shortening the diagnostic delay for a better outcome in these patients.

Prescribed Performance Tracking Control of Time-Delay Nonlinear Systems With Output Constraints

The problem of prescribed performance tracking control for unknown time-delay nonlinear systems subject to output constraints is dealt with in this paper. In contrast with related works, only the most fundamental requirements, i.e., boundedness and the local Lipschitz condition, are assumed for the allowable time delays. Moreover, we focus on the case where the reference is unknown beforehand, which renders the standard prescribed performance control designs under output constraints infeasible. To conquer these challenges, a novel robust prescribed performance control approach is put forward in this paper.Herein, a reverse tuning function is skillfully constructed and automatically generates a performance envelop for the tracking error. In addition, a unified performance analysis framework based on proof by contradiction and the barrier function is established to reveal the inherent robustness of the control system against the time delays. It turns out that the system output tracks the reference with a preassigned settling time and good accuracy,without constraint violations. A comparative simulation on a two-stage chemical reactor is carried out to illustrate the above theoretical findings.

Attosecond ionization time delays in strong-field physics

Electronic processes within atoms and molecules reside on the timescale of attoseconds. Recent advances in the laserbased pump-probe interrogation techniques have made possible the temporal resolution of ultrafast electronic processes on the attosecond timescale, including photoionization and tunneling ionization. These interrogation techniques include the attosecond streak camera, the reconstruction of attosecond beating by interference of two-photon transitions, and the attoclock. While the former two are usually employed to study photoionization processes, the latter is typically used to investigate tunneling ionization. In this review, we briefly overview these timing techniques towards an attosecond temporal resolution of ionization processes in atoms and molecules under intense laser fields. In particular, we review the backpropagation method, which is a novel hybrid quantum-classical approach towards the full characterization of tunneling ionization dynamics. Continued advances in the interrogation techniques promise to pave the pathway towards the exploration of ever faster dynamical processes on an ever shorter timescale.

Examining the association between delay discounting,delay aversion and physical activity in Chinese adults with type-2 diabetes mellitus

BACKGROUND The role of physical activity in diabetes is critical,influencing this disease's development,man-agement,and overall outcomes.In China,22.3%of adults do not meet the minimum level of physical activity recommended by the World Health Organization.Therefore,it is imperative to identify the factors that contributing to lack of physical activity must be identified.AIM To investigate the relationship among delay discounting,delay aversion,glycated hemoglobin(HbA1c),and various levels of physical activity in Chinese adults diagnosed with type 2 diabetes mellitus(T2DM).METHODS In 2023,400 adults with T2DM were recruited from the People's Hospital of Linxia Hui Autonomous Prefecture of Gansu Province.A face-to-face questionnaire was used to gather demographic data and details on physical activity,delay discounting,and delay aversion.In addition,HbA1c levels were measured in all 400 participants.The primary independent variables considered were delay discounting and delay aversion.The outcome variables included HbA1c levels and different intensity levels of physical activity,including walking,moderate physical activity,and vigorous physical activity.Multiple linear regression models were utilized to assess the relationship between delay discounting,delay aversion,and HbA1c levels,along with the intensity of different physical activity measured in met-hours per week.RESULTS After controlling for the sample characteristics,delay discounting was negatively associated with moderate physical activity(β=-2.386,95%CI:-4.370 to-0.401).Meanwhile,delay aversion was negatively associated with the level of moderate physical activity(β=-3.527,95%CI:-5.578 to-1.476)in the multiple linear regression model,with statistically significant differences.CONCLUSION Elevated delay discounting and increased delay aversion correlated with reduced levels of moderate physical activity.Result suggests that delay discounting and aversion may influence engagement in moderate physical activity.This study recommends that health administration and government consider delay discounting and delay aversion when formulating behavioral intervention strategies and treatment guidelines involving physical activity for patients with T2DM,which may increase participation in physical activity.This study contributes a novel perspective to the research on physical activity in adults with T2DM by examining the significance of future health considerations and the role of emotional responses to delays.

Spectrum of delayed post-hypoxic leukoencephalopathy syndrome:A systematic review

BACKGROUND Delayed post hypoxic leukoencephalopathy syndrome(DPHLS),also known as Grinker’s myelinopathy,is a rare but significant neurological condition that manifests days to weeks after a hypoxic event.Characterized by delayed onset of neurological and cognitive deficits,DPHLS presents substantial diagnostic and therapeutic challenges.AIM To consolidate current knowledge on pathophysiology,clinical features,diagnostic approaches,and management strategies for DPHLS,providing a comprehensive overview and highlighting gaps for future research.METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines,we systematically searched PubMed,ScienceDirect and Hinari databases using terms related to delayed post-hypoxic leukoencephalopathy.Inclusion criteria were original research articles,case reports,and case series involving human subjects with detailed clinical,neuroimaging,or pathological data on DPHLS.Data were extracted on study characteristics,participant demographics,clinical features,neuroimaging findings,pathological findings,treatment,and outcomes.The quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.RESULTS A total of 73 cases were reviewed.Common comorbidities included schizoaffective disorder,bipolar disorder,hypertension,and substance use disorder.The primary causes of hypoxia were benzodiazepine overdose,opioid overdose,polysubstance overdose,and carbon monoxide(CO)poisoning.Symptoms frequently include decreased level of consciousness,psychomotor agitation,cognitive decline,parkinsonism,and encephalopathy.Neuroimaging commonly revealed diffuse T2 hyperintensities in cerebral white matter,sometimes involving the basal ganglia and the globus pallidus.Magnetic resonance spectroscopy often showed decreased N-acetylaspartate,elevated choline,choline-to-creatinine ratio,and normal or elevated lactate.Treatment is often supportive,including amantadine,an antioxidant cocktail,and steroids.Hyperbaric oxygen therapy may be beneficial in those with CO poisoning.Parkinsonism was often treated with levodopa.Most of the patients had substantial recovery over the course of months and many cases had some residual neurocognitive deficits.CONCLUSION DPHLS remains a complex and multifaceted condition with various etiologies and clinical manifestations.Early recognition and appropriate management are crucial to improving patient outcomes.Future research should focus on standardizing diagnostic criteria,using advanced imaging techniques,and exploring therapeutic interventions to improve understanding and treatment of DPHLS.Conducting prospective cohort studies and developing biomarkers for early diagnosis and monitoring will be essential to advance patient care.

Analysis and Design of Time-Delay Impulsive Systems Subject to Actuator Saturation

This paper investigates the exponential stability and performance analysis of nonlinear time-delay impulsive systems subject to actuator saturation. When continuous dynamics is unstable, under some conditions, it is shown that the system can be stabilized by a class of saturated delayed-impulses regardless of the length of input delays. Conversely, when the system is originally stable, it is shown that under some conditions, the system is robust with respect to sufficient small delayed-impulses. Moreover, the design problem of the controller with the goal of obtaining a maximized estimate of the domain of attraction is formulated via a convex optimization problem. Three examples are provided to demonstrate the validity of the main results.

A nonlocal dispersal and time delayed HIV infection model with general incidences

Biologically,because of the impact of reproduction period and nonlocal dispersal of HIV-infected cells,time delay and spatial heterogeneity should be considered.In this paper,we establish an HIV infection model with nonlocal dispersal and infection age.Moreover,applying the theory of Fourier transformation and von Foerster rule,we transform the model to an integrodifferential equation with nonlocal time delay and dispersal.The well-posedness,positivity,and boundedness of the solution for the model are studied.

Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching Pub Med for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunostomy”, “pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.

Designing Proportional-Integral Consensus Protocols for Second-Order Multi-Agent Systems Using Delayed and Memorized State Information

This paper is concerned with consensus of a secondorder linear time-invariant multi-agent system in the situation that there exists a communication delay among the agents in the network.A proportional-integral consensus protocol is designed by using delayed and memorized state information.Under the proportional-integral consensus protocol,the consensus problem of the multi-agent system is transformed into the problem of asymptotic stability of the corresponding linear time-invariant time-delay system.Note that the location of the eigenvalues of the corresponding characteristic function of the linear time-invariant time-delay system not only determines the stability of the system,but also plays a critical role in the dynamic performance of the system.In this paper,based on recent results on the distribution of roots of quasi-polynomials,several necessary conditions for Hurwitz stability for a class of quasi-polynomials are first derived.Then allowable regions of consensus protocol parameters are estimated.Some necessary and sufficient conditions for determining effective protocol parameters are provided.The designed protocol can achieve consensus and improve the dynamic performance of the second-order multi-agent system.Moreover,the effects of delays on consensus of systems of harmonic oscillators/double integrators under proportional-integral consensus protocols are investigated.Furthermore,some results on proportional-integral consensus are derived for a class of high-order linear time-invariant multi-agent systems.

Assessment of the three representative empirical models for zenith tropospheric delay(ZTD)using the CMONOC data

The precise correction of atmospheric zenith tropospheric delay(ZTD)is significant for the Global Navigation Satellite System(GNSS)performance regarding positioning accuracy and convergence time.In the past decades,many empirical ZTD models based on whether the gridded or scattered ZTD products have been proposed and widely used in the GNSS positioning applications.But there is no comprehensive evaluation of these models for the whole China region,which features complicated topography and climate.In this study,we completely assess the typical empirical models,the IGGtropSH model(gridded,non-meteorology),the SHAtropE model(scattered,non-meteorology),and the GPT3 model(gridded,meteorology)using the Crustal Movement Observation Network of China(CMONOC)network.In general,the results show that the three models share consistent performance with RMSE/bias of 37.45/1.63,37.13/2.20,and 38.27/1.34 mm for the GPT3,SHAtropE and IGGtropSH model,respectively.However,the models had a distinct performance regarding geographical distribution,elevation,seasonal variations,and daily variation.In the southeastern region of China,RMSE values are around 50 mm,which are much higher than that in the western region,approximately 20 mm.The SHAtropE model exhibits better performance for areas with large variations in elevation.The GPT3 model and the IGGtropSH model are more stable across different months,and the SHAtropE model based on the GNSS data exhibits superior performance across various UTC epochs.

Joint computation offloading and parallel scheduling to maximize delay-guarantee in cooperative MEC systems

The growing development of the Internet of Things(IoT)is accelerating the emergence and growth of new IoT services and applications,which will result in massive amounts of data being generated,transmitted and pro-cessed in wireless communication networks.Mobile Edge Computing(MEC)is a desired paradigm to timely process the data from IoT for value maximization.In MEC,a number of computing-capable devices are deployed at the network edge near data sources to support edge computing,such that the long network transmission delay in cloud computing paradigm could be avoided.Since an edge device might not always have sufficient resources to process the massive amount of data,computation offloading is significantly important considering the coop-eration among edge devices.However,the dynamic traffic characteristics and heterogeneous computing capa-bilities of edge devices challenge the offloading.In addition,different scheduling schemes might provide different computation delays to the offloaded tasks.Thus,offloading in mobile nodes and scheduling in the MEC server are coupled to determine service delay.This paper seeks to guarantee low delay for computation intensive applica-tions by jointly optimizing the offloading and scheduling in such an MEC system.We propose a Delay-Greedy Computation Offloading(DGCO)algorithm to make offloading decisions for new tasks in distributed computing-enabled mobile devices.A Reinforcement Learning-based Parallel Scheduling(RLPS)algorithm is further designed to schedule offloaded tasks in the multi-core MEC server.With an offloading delay broadcast mechanism,the DGCO and RLPS cooperate to achieve the goal of delay-guarantee-ratio maximization.Finally,the simulation results show that our proposal can bound the end-to-end delay of various tasks.Even under slightly heavy task load,the delay-guarantee-ratio given by DGCO-RLPS can still approximate 95%,while that given by benchmarked algorithms is reduced to intolerable value.The simulation results are demonstrated the effective-ness of DGCO-RLPS for delay guarantee in MEC.

An analytical model to estimate the time delay to reach spontaneous ignition considering heat loss in oil reservoirs

During air injection into an oil reservoir,an oxidation reaction generates some heat to raise the reservoir temperature.When the reservoir temperature reaches an ignition temperature,spontaneous ignition occurs.There is a time delay from the injection to ignition.There are mixed results regarding the feasibility of spontaneous ignition in real-field projects and in laboratory experiments.No analytical model is available in the literature to estimate the oxidation time required to reach spontaneous ignition with heat loss.This paper discusses the feasibility of spontaneous ignition from theoretical points and experimental and field project observations.An analytical model considering heat loss is proposed.Analytical models with and without heat loss investigate the factors that affect spontaneous ignition.Based on the discussion and investigations,we find that it is more difficult for spontaneous ignition to occur in laboratory experiments than in oil reservoirs;spontaneous ignition is strongly affected by the initial reservoir temperature,oil activity,and heat loss;spontaneous ignition is only possible when the initial reservoir temperature is high,the oil oxidation rate is high,and the heat loss is low.

Awake rabbit model of ischemic spinal cord injury with delayed paraplegia:The role of ambient temperature

Background:Paraplegia after spinal cord ischemia is a devastating condition in the clinic.Here,we develop an awake rabbit model of spinal cord ischemia with delayed paraplegia and explore the influence of ambient temperature on the outcomes after injury.Methods:A total of 47 male rabbits were involved in the present study.Transient spinal cord ischemia was induced by occluding the infrarenal abdominal aorta of awake rabbits at different ambient temperatures.To find the optimal conditions for developing delayed paraplegia,hindlimb motor function after ischemia was evaluated between experiments.Results:The onset and magnitude of ischemic injury varied with the ambient temperature maintained during the peri-i schemia period.More serious spinal cord injury occurred when ischemia was induced at higher temperatures.At 18°C,25-minute ischemia resulted in 74%of rabbits developing delayed paraplegia.At a temperature of 28°C or higher,most of the animals developed acute paraplegia immediately.While at 13°C,rabbits usually regained normal motor function without paraplegia.Conclusion:This awake rabbit model is highly reproducible and will be helpful in future studies of delayed paraplegia after spinal cord ischemia.The ambient temperature must be considered while using this model during investigation of therapeutic interventions.