Patient Safety in the Use of Mechanical Restraints: Regulatory Compliance among Hospitals in the City of Buenos Aires and Proposal for Its Improvement

Introduction: Mechanical or physical restraint is an exceptional therapeutic resource to immobilize a subject and thus guarantee the safety of the patient and/or third parties in the face of high-risk behaviors, but it entails multiple crossings (bioethical, philosophical, medical, psychological, legal). Framed in the so-called “safety culture” developed by the WHO, based on the Protocol for its implementation of the CABA and attentive to its frequent use in CABA by different hospital services (medical clinic, geriatrics, intensive care and medical guards) we consider it necessary its study in terms of compliance with the risks it entails and its management. Objectives: Identify regulatory compliance with the GCABA Mechanical restraint (MR) Protocol from a patient safety perspective, as well as describe the clinical and medicolegal aspects, and propose the usefulness of a tool for its management and control. Methodology: Observational, descriptive, transversal and prospective work through the analysis of Clinical Records with indication of MR using a rubric-type form. 177 cases were analyzed between September-November 2023 from three hospitals of the Government of the City of Buenos Aires, statistical parameters were applied and graphs were made. Results: Only 12.99% complied with the Protocol. In the mental health specialized hospital compliance was almost 5 times greater than in the general one, and in the emergency services compliance was 12 times greater than in Inpatient services. We found that the start or end time of MR was not recorded and only 43% described the causes/justifications for the indication (mostly in Emergency and Specialized hospitals), with the MR average time being shorter in Emergency. Conclusions: Only 1.3 out of 10 patients reliably completed the Protocol and it was mostly in the mental health specialized hospital and the emergency services. The results show non-compliance behavior in the application and management of the risk that the use of mechanical restraints entails, being causes for criminal litigation. We consider that the checklists are useful to complete the Protocol and thus provide security to patients and professionals.

Planning and construction of Xiong’an New Area(city of over 5 million people):Contributions of China’s geologists and urban geology

China established Xiong’an New Area in Hebei Province in 2017,which is planned to accommodate about 5 million people,aiming to relieve Beijing City of the functions non-essential to its role as China’s capital and to expedite the coordinated development of the Beijing-Tianjin-Hebei region.From 2017 to 2021,the China Geological Survey(CGS)took the lead in multi-factor urban geological surveys involving space,resources,environments,and disasters according to the general requirements of“global vision,international standards,distinctive Chinese features,and future-oriented goals”in Xiong’an New Area,identifying the engineering geologic conditions and geologic environmental challenges of this area.The achievements also include a 3D engineering geological structure model for the whole area,along with“one city proper and five clusters”,insights into the ecology and the background endowment of natural resources like land,geothermal resources,groundwater,and wetland of the area before engineering construction,a comprehensive monitoring network of resources and environments in the area,and the“Transparent Xiong’an”geological information platform that is open,shared,dynamically updated,and three-dimensionally visualized.China’s geologists and urban geology have played a significant role in the urban planning and construction of Xiong’an New Area,providing whole-process geological solutions for urban planning,construction,operation and management.The future urban construction of Xiong’an New Area will necessitate the theoretical and technical support of earth system science(ESS)from various aspects,and the purpose is to enhance the resilience of the new type of city and to provide support for the green,low-carbon,and sustainable development of this area.

The Fuzzy Synthesizing Evaluation of City's Environmental Quality Based on GIOWA Operator:A Case of 13 Cities of Jiangsu Province

In this paper, the generally induced ordered weighted averaging (GIOWA) operator is used to construct the fuzzy evaluating system of the quality of a city’s environment including air, water and noise. Based on the part data of air, water and noise of the 13 cities under the jurisdiction of Jiangsu provincial government in 2002, a case study is given. The evaluating results show that the evaluating system of the quality of a city’s environment based on the GIOWA operator can reflect the condition of pollution controlled and environmental quality of a city in a period of time.

Study on City Environment,Safety and Health from the Viewpoint of Ecological Risks

Urban ecological risk analysis is a relatively new study field.Rapid industrial modernization and urbanization have significantly improved the living standards of the city.However,as environmental,safety and health issues are causing widespread concern,these problems have potential serious threat on ecosystems and human health.So how to solve many problems arising from city has become a key to sustainable development of human civilization.The present article analyzed the major problems that the city confronts and pointed out the main measures from the aspects of urban environment,safety and health.

Order Exponential Evaluation Model for Road Traffic Safety in City Clusters

This study presents an order exponential model for estimating road traffic safety in city clusters.The proposed model introduces the traffic flow intrinsic properties and uses the characteristics and regular patterns of traffic development to identify road traffic safety levels in city clusters.Additionally,an evaluation index system of city cluster road traffic safety was constructed based on the spatial and temporal distribution.Then Order Exponential Evaluation Model(OEEM),a comprehensive model using order exponent function for road traffic safety evaluation,was put forward,which considers the main characteristics and the generation process of traffic accidents.The model effectively controlled the unsafe behavior of the traffic system.It could define the levels of city cluster road traffic safety and dynamically detect road safety risk.The proposed model was verified with statistical data from three Chinese city clusters by comparing the common model for road traffic safety with an ideal model.The results indicate that the order exponent approach undertaken in this study can be extended and applied to other research topics and fields.

Safe Vegetable Consumption in Hue City:A Case Study of Food Safety Situation in Vietnam

Food safety has become a growing concern for citizens in the modern society when consuming unsafe food that directly impacts public health,life quality and well-being of each country.People of Vietnam in general and specially in Hue city have been facing challenge of vegetable unsafety.A survey concerning the consumption of safe vegetables was conducted in Hue city,Vietnam.Data were collected by using a well-structured questionnaire from representative of 30 consumers,30 producers and 10 collectors.The results showed that lettuce,sweet potato and Chinese mustard were identified as the most important vegetables to consumers in Hue city.Most of the consumers purchased vegetable every day.The cost of vegetable in every transaction was about 30,000 VND.This expenditure has not created a great motivation for developing safe vegetable production.Most of the consumers in Hue city showed high interest,demand,trust and satisfaction for safe vegetable.However,50%of the consumers reported that the price of the safe vegetable was quite expensive and price was not matched with their quality.Moreover,there were some disadvantages in each stage of vegetable supply chain.For example,land,seed,capital,cultivation techniques,preliminary processing,preservation,brand name,trademark and place to consume have not met the requirement of high technology production for the supply chain of safe vegetables.The chain linking between the production and consumption of vegetables is not sustainable.Producers and consumers do not have closely links.Vegetable can not be traced to origin and there is no safe certificate.The consumers believe the quality of vegetables depending on the prestige suppliers,such as,the vegetable shops with foreign consultants.Safe vegetables of farmers are very difficult to be certified for safe vegetables.Solutions and suggestions to Hue city are proposed that it is necessary to establish the vegetable production area in Hue city.Vegetable growers should be supported with capital,knowledge,technology,vegetable preliminary processing and preservation.They should be supported to build a trademark and certificate of vegetable safety and establish the chains of effective safe vegetable consumption.

基于西门子S7 Safety技术的烟厂物流安全系统

针对烟企物流系统安全性问题,介绍了一种基于西门子S7 Safety技术的物流安全系统,给出相关安全控制程序编写流程。

The Scale of Constructing Mountainous Cities in Yunnan Province based on “Benchmark” Farmlands

In 2011, Yunnan provincial committee and government proposed the strat- egy of constructing mountainous cities in order to protect farmlands and guarantee crop safety, which makes full use of hills and gentle-slopes and transforms land use pattern. However, social and economic development performs unevenly in Yun- nan, supplemented by varied geographical conditions, so that constructing mountain- ous cities should proceed as per local conditions. The research proposed the con- trol of constructing mountainous cities provided crop safety under the principle of farmland protection and measured the quantities of demanded construction lands ac- cording to science of population prediction and ekistics, based on which the control scales of constructing mountainous cities were determined by multiplying basic farm- land coefficient and the area of newly increased construction lands. The research is of significance for guiding the construction of mountainous cities and avoiding the occupation of construction lands on farmlands.

Vulnerability of Large City and Its Implication in Urban Planning: A Perspective of Intra-urban Structure

Vulnerability is a new field and analytical tool in the study of urban safety. Analysis and assessment of vulnerability provide a new basis for urban planning. This study constructed a quantitative index system for assessing vulnerability, based on the city′s sensitivity and emergency response capacity. City size, density, and spatial form influence a city′s sensitivity to crises and risks, to which vulnerability is positively related. Levels of socio-economic development, infrastructures, and emergency management contribute to a city′s emergency response capacity, with which vulnerability is inversely associated. Vulnerability of 19 large Chinese cities was assessed. Harbin and Shenzhen demonstrated the highest and lowest vulnerability among 19 cities, while Beijing, Shanghai and Guangzhou ranked the 5th, the 9th and the 12th. Spatially, northern cities tended to be more vulnerable than southern cities. And the differences in vulnerability among cities were explored based on cities′ physical geography conditions, level of socioeconomic development, infrastructures, regional status, history of disaster, history of urban planning and development, government policies, etc.

Spatial variation of health risk of groundwater for drinking water supply in Mingshan County,Ya'an City,China

Rural drinking water safety is a growing concern in China. This study investigated the health risk of pollution of groundwater for the drinking water supply in Mingshan County, Ya＇an City, in Sichuan Province, China, using 46 samples from the years 1991 to 2010. Carcinogenic, non-carcinogenic, and total risks were assessed by the model recommended by the United States Environmental Protection Agency （U.S. EPA）. Thematic maps of the risks caused by single and multiple factors were generated from inverse distance weighting interpolation （IDW） and the geostatistical analysis functions of ArcGIS. The results show that the carcinogenic risks caused by chemicals in groundwater for drinking water supply are low, within the acceptable interval for risk management. However, non-carcinogenic risks are high and the number of sampling sites with risk values exceeding the standards amounted to 29. Non-carcinogenic risks of Cr6＋, nitrate, fluoride, and Fe at sites 43, 46, 50, 64, 67, and 74 were the sources that caused high total health risk. This study reveals the risk level of groundwater quality and orders of treatment of pollutants, and provides a scientific basis for groundwater management in this area.

Systematic review: Safety of balloon assisted enteroscopy in Crohn's disease

AIM To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy(BAE) in Crohn's disease(CD). METHODS Systematic review(PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy(DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.RESULTS Per procedure perforation rate of diagnostic BAE in CD was 0.15%(95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications(0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12%(95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications(0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74%(95%CI: 0.85-3.55). Eighty-six percentof therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients. CONCLUSION Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprineor 6-mercaptopurine intolerant IBD patients

AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year.METHODS: Database analysis.RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8×108 RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%)and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly.CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.

Developing a Subjective Evaluation Scale for Assessing the Built Environments of China’s Hygienic City Initiative

Objective To develop a preliminary subjective evaluation scale for assessing the built environments of China’s Hygienic City Initiative and to evaluate its reliability and validity.Methods The initial items of the scale were determined based on a review of policy documents and consultations with experts. The final items of the scale were confirmed through individual interviews with residents combined with the discretetrend method, critical ratio method, correlation coefficient method, and factor analysis method. Then, the dimensions of the scale were determined using exploratory factor analysis(EFA). The Cronbach’s α coefficient, split-half reliability coefficient, and confirmatory factor analysis(CFA) were used to assess the reliability and validity of the scale.Results A scale containing five dimensions with 22 items was established, including urban lifestyle,governance, basic functions, environmental sanitation, and amenities. The Cronbach’s α coefficient of the scale was 0.876, and the split-half reliability coefficient was 0.796. The CFA results indicate that each inspection level was within the standard limit.Conclusion The preliminarily subjective evaluation scale for assessing the built environments of China’s Hygienic City Initiative demonstrates a high level of reliability and validity. Additional empirical studies should be carried out to further verify the value of the scale in terms of practical application.

Rank-size Distributions of Chinese Cities: Macro and Micro Patterns

A large number of studies have been conducted to find a better fit for city rank-size distributions in different countries. Many theoretical curves have been proposed, but no consensus has been reached. This study argues for the importance of examining city rank-size distribution across different city size scales. In addition to focusing on macro patterns, this study examines the micro patterns of city rank-size distributions in China. A moving window method is developed to detect rank-size distributions of cities in different sizes incrementally. The results show that micro patterns of the actual city rank-size distributions in China are much more complex than those suggested by the three theoretical distributions examined(Pareto, quadratic, and q-exponential distributions). City size distributions present persistent discontinuities. Large cities are more evenly distributed than small cities and than that predicted by Zipf′s law. In addition, the trend is becoming more pronounced over time. Medium-sized cities became evenly distributed first and then unevenly distributed thereafter. The rank-size distributions of small cities are relatively consistent. While the three theoretical distributions examined in this study all have the ability to detect the overall dynamics of city rank-size distributions, the actual macro distribution may be composed of a combination of the three theoretical distributions.

The Impact of Government Supervision and Consumer Purchasing Behavior on Food Safety

This paper aims at the theoretical analysis to the impact of government supervision and consumer purchasing behavior on food quality security, so as to look for safety strategies and measures to strengthen and improve the level of food safety in China. Reputation mechanism is introduced and Bayesian approach is based on, in which government supervision as well as consumer purchasing behavior is taken as crucial factors to impact on the food quality security. As to the proposed quantitative indicators, government supervision includes exposure rate, fine and etc.;at the same time, consumer purchasing behavior includes consumer’s WTP for security food and consumer expectations to food safety. Taking China’s dairy industry as an example, it makes simulation by Netlog. The results show that consumer purchasing behavior alone has little effect on the dairy companies’ decision-making to be honest or counterfeiting enterprises. However, combination government supervision with purchasing behavior has great impact, and plays very good effects on food safety.

Purchase willingness of new energy vehicles: A case study in Jinan City of China

Speeding up the promotion of new energy vehicles is an important measure to optimize the energy structure,promote energy conservation and emission reduction,and develop the economy sustainability.The research uses a questionnaire survey to analyze the residents’willingness to purchase new energy vehicles in Jinan Gty of China,and utilizes the binomial logistic regression model and Global Moran's I to explain the impact of three factors(including responden ts'personal characteristics and subjective cognition,products,and social environment)on the purchase willingness of new energy vehicles.According to the survey,75.12%of the responden ts consider buying new energy vehicles in the future,but only 11.66%of the respondents know new energy vehicles well.It can be seen that the respondents in Jinan City generally have an insufficient understanding of new energy vehicles.It may lead to a decline in residents’trust in new energy vehicles,which will in turm affect their purchase willingness.Based on the survey,we find that women who live far from the city center enjoy high incomes and have a low-carbon awareness,generally exhibit a higher willingness to purchase new energy vehicles.Spatial distribution of the purchase willingness has certain aggregation characteristics,showing a positive spatial correlation pattern.Purchase willingness has a certain positive diffusion effect in space,and areas with a higher purchase willingness have a positive driving effect on their surrounding regions.Spatial distribution of the purchase willingness can be used as one of the breakthroughs in promoting new energy vehicles.In addition,safety,price,after-sales service,and infrastruicture of new energy vehicles are important determinants of people's purchase willingness.Among the types of subsidies,financial subsidy is most effective on the residents’purchase wilingness.Our research provides an impor tant information for the promotion of new energy vehicles in the region.

Technical Investigation on V2G,S2V,and V2I for Next Generation Smart City Planning

The paper investigates a few of the major areas of the next generation technological advancement,“smart city planning concept”.The areas that the paper focuses are vehicle to grid(V2G),sun to vehicle(S2V),and vehicle to infrastructure(V2I).For the bi-directional crowd energy single entity concept,V2G and building to grid(B2G)are the primary parts of distributed renewable generation(DRG)under smart living.This research includes an in-depth overview of this three major areas.Next,the research conducts a case analysis of V2G,S2V,and V2I along with their possible limitations in order to find out the novel solutions for future development both for academia and industry levels.Lastly,few possible solutions have been proposed to minimize the limitations and to develop the existing system for future expansion.

Study on Landscape Pattern Based on Landsat-8 in the Center of Chengdu City, China

Study on landscape spatial pattern in the center of Chengdu City is based on the Landsat-8 image by using 3S technique and spatial pattern analysis software Fragstats 3.3. The results showed that there covered an area of 193.92 km2 in the center of Chengdu City. 55.24% of the total area was made up of buildings, covering an area of 107.12 km2, and the overall landscape of impervious ground-based. There were 22,666 patches;29.67% of the patches were roads. The human interference of buildings, roads and green space was a maximum;fragmentation of the highest was green space. The fragmentation of overall urban landscape was high;the diversity was low;the value of Shannon’s diversity index was 0.63;the value of Shannon’s evenness index was 0.70. All kinds of landscape distribution were not balanced, and lack of connectivity. This research puts important reference for creating good urban landscape space and restoring the natural ecological environment in the western regions of China.

Effects of proton pump inhibitors on inflammatory bowel disease:An updated review

Inflammatory bowel disease(IBD)is believed to be caused by various factors,including abnormalities in disease susceptibility genes,environmental factors,immune factors,and intestinal bacteria.Proton pump inhibitors(PPIs)are the primary drugs used to treat acid-related diseases.They are also commonly prescribed to patients with IBD.Recent studies have suggested a potential association between the use of certain medications,such as PPIs,and the occurrence and progression of IBD.In this review,we summarize the potential impact of PPIs on IBD and analyze the underlying mechanisms.Our findings may provide insights for conducting further investigations into the effects of PPIs on IBD and serve as an important reminder for physicians to exercise caution when prescribing PPIs to patients with IBD.

An exploratory study of food safety and food handling: Examining ready-to-eat foods in independent delicatessen operations

The US Center for Disease Control and Prevention (CDC, 2009) reports that each year 76 million cases of foodborne illness occur with over 300,000 people hospitalized and 5000 deaths. This study, phase I of a continuing study, identifies key areas for food safety improvement. This study is designed as an exploratory evaluation of independently owned and operated delicatessen operations, using Escherichia coli and Staphylococcus aureus as indicators to assess food handling and the public’s risk for pathogenic contamination from commonly served ready-to-eat/take-away foods. The analysis consisted of a comprehensive strategy of laboratory testing of samples for pathogenic contamination, informal field observation of food handling procedures, and the examination of the most recent health inspection reports for each of the 18 operations visited. The deli turkey, cream cheese and lettuce were tested using bacteria indicator plates. The results showed widespread levels of contamination. Of the 54 samples tested for Escherichia coli, 26 showed positive results which are ~45% for E. coli contamination. Of the 54 samples tested for Staphy-lococcus aureus, 31 showed positive results which are ~57% for S. aureus contamination. One issue discovered while conducting the study was the lack of consistent uniform international standards of contamination tolerance levels. The informal field observations and health report analyses revealed widespread temperature violations and numerous instances of poor food handling. The study offers independent practitioners a strategy designed to improve their health inspections scores, food handling, and mitigation of operator liability. Independent operators traditionally do not enjoy the resources of centralized supervision and expert on-staff training;yet in aggregate they account for significant volume in both dollars and the quantity of product served. This study adds needed scrutiny to this important food niche.