Concept Analysis: Emergency Department Crowding and Length of Stay before and after an Increase in Catchment Area

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

Entry-Level Forward Surgical Team Training Is Associated with Increased Confidence of Primary Combat Surgeons

Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.

基于新型聚类算法IncreaseK-Means的Blog相似度分析

针对现有聚类算法K-均值存在事先指定聚类类数及仿射传播存在计算复杂度偏高的缺陷,提出了一种新型的聚类算法IncreaseK-Means,并将其应用到Blog内容的相似度聚类分析中,较好地满足了社区发现和话题跟踪的需求.仿真结果表明:在Blog文本聚类分析中,IncreaseK-Means在时间上与K-Means相近,在精度上与仿射传播接近,适用于大规模网络文本的分析处理.

Increased plant density and reduced N rate lead to more grain yield and higher resource utilization in summer maize

Planting at an optimum density and supplying adequate nitrogen（N） to achieve higher yields is a common practice in crop production, especially for maize（Zea mays L.）; however, excessive N fertilizer supply in maize production results in reduced N use efficiency（NUE） and severe negative impacts on the environment. This research was conducted to determine the effects of increased plant density and reduced N rate on grain yield, total N uptake, NUE, leaf area index（LAI）, intercepted photosynthetically active radiation（IPAR）, and resource use efficiency in maize. Field experiments were conducted using a popular maize hybrid Zhengdan 958（ZD958） under different combinations of plant densities and N rates to determine an effective approach for maize production with high yield and high resource use efficiency. Increasing plant density was clearly able to promote N absorption and LAI during the entire growth stage, which allowed high total N uptake and interception of radiation to achieve high dry matter accumulation（DMA）, grain yield, NUE, and radiation use efficiency（RUE）. However, with an increase in plant density, the demand of N increased along with grain yield. Increasing N rate can significantly increase the DMA, grain yield, LAI, IPAR, and RUE. However, this increase was non-linear and due to the input of too much N fertilizers, the efficiency of N use at NCK（320 kg ha^（–1）） was low. An appropriate reduction in N rate can therefore lead to higher NUE despite a slight loss in grain production. Taking into account both the need for high grain yield and resource use efficiency, a 30% reduction in N supply, and an increase in plant density of 3 plants m^（–2）, compared to LD（5.25 plants m^（–2））, would lead to an optimal balance between yield and resource use efficiency.

Spatial Distribution of the Increased Porosity of Cement Paste due to Calcium Leaching

Using the tomography image, a method to characterize the 3D spatial distributions of increased porosity was proposed, and the increased porosity distributions of cement pastes with different leaching degrees were given using the current method. The leaching processes of CH/C-S-H and the contribution of CH/C-S-H leaching to porosity evolution were discussed. The proposed method can be applied to all cement- based materials with any leaching degrees. From the quantitative increased porosity results, we find that the CH leaching finished quickly on the sharp CH leaching front.

Tea Consumption is Associated with Increased Risk of Kidney Stones in Northern Chinese： A Cross-sectional Study

Kidney stones are a common urinary system condition that can progress to kidney disease. Previous studies on the association between tea consumption and kidney stones are inconsistent. A cross-sectional study to investigate the association between tea consumption and kidney stones was conducted from 2013 to 2014 and recruited 9,078 northern Chinese adults. A total of 8,807 participants were included in the final analysis. Participants＇ prevalence of kidney stones was 1.07%, 1.73%, and 2.25% based on their tea consumption frecluencv of never, occasionally,

NUMERICAL SIMULATION OF THE RELATIONSHIP BETWEEN THE MAINTENANCE AND INCREASE IN HEAVY RAINFALL OF THE LANDING TROPICAL STORM BILIS AND MOISTURE TRANSPORT FROM LOWER LATITUDES

The NCEP/NCAR reanalysis, Japan Meteorological Agency(JMA) tropical cyclone tracks and intensive surface observations are used to diagnose the features of moisture transport of tropical storm Bilis(No. 0604), which is simulated by the WRF(weather research and forecasting) mesoscale numerical model. It is shown that the Bilis was linked with the moisture channel in the lower latitudes after its landing. Meanwhile, the cross-equatorial flows over 80°-100°E and Somali were active and brought abundant water vapor into the tropical storm, facilitating the maintenance of the landing storm with intensified heavy rainfall along its path. The simulation suggested that the decreased water vapor from lower latitudes prevents the maintenance of Bilis and the development of rainfall. While the cross-equatorial flows over 80°-100°E and Somali were in favor of keeping the cyclonic circulation over land. If the moisture supply fro m the Somali jet stream was reduced, the strength and area of heavy rainfall in tropical cyclone would be remarkably weakened. Consequently, the decreased water vapor from lower latitudes can remarkably suppress the deep convection in tropical storm, then Bilis was damped without the persistent energy support and the rainfall was diminished accordingly.

Spatial distribution modeling of temperature increase for the uplifted mountain terrains and its characteristics in Southwest China

Local temperature changes in mountain areas are significantly affected by the uplifted mountain terrains. Understanding how temperature increase with mountain terrains is an important component in accurately modeling the spatial distribution of temperature. The study, after minimizing the effect of elevation and latitude, quantitatively simulated the temperature increase in the uplifted mountain terrains, described the characteristics in the spatial distribution of warming areas with different magnitudes, and identified the correlated indices of mountain bodies for warming. Selecting Yunnan Province in southwest China as the study area, we simulated the warming field on a baseline surface at the average elevation of 2000 m and average latitude of 24.96°. The results indicated that the warming magnitudes in different local areas varied with the change in the spatial locations, and the warming process concentrated in the mountainous regions. Throughout the entire study area, the warming field presented a general pattern of three terraces from the regions of high mountains to middle mountains and then low mountains. The areasof high warming magnitude mainly surrounded large mountain bodies and were distributed on the upper part. The areas of low warming magnitude clustered in the valleys and basins of the middle mountain region, mostly on the lower part of the large mountain bodies and its branches. The areas with zero warming magnitude occurred in the low mountains and broad valleys, which were distributed largely on the lower parts of the middle mountains and in most of the valleys. Quantified sampling analysis demonstrated good positive correlation between the warming magnitudes in uplifted mountain terrains and the volume index of the mountain body, as well as elevation difference, with the coefficients corresponding to 0.82 and 0.91, respectively.

The effect of sea surface temperature increase on the potential habitat of Ommastrephes bartramii in the Northwest Pacific Ocean

In the Northwest Pacific Ocean, the squid jigging fisheries from China, Japan and other countries and regions have targeted the west winter-spring cohort of neon flying squid（Ommastrephes bartramii） from August to November since the 1970 s. This squid is a short-lived ecological opportunist with a life-span of about one year,and its population is labile and recruitment variability is driven by the environment or climate change. This variability provides a challenge for ones to forecast the key habitats affected by climate change. The catch data of O. bartramii from Chinese squid jigging fishery and the satellite-derived sea surface temperature（SST） data are used in the Northwest Pacific Ocean from August to November of 1998 to 2004, the SST preferences of O.bartramii corresponding to high values of catch per fishing day（CPUE） are determined and monthly potential habitats are predicted using a histogram analysis of the SST data. The possible changes in the potential habitats of O. bartramii in the Northwest Pacific Ocean are estimated under four climate change scenarios based on the Fourth Assessment Report（AR4） of the Intergovernmental Panel on Climate Change, i.e., 0.5, 1, 2 and 4°C increases in the SST because of the climate change. The results reveal an obvious poleward shift of the potential habitats of O. bartramii in the Northwest Pacific Ocean.

Special Lateral Increase in a Permian Rugose Coral Kepingophyllum aksuence Wu et Chow

Well-preserved specimens of Kepingophyllum aksuence Wu et Chow were collected from Early Permian strata in western Tarim Basin, Xinjiang. More than 100 serial thin sections were made for this study. Kepingophyllum aksuence displays a unique increase pattern. The bud appears in lonsdaleoid dissepiments between the corallites where the wall of parent corallite disappears and the area becomes aphroid. This increase pattern is different from other lateral increases of most colonial rngose corals, and therefore has taxonomic significance to differentiate Kepingophyllidae from other compound rugose corals. It is also discussed that Kepingophyllum aksuence has a high ＂reproductive integration＂, which means a rapid growth of buds during the offsetting process. Kepingophyllum was possibly originated from Ivanovia and was also a probable ancestor of Wentzellophyllum, which is supported here by more or less the similarity of the blastogeny in different stages of three taxa.

ESTIMATION OF THE CRITICAL RATE OF TEMPERATURE INCREASE OF THERMAL EXPLOSION OF NITROCELLULOSE USING NON-ISOTHERMAL DSC

A method of estimating the critical rate of temperature increase of thermal explosion for the first orderautocatalytic decomposition reaction system using non-isothermal DSC is presented. Information is obtained on theincreasing rate of temperature in nitrocellulose containing 13.54% of nitrogen when the first order autocatalytic decomposition converts into thermal explosion.

The Salt Reduction and Yield Increase Effects of Smashing Ridging Transforming Saline-alkali Land and Its Development Prospects

Using smashing ridging tillage machine and smashing ridging technology invented by the authors, transformation test of saline-alkali land by smashing ridging was conducted respectively in Xinjiang and Shaanxi during 2015 -2016. The results showed, in severe saline-alkali soil of Xin-jiang ,after growing cotton by smashing ridging, total salt in soil decreased by 31.31 %, cotton production increased by 48.80%, and salinity level declined from severe to moderate; in mild saline-alkali soil of Shaanxi, after growing summer corn by smashing ridging, total salt in soil decreased by 42.37%, corn yield increased by 34.83%, salinity degree changed from mild desalination to normal farmland ; in Ningxia, Inner Mongolia 7 Gansu ,Jilin, Henan, Hebei, and so on, smashing ridging tillage practice in different types of saline-alkali land was conducted ; according to the salt reduction and yield increase effects of saline-alkali land after smashing ridging, the development prospect of smashing ridging technique in improvement and application of saline-alkali land was proposed.

Increase of Income of Farmers and Herdsmen in Tibet in the New Period

The disposable income per capita of rural residents in Tibet was 7471 yuan in 2014. There is a high gap with the national average disposable income per capita of rural residents( 10489 yuan). Thus,it is urgent to increase income of farmers and herdsmen in Tibet. On the basis of literature in recent years,this paper analyzed methods for increasing income of farmers and herdsmen in Tibet,major factors restricting increase of their income,and approaches for increasing their income. It is expected to provide certain reference for further expanding ideas of increase of their income in the new period.

Down-regulation of Hsp90 could change cell cycle distribution and increase drug sensitivity of tumor cells

:AIM To construct Hsp90 antisense RNAeukaryotic expression vector, transfect it intoSGC7901 and SGC7901/VCR of MDR-type humangastric cancer cell lines, HCC7402 of humanhepatic cancer and Eel09 of human esophagealcancer cell lines, and to study the cell cycledistribution of the gene transected cells andtheir response to chemotherapeutic drugs.METHODS A I .03kb cDNA sequence of Hsp90Pwas obtained from the primary plasmid phHsp90by EcoR 1 and BamH I nuclease digestion andwas cloned to the EcoR 1 and BamH 1 site ofthe pcDNA by T4DNA ligase and an antisenseorientation of Hsp900 expression vector wasconstructed. The constructs were transfectedwith lipofectamine and positive clones wereselected with G418. The expression of RNA wasdetermined with dot blotting and RNaseprotection assay, and the expression of Hsp90protein determined with Western blot. Cell cycledistribution of the transfectants was analyzedwith flow cytometry, and the drug sensitivity ofthe transfectants to adriamycin (ADR ),vincrinstine (VCR ), mitomycin (MMC ) andcyclophosphamide (CTX ) with MTT andintracellular drug concentration of thetransfectants was determined with flowcytometry.RESULTS In EcoR 1 and BamH I restrictionanalysis, the size and the direction of the clonedsequence of Hsp900 remained what had beendesigned and the gene constructs were namedpcDNA-Hsp90. AH^SGC7901, AH^SGC7901/ VCR,AH-HCC7402 and AH-Eel09 cell clones allexpressed Hsp90 anti--sense RNA. Theexpression of Hsp90 was down--regulated in AHSGC7901, AH--SGC7901/ VCR, AH-HCC7402 andAH--Eel09 cell clones. Cell cycle distribution waschanged differently. In AH-SGC7901/ VCR andAH-Ec109 cells, G, phase cells were increased; Sphase and G, phase cells were decreased ascompared with their parental cell lines. In AHSGC7901 cell, G, phase cells were decreased, Qphase cells increased and S phase cells were notchanged, and in AH-HCC7402 cells G,, S and qphase cells remained unchanged as comparedwith their parental cell lines. The sensitivity ofAH--SGC7901, AH--SGC7901/ VCR, AH-HCC7402 andAH-Ec109 to chemotherapeutic drugs, thesensitivity ot AH--SGC7901/ VCR to ADR, VCR,MMC and CTX the sensitivity of AH-HCC7402 toADR and VCR, and the sensitivity of Eel09 toADR, VCR and CTX all increased as comparedwith their parental cell lines. The meanfluorescence intensity of ADR in AH--SGC7901,AH-SGC7901/ VCR, AH--HCC7402 and AH-Ec109was also significantly elevated (P< 0. 05).CONCLUSION Down-regulation of HsP90 couldchange cell cycle distribution and increase thedrug sensitivity of tumor cells.

Changes in Myofibrillar and Mitochondrial Compartments during Increased Activity: Dependance from Oxidative Capacity of Muscle

Striated muscle tissue contains fibers with high oxidative capacity (heart muscle), higher oxidative capacity (type I and IIA fibers of skeletal muscle) and low oxidative capacity (type IIB/X fibers of skeletal muscle). Muscle fibers with higher oxidative capacity contain large mitochondria tightly packed with cristae as well as small forms of mitochondria containing relatively few cristae. The intensive development of the mitochondrial apparatus in the post-activity period reflects the adaptive processes, which is intended to supply the increased energy requirements of muscle fibers with higher oxidative capacity. Muscle fibers with low oxidative capacity contain significantly less mitochondria than fibers with higher capacity. It is typical to type IIB fibers that after intensive muscle activity there are damaged myofibrils in a relatively small area, some myofibrils are twisted and lose the connection with the neighboring structures. It is still not fully known how skeletal muscles with different oxidative capacity respond to an increased functional activity and what differences exist in these fibers between oxidative capacity and function of myofibrils. The aim of the present short review was to compare structural-functional changes in mitochondrial and myofibrillar compartments of heart and skeletal muscle fibers with different oxidative capacity and the effect of increased functional activity on the interaction of these compartments.

Understanding the mechanism of capacity increase during early cycling of commercial NMC/graphite lithium-ion batteries

A capacity increase is often observed in the early stage of Li-ion battery cycling.This study explores the phenomena involved in the capacity increase from the full cell,electrodes,and materials perspective through a combination of non-destructive diagnostic methods in a full cell and post-mortem analysis in a coin cell.The results show an increase of 1%initial capacity for the battery aged at 100%depth of discharge(DOD)and 45℃.Furthermore,large DODs or high temperatures accelerate the capacity increase.From the incremental capacity and differential voltage(IC-DV)analysis,we concluded that the increased capacity in a full cell originates from the graphite anode.Furthermore,graphite/Li coin cells show an increased capacity for larger DODs and a decreased capacity for lower DODs,thus in agreement with the full cell results.Post-mortem analysis results show that a larger DOD enlarges the graphite dspace and separates the graphite layer structure,facilitating the Li+diffusion,hence increasing the battery capacity.

Improving school physical education to increase physical activity and promote healthy growth of Chinese school-aged children Time for action

Throughout its more than 5000-year history,China has a long tradition of encouraging active engagement in physical and sport activities.1,2This enduring tradition,however,has been facing some major headwinds as China continues to experience demographic and environmental changes related to aging,urbanization,and lifestyle shifts.3-5Mounting evidence indicates increasing levels of sedentary behaviors。

Increased plasma galectin-1 correlates with advanced glycation end products and interleukin-1β in patients with proliferative diabetic retinopathy

Dear Editor,Galectin-1, one of galactoside-binding lectin family proteins, has been shown to regulate cell growth, migration, and proliferation, where it binds many receptors depending on their glycosylation profile, rather than its specific receptors.

Association of Increased Urine Brain Derived Neurotrophic Factor with Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

Urinary brain-derived neurotrophic factor（BDNF）, an ubiquitous neurotrophin, was found to rise in patients with benign prostatic hyperplasia（BPH）. We hypothesized that the urinary level of BDNF could be a potential biomarker for lower urinary tract symptoms（LUTS） in patients with BPH. Totally, 76 patients with BPH-caused LUTS and 32 male control subjects without BPH were enrolled. International Prostate Symptom Score（IPSS） was applied to assess the symptom severity of LUTS. Urodynamic tests were performed for the diagnosis of underlying detrusor overactivity（DO） in the patients with BPH. Urine samples were collected from all subjects. Urinary BDNF levels were measured using enzyme-linked immunosorbent assays and normalized by urinary creatinine（Cr） levels. Seventy-six BPH patients were divided into moderate LUTS group（n=51, 720） according to the IPSS. Of the 76 BPH patients, DO was present in 34（44.7%） according to the urodynamic test. The urinary BDNF/Cr levels were significantly higher in BPH patients with moderate LUTS（8.29±3.635, P〈0.0001） and severe LUTS（11.8±6.44, P〈0.0001） than normal controls（1.71±0.555）. Patients with severe LUTS tended to have higher urinary BDNF/Cr levels than patients with moderate LUTS（11.8±6.44 vs. 8.29±3.635, P=0.000）. The conditions of BPH with LUTS correlated with elevated urinary BDNF levels, and urinary BDNF levels were even higher in BPH-DO patients. The results of this study have provided evidence to suggest that urinary BDNF level test could evaluate the severity of LUTS in BPH patients, and BDNF level can be used as a biomarker

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction

OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.