Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning

BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to fi nd a light-weight,convenient prediction method through machine learning.METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation.RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the fi ve most important features were acuity,arrival transportation,age,shock index,and respiratory rate.CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Objective: To explore the practice and application of infection prevention and control strategies in risk departments during the COVID-19 epidemic, and to formulate the infection prevention and control measures to provide advice and guidance in risk departments. Methods: According to the latest plan of diagnosis and treatment, prevention and control issued by the National Health Commission, expert advice and consensus, combined with the actual situation in our hospital, a series of infection prevention and control measures of COVID-19 in risk department was formulated. Results: During the epidemic period, the prevention and control measures of nine risk departments including emergency operation, anesthesiology, endoscopy center, blood purification center, otolaryngology, stomatology, medical imaging department, medical cosmetology department and pulmonary function room were established from six aspects, including pre-examination and screening, medical technology control, personnel management, personal protection, environmental disinfection, medical waste disposal, etc. Conclusion: During the epidemic period, the infection prevention and control strategy of risk departments is one of the key links to control the spread of the epidemic, and risk departments must pay attention to and strictly implement various infection prevention and control measures.

Assessing the Impact of Regulations on Radiation Safety Culture and Practices in Radiology Departments

Background: The need to establish a strong culture around radiation safety is derived from the assertion that medical practitioners, patients, and third parties should not be exposed to unnecessary radiation. Authorities have endeavored to enact policies to protect all employers and patients in radiology departments. Objectives: To assess the impact of radiation safety practices and regulations on the ongoing improvements in radiation safety culture and practices in radiology departments. This will be achieved through a subjective assessment of national and international rules and regulations by healthcare professionals. Materials and Methods: We conducted a questionnaire survey in the radiology departments of three JCI-accredited hospitals in the Riyadh region to identify and assess the impact of national radiation regulations and the accompanying processes on the improvement of radiation safety culture and practices in radiology departments. Results: There were statistically significant differences in the grading system results among various groups of respondents, based on their educational level. Also, there are statistically significant differences between the assessments of safety level results in the answers provided by various groups of respondents according to education level in favor of the master’s degree. Conclusion: The study concludes that technicians with a diploma degree require stricter regulation. Furthermore, the results of this study suggest that an exposure tracking system and a regulatory action supporting it may be useful in the ongoing task of improving patients’ radiation safety.

Research on the Path of Further Deepening the Reform and Internationalization of English Education in the Hainan Free Trade Zone

With the establishment of the Hainan Free Trade Zone(FTZ),the internationalization of English education has become a key element of the region’s educational reform efforts.As globalization intensifies,fostering an internationalized English education system is crucial for improving the competitiveness and global positioning of the Hainan FTZ.This study explores the multiple pathways and strategies for promoting the internationalization of English education in the Hainan FTZ,focusing on aspects such as policy support,curriculum reform,teacher training,international collaboration,and the effective allocation of educational resources.By examining the current state of English education in the region,identifying key challenges,and drawing insights from successful domestic and international cases-particularly from free trade zones elsewhere-this paper offers actionable recommendations.These suggestions aim to enhance the region’s educational outcomes,thereby bolstering the Hainan FTZ’s broader objectives of economic growth and enhanced global connectivity.The proposed strategies also seek to elevate the international stature of the Hainan FTZ as a regional hub for talent development,international exchange,and soft power enhancement.

Research on the Current Situation of China’s Higher Education Students Studying Abroad in the Context of Higher Education Internationalization

In the context of education internationalization,the internationalization of higher education has become a major trend in the field of education in most countries,with international student education as the core.This phenomenon promotes cultural exchanges and integration among countries as well as higher education reform,which is of great significance in enhancing the international influence of higher education in each country.However,there are also some challenges faced by higher education students when studying abroad.The article digs into the origin and history of studying abroad,analyzes the current situation and reasons for higher education students in China to study abroad,discusses the opportunities and challenges faced by higher education students in China when studying abroad,and analyzes the trend of studying abroad in China.

Influence of resilience on depression among nurses in clean operating departments:The mediating effect of life satisfaction

BACKGROUND A clean operating room is an important part of surgical and critical treatment in hospitals.The workload is substantial,the pace is rapid,and the working environment is intense;therefore,nurses who work in clean operating rooms are constantly challenged,which can lead to anxiety,depression,and other mental health issues.Life satisfaction and resilience are important factors that ensure mental health.Therefore,exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork.AIM To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department.METHODS From April to November 2022,196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study.Participants were selected using convenience sampling.Participants’gender,age,marital status,position,length of service,personal monthly income,daily working hours,employment status,and professional title were collected,and the Connor-Davidson resilience scale,satisfaction with life scale,and selfrating depression scale were used to evaluate resilience,life satisfaction,and depression.The researchers conducted professional training in advance,introduced the research methods to the participants before the investigation,and explained the study’s significance and purpose.Surveys were distributed and collected on-site.Each questionnaire took 30 min to complete.RESULTS The average scores for life satisfaction,resilience,and depression were 3.13(±0.28),4.09(±0.78),and 56.21(±8.70),respectively.The correlation between resilience and depression was negative(r=-0.829,P<0.01).Life satisfaction was positively related to resilience(r=0.855,P<0.01)and negatively related to depression(r=-0.778,P<0.01).The relationship between resilience and depression was partially mediated by life satisfaction.The value of the mediating effect was-6.853(26.68%of the total effect).CONCLUSION Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Internationalization of Higher Education:A Critical Literature Review of the UK Outward Student Mobility

The outward student mobility has been recognized as an instrument for the internationalization of higher education(IHE)world-widely and in the UK.This paper intends to critically review the existing literature in order to identify the current trend and issues of the UK outward student mobility under the IHE.It points out that the focus of current international educational activities is attracting foreign/inward students out of the economic impetus in the UK.Consequently,the outward student mobility is given the less recognition than the inward one in the UK policy-making and researches,which could lead the imbalanced gains for UK-domiciled students.Thus,it suggests that both the UK government education sectors and institutions should more develop the outward student mobility;moreover,future researches could investigate more about outward students’personal development.

Effect of the Implementation of Emonc in the Reduction of Maternal Deaths in the Department of Collines from 2018 to 2022

Background: Maternal and neonatal mortality remains a public health problem in Benin. Each year, approximately 1500 maternal deaths and more than 12,000 newborn deaths are recorded there. In order to correct the situation, strategies such as the implementation of Emergency Obstetric and Neonatal Care (EmONC) were initiated. Objective: Determine the rates of maternal deaths in EmONC centers in the Collines department from 2018 to 2022. Framework and Methods: The study took place in Benin precisely in the Collines department. This was a descriptive cross-sectional study. Data collection was carried out during the first two weeks of January 2023 and covered data from the 09 Basic Emergency Obstetric and Neonatal Care centers (BEMONC) and the Obstetric and Neonatal Care centers of Complete Emergency (CEmONC) of the Collines department from 2018 to 2022. An estimate of the ratios of maternal deaths occurring at the level of the EmONC centers of the Collines department from 2018-2022 was carried out followed by constructive suggestions. Results: During the five years (2018 to 2022), the Collines department recorded 42,582 live births with 148 maternal deaths, i.e. a ratio of 348 maternal deaths per 100,000 live births. Between 2018 and 2022, the highest maternal death ratio was recorded in 2019, i.e. 425 maternal deaths per 100,000 live births for all EmONC centers and 607 maternal deaths per 100,000 live births in EmONC centers. The highest maternal death ratio at the BEmONC center level was recorded in 2020, i.e. 129 maternal deaths per 100,000 births. Conclusion: These results suggest that despite the implementation of EmONC in the Collines department, maternal deaths have not decreased. To improve these outcomes for a reduction in maternal deaths, urgent action must be taken.

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.

Assessment of Satisfaction in the Reception and Emergency Department of a Health Center

Introduction The main objective of any healthcare establishment must be to ensure the quality of patient care and customer satisfaction. It is necessary to regularly assess patient satisfaction. The aim of this study was to assess the level of satisfaction of customers aged over 18 years attending the emergency department of the health center. Methodology This was a descriptive and analytical cross-sectional study of patients aged 18 years and over, who attended the Samu Municipal emergency department between 02 and 30 May 2023. The satisfaction index was determined using the adapted 2009 SAPHORA-MCO questionnaire and the Likert satisfaction scale. Results A total of 400 patients were surveyed. The average age was 35 years, with a standard deviation of 14.7. Of those surveyed, 51% were women, 87% were educated, 50% lived in Grand Yoff and 59.5% were unemployed. Satisfaction levels linked to perception of the cost of care (72%), waiting time (64.3%), information given to patients (69.1%) and pain management (74 .5%) are fair. On the other hand, the levels of satisfaction linked to administrative procedures (82.5%), staff attitudes towards patients (84%), staff availability (86.4%), patient privacy (89.2%), general atmosphere (87.2%), staff competence (87.3%), and the effectiveness of care (89.4%) were satisfactory. The average waiting time was 38 minutes. However, 32% of patients waited less than 30 minutes and 92% less than an hour. The satisfaction index linked to administration and reception was 72.9% and 79.85%, respectively. The satisfaction index linked to the administration and technical quality of care is equal to 85.8% and 83.7%, respectively. The overall satisfaction index is equal to 80.6%;the level of satisfaction of users of the health structure is satisfactory. Conclusion Patient satisfaction is an essential part of quality care. Patient satisfaction must be based on effective communication from the healthcare team and the creation of a patient-caregiver relationship.

Laboratory or Department?Exploration and Creation in Computer Science and Technology

In the very beginning,the Computer Laboratory of the University of Cambridge was founded to provide computing service for different disciplines across the university.As computer science developed as a discipline in its own right,boundaries necessarily arose between it and other disciplines,in a way that is now often detrimental to progress.Therefore,it is necessary to reinvigorate the relationship between computer science and other academic disciplines and celebrate exploration and creativity in research.To do this,the structures of the academic department have to act as supporting scaffolding rather than barriers.Some examples are given that show the efforts being made at the University of Cambridge to approach this problem.

Factors Associated with High Blood Pressure and Diabetes Cormobidity in Littoral Department of Benin, in 2023

Introduction: The number of people suffering from diabetes and hypertension (HBP) is increasing worldwide and particularly in sub-Saharan Africa, despite the fact that they are preventable. The aim of our study is to determine the factors associated with hypertension and diabetes comorbidity in the Department of Littoral in 2023. Study Setting and Methods: Our study took place in the Department of Littoral in Benin. It was a cross-sectional general population study conducted over a three-month period from April 10 to July 10, 2023. It included subjects aged 18 and over with or without a history of hypertension and/or diabetes. The sampling method was probabilistic and the technique used was a WHO three-stage cluster survey. The dependent variable is comorbidity of hypertension and diabetes. A logistic regression model was used to identify factors associated with hypertension-diabetes comorbidity. Results: The study population was predominantly female (59.9%). The mean age was 44 ± 17. A total of 48 (8.8%) of the subjects in the study suffered from both diabetes and hypertension. Factors associated with comorbidity of hypertension and diabetes were age ≥ 50 years (OR: 5.48;95% CI: 2.69 - 12.20;p = 0.001);male sex (OR: 2.98;95% CI: 1.39 - 6.46;p = 0.005);too much salt or salty sauce consumed (OR: 6.06;95% CI: 1.56 - 22.20;p = 0.034);abdominal obesity (OR: 6.12;95% CI: 2.79 - 14.3;p = 0.001). Conclusion: Hypertension and diabetes are emerging as major public health problems in Benin. The main associated factors were age, gender, the amount of salt or salty sauce consumed and abdominal obesity. A response is urgently needed to act on the factors identified in order to avoid possible complications and an increase in prevalence.

Epidemiology of Hand Injuries That Presented to the Emergency Department of a Tertiary Care Facility in Suburban Mumbai, India: A Study Including 489 Patients

Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can vary significantly depending on the mechanism and pattern of injuries, which is why it is imperative for emergency physicians to recognize the complexities, and the potential repercussion of missed injuries in such cases. Objective: The aim of this study is to provide epidemiological information on hand injuries and their patterns. The objective is 1) to assess whether most hand injuries are superficial (simple), or involve underlying deeper structures (complex) and 2) to assess whether most hand injuries presented to the emergency department were managed by the emergency physician or plastic/orthopaedic surgeon. Methods: This retrospective single-centre observational study conducted at an emergency department in a tertiary care hospital in Mumbai, India collected data from hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, and disposition plans were analysed. Results: A total of 489 cases sustained hand injuries over a period of one year. The patients were predominantly males in the 20 - 30 year age group and injuries were mainly sustained over the right hand. Most of the injuries were sustained at home (42%). The most common mechanism (34%) was sharp object injury (including needle-stick and other sharps in hospital), followed by blunt injury (30%). Among grievous hand injuries, door jamb was a mechanism noted in 11% of patients, accounting for 50% of all crush injuries. Lacerations were the most common pattern (24.7%) noticed, followed closely by fractures (23.3%). Digits II - IV were injured most commonly (54%), followed by carpals (14%) and the thumb (10%). Nearly 80% of the hand injuries were managed by emergency physicians alone, with 61% of cases involving superficial structures. Though 14% of the cases required plastic surgery intervention, the initial evaluation of all these patients was performed by the emergency physician. Conclusions: Our study highlights the burden of hand injuries on the emergency physician, as well as the odds of missed injuries, directly indicating the necessity of a thorough anatomical knowledge of the structures of the hand, and in turn, a proper physical examination. A dedicated registry for hand trauma would help quantify the mechanism and pattern of injuries, and formulate preventive strategies.

Factors Associated with Voluntary Cosmetic Depigmentation in Schools in the Collines Department (Benin)

Skin depigmentation is a worrying practice that is gaining popularity, particularly among young girls. However, this practice poses health risks. It also reflects a negative view of black skin color. This was a cross-sectional study carried out between April and May 2023 which involved 1039 female students from schools and universities in the Collines department selected by stratified sampling. Data was collected during a face-to-face interview using a questionnaire providing information on the demographic, socio-cultural, and economic characteristics of the girls. The depigmentation products used were identified as well as the complications caused by the use of these products. Statistical analysis made it possible to calculate the frequencies and logistic regression made it possible to identify the factors associated with depigmentation. The prevalence of depigmentation among the girls surveyed was 78.2%. The main products used were soaps based on mercurial derivative and hydroquinone (21.6%) and lotions based on hydroquinone and corticosteroids (75.7%). The factors associated with the practice of depigmentation were the ethnicity of the respondents (OR = 2.52;95% CI = [0.47 - 13.33], p = 0.001);the average monthly income of the parents (OR = 3.26;95% CI = [1.71 - 6.09], p = 0.003);the opinion of the respondents on depigmentation (OR = 2.48;95% CI = [0.84 - 7.3], p < 0.001) and the value given to light skin versus black skin (OR = 3.41;95% CI = [2.32 - 5.01], p < 0.001). In conclusion, the prevalence of depigmentation among the girls surveyed is high. Consequently, reinforced awareness measures and stricter control of bleaching products are imperative to address this high prevalence of the phenomenon.

Challenges and Countermeasures for Private Universities in Providing Education for International Students

Private universities are one of the forces driving the internationalization of higher education in China.Private universities are taking advantage of the trend to provide education for international students,playing an important role in the high-quality development of higher education in China.However,they also face challenges such as insufficient policy support,lack of management experience,and limited enrollment channels.Breakthroughs can be made through methods such as refining content,expanding enrollment channels,and attracting talent.

Analysis of the Books Issued by Yadong Library, Published by Peking University Publishing Department: Taking Several Bibliography Advertisements Carried in Newspapers and Magazines From 1919-1922 as Examples

Based on several bibliographic advertisements carried in newspapers and magazines from 1919 to 1922 for books published by Peking University Publishing Department,and issued by Yadong Library,the paper analyzes the characteristics of the books published by Peking University Publishing Department during this period,and points out that Yadong Library entered its golden period of development due to move from the alley to the main road and obtain the management rights of the books published by Peking University Publishing Department.

Empowering Culture Change:Internationalization in the Academic Department

Internationalization of higher education has widespread benefit to society and has become the expected norm.The literature offers many calls for and models of comprehensive internationalization.Society expects higher education graduates to be global ready when they graduate.Responsible citizenship and professional life require that people be inclusive and sensitive to the worldviews of others.Those calls for change raise an opportunity:a model for culture change to be followed by others.University programming is centered at the department,which is the center of faculty life(e.g.,teaching,curricular change,interaction with peers,promotion and tenure).The academic department is the center of institutional change.We used a three-year,inclusive process,to develop a strategic,international,intercultural plan for a department in a comprehensive US university.Our plan includes four themes,complemented by 12 goals.Each goal has actions with time frames(i.e.,1-3 years,5-7 years,10-12 years).There are 49 total actions.Among those,28 are in the 1-3 year time frame,and each of those has a responsible actor(e.g.,individual or committee).The plan is adaptive,and includes assessment to advance accountability and transparency.We began implementation coincident with the pandemic,and with significant social unrest in our community and nation.The year of experience provided both affirmation and redirection.Our model guides departmental change,empowering necessary growth and offering a model for others wishing to advance internationalization.

On Significance of Cross-cultural Communication in International Business-Specified on Accounting Internationalization

There is limited information about intercultural communication during the process of accounting internationalization,and Chinese accounting still has a long way to go because of the disparity in accounting principles,business culture and so on.This paper talks about the necessity of accounting internationalization and the importance of intercultural communication skill,aiming at reminding people that a good command of intercultural communication skill is a must.Some suggestions are given in hope of contributing to cross-cultural communication during the process of Chinese accounting internationalization.