Research on Public Engineering Emergency Decision-Making Based on Multi-Granularity Language Information

To effectively deal with fuzzy and uncertain information in public engineering emergencies,an emergency decision-making method based on multi-granularity language information is proposed.Firstly,decision makers select the appropriate language phrase set according to their own situation,give the preference information of the weight of each key indicator,and then transform the multi-granularity language information through consistency.On this basis,the sequential optimization technology of the approximately ideal scheme is introduced to obtain the weight coefficient of each key indicator.Subsequently,the weighted average operator is used to aggregate the preference information of each alternative scheme with the relative importance of decision-makers and the weight of key indicators in sequence,and the comprehensive evaluation value of each scheme is obtained to determine the optimal scheme.Lastly,the effectiveness and practicability of the method are verified by taking the earthwork collapse accident in the construction of a reservoir as an example.

Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

The Status Quo of Disease Emergency Assistance System in China

This paper analyzes the operation mechanism of Disease Emergency Assistance system in China, and discusses what problem sexist on its workings. Results: The results of data analysis from 2015 to 2016 and field survey show that the pattern of Disease Emergency Assistance system has formed initially, and system plays the important role in solving the problem that some people are hard to require health emergency services. But, there are still some problems mainly including object identification, assistance in departments, operating rules in fund application and payment and fund using etc. Conclusions: using the network technique to improve the way of identifying object, elaborating laws and constructing information system.

Information Aggregation of Group Decision-Making in Emergency Events

Information is a key factor in emergency management, which helps decision makers to make effective decisions. In this paper, aiming at clarifying the information aggregation laws, and according to the characteristic of emergency information, information relative entropy is applied in the information aggregation to establish the information aggregation model of emergency group decision-making. The analysis shows that support and credibility of decision rule are the two factors in information aggregation. The results of four emergency decision-making groups in case study support the analysis in the paper.

Characteristics of Decision-Making by Family Members When Older Adults Are Hospitalized in Emergency Cases with Life-Threatening Conditions

Aim: This study aims to elucidate decision-making characteristics based on interviews with family members with experience in having to select treatments for older adult patients who have been hospitalized following emergency transport to the hospital. Design: Semi-structured interviews were conducted with 10 individuals with experience in surrogate decision-making for an older adult family member. Methods: The recorded interview data were transcribed verbatim, divided into minimum semantic units, and coded. Next, categories and subcategories were abstracted. A comparison was made with the conceptual constructs of a previous study that examined decision-making by families in a life-threatening crisis. Results: Four categories were extracted from 489 antecedents, 370 attributes, and 388 consequences. One new category was abstracted for each of: 1) antecedents: observing abnormalities and responding, while being worried about death;2) attributes: deliberating on the patient prognosis, the relationship with the patient, and what they believe the patient would want;and 3) consequences: continuing support during convalescence. It is desirable to provide support based on the characteristics of families of older adults, including considering the psychological burden on the families who make surrogate decisions, and also the burden of subsequent caregiving because it is not and in the present environment has not been common for patients to express their wishes beforehand.

Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

A comparison of perspectives on costs in emergency care among emergency department patients and residents

BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department(ED). We compare ED resident and patient perspectives surrounding costs in emergency care.METHODS: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients(>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded theory.RESULTS: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on costs.CONCLUSION: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insuf? cient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs.

Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of “time”.

融合知识图谱和案例推理的燃气应急辅助决策研究

燃气事故发生时,应急处置人员基于文本资料查询应急处置方案难以满足处置科学性与快速性的需求。为此,提出了一种融合知识图谱和案例推理的燃气应急辅助决策方法。将已有燃气事故案例文本资料以知识图谱的形式存储与表示,利用案例推理的属性相似度与关系相似度加权计算方法,根据事故目标案例与源案例的综合相似度,检索出最佳相似源案例作为现场处置人员应急处置决策的重要参考,并将新的案例与处置措施存储于燃气应急处置知识图谱库中,实现处置措施的知识更新。通过案例相似度权重分配、属性权重分配、属性相似度方法选取,以及案例验证等,验证了本文方法的合理性与有效性。

四川地震应急信息共享服务系统在芦山6.1级地震中的应用与启示

通过分析宝兴县防震减灾部门以及市县抗震救灾联合指挥部在开展抗震救灾工作中的实际需求,总结四川地震应急信息共享服务系统在应对“四川芦山6.1级地震”应急处置过程中取得了的应用实效,得出一些启示与建议,以此指导系统升级完善,逐步将“四川地震应急信息共享服务系统”建设成具有专业性、针对性和时效性的系统,利用专业的信息化技术手段,真正打通震后最后1km,服务于县级抗震救灾,提升基层震后应急信息服务能力,为震后地方指挥决策提供信息支撑。

自然周期卵泡早排的预测及提前取卵价值评估

目的探究卵巢储备功能减退(DOR)患者采用自然周期体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕中影响卵母细胞提前排逸的因素,比较患者扳机后提前及正常取卵的治疗结局,评价提前取卵的临床应用价值。方法回顾性队列研究分析2020年1月至2023年4月期间于南京医科大学第一附属医院生殖医学中心采用自然周期IVF/ICSI-ET助孕的815名DOR患者临床资料,根据取卵日卵母细胞是否提前排逸分为取卵日卵母细胞未早排组(A组,n=712)和取卵日卵母细胞早排组(B组,n=103)。再依据扳机后取卵时间分别将A、B两组细分:扳机后36 h取卵(A1组和B1组,扳机日血LH<20 U/L)和扳机后24 h取卵(A2组和B2组,扳机日血LH≥20 U/L),分析比较4组患者的临床数据及妊娠结局。结果各组患者的年龄、体质量指数(BMI)、抗苗勒管激素水平及月经情况等差异均无统计学意义(P>0.05)。促排卵情况比较:取卵时间相同时,未早排患者与早排组相比(即A1组与B1组、A2组与B2组相比),取卵周期起始第3天最大卵泡直径、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))水平及扳机药物种类差异无统计学意义(P均>0.05);A1组患者扳机日E_(2)、LH及孕酮(P)水平均显著低于B1组(P均<0.05)。卵母细胞未早排两组间实验室及临床结局比较:正常取卵A1组的受精率及卵裂率均较提前取卵的A2组显著提高,而A2组无可移植胚胎率显著高于A1组(P均<0.05);两组间的未获卵率、胚胎形成率、优质胚胎率、囊胚形成率、优质囊胚率、鲜胚移植率、全胚冷冻率差异均无统计学意义(P均>0.05);在鲜胚移植周期中,两组间的HCG阳性率、临床妊娠率、流产率、活产率差异无统计学意义(P>0.05),但A1组的累积HCG阳性率、累积临床妊娠率、累积活产率均显著高于A2组(P均<0.05)。结论在自然周期卵泡发育过程中,若LH峰提前出现,相比正常时间收集卵母细胞,采取扳机后提前取卵虽然增加了获卵数,但并不能改善患者的助孕结局。在取卵周期的起始阶段,尚缺乏有效指标来预测本周期LH峰的提前出现及卵母细胞早排的风险。

考虑车辆运动预测的AEB系统控制策略

针对自动紧急制动(autonomous emergency braking,AEB)系统弯道适应性差及舒适性不佳的问题,提出了一种基于高斯过程运动预测,考虑变曲率弯道和制动舒适性的AEB系统控制策略。基于三次样条曲线建立行车道路模型,对前车进行定位,并计算相对曲线距离。考虑车辆运动的非线性特性以及时间效应,建立基于高斯过程理论的车辆运动预测模型,设计了基于预测碰撞时间的分级预警与制动控制策略。联合仿真结果表明:提出的控制策略能够有效实现车辆的避撞,解决了AEB系统在复杂动态工况下的弯道适应性和制动舒适性问题。

信息受限情况下多出口应急疏散仿真分析

为了研究多出口房间疏散过程中行人信息掌握程度异质化及行人间存在利他互助行为时系统疏散动力学的演化,提出考虑行人帮助行为的改进社会力模型,基于不同的疏散信息掌握程度,构建有/无帮助行为的出口选择策略。研究结果表明:群体密度较低且存在帮助行为时,信息掌握程度越高疏散效率越高;群体密度较高时结论相反,信息掌握程度较低时,帮助行为能有效削弱“快即是慢”效应;信息掌握程度较高时,帮助行为则可能抑制疏散效率。研究结果不仅在理论上深化了对多出口房间疏散动力学的理解,而且在实际场景中对提高疏散效率和安全性具有重要借鉴意义。

基础数据信息系统在高铁应急处置中的应用与展望

截止2022年底,我国已建成世界上规模最大的高速铁路网,为人民提供了安全、快捷、便利的出行方式,使得高铁成为人民出行的首选。但是在高铁运行时一旦出现设备故障,如不能正确且及时的处置,将会严重干扰高铁正常的运行秩序,引起社会关注,影响高铁声誉。通过对既有高铁应急处置作业方式的分析,目前存在数据涉及面广、存储形式多样、查阅不便、综合应用效果差等痛点,为此提出搭建基础数据信息系统的构想,通过实际应用,实现了设备信息查询效率提高2.2倍以上,准确率提高到99.66%,系统查看现场设备信息使用率高达100%。

地空协同场景下加权模糊聚类用户簇划分方法

为了解决应急通信场景下使用无人机作为空中基站进行辅助通信时涉及的无人机基站部署策略中的用户簇划分问题,在兼顾无人机基站性能和用户体验的条件下,提出一种基于特征加权的模糊聚类(Improved FCM)算法。首先,根据每个无人机基站的信号覆盖范围和最大服务用户数量的性能约束,针对随机分布条件下的用户簇在划分过程中算法计算量大不易收敛的问题,提出一种基于距离加权的特征加权节点数据投影算法;其次,针对同一用户处于多个簇有效范围内时用户划分的有效性和无人机基站资源的最大化利用问题,提出一种基于用户位置和无人机基站负载均衡的价值加权算法。实验结果表明,所提方法充分满足无人机基站的服务性能约束,且与几何分形法(GFA)、谱聚类(Sp-C)等算法相比,特征加权模糊聚类算法获得的平均负载率和覆盖比是最优的,分别达到了0.774和0.0263,因此,该算法可为应急通信场景下的用户簇划分问题提供一种可行的解决方案。

Clinical decision-making by the emergency department resident physicians for critically ill patients

The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by the Emergency Department of Peking Union Medical College Hospital were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents.The application of decision-making strategies by PG1 and PG3 groups,which means the residents in first year and the third year,were compared.The patients were treated according to pattern recognition(43.0%),hypotheticodeductive reasoning(23.4%),event-driven models(19.3%),and rule-using algorithms(5.9%).A significant difference was found between PG1 and PG3 groups(χ^(2)=498.01,P<0.001).Pattern recognition and hypotheticdeductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients.The decision-making processes applied by junior and senior residents were significantly different,although neither group adequately applied rule-using algorithms.Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.

A method for emergency response alternative decision-making under uncertainty

In this paper,an emergency decision-making method,based on case-based reasoning and cloud model,is proposed to solve the risk decision-making problem in emergency response.Casebased reasoning,by allowing the decision-maker to referring to past decisions,introduces a short-cut to formulate feasible emergency alternatives.Cloud model is used to evaluate and optimise the emergency response alternatives.To evaluate emergency response alternatives,the decision criterion must be determined according to the aim and characteristics of emergency rescue in disasters or accidents.Then,the weight cloud and evaluation cloud of the decision criterion are determined by the Delphi method combined with backward cloud generator,and the synthesised cloud of each alternative is calculated through arithmetic rules of cloud.Finally,a ranking of all response alternatives can be determined,and the best alternative is selected.Case study shows that the method makes the conversion between qualitative description and quantitative indication more effective.

Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma

Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.

AUSTRALIA'S GLOBAL ODA PROGRAM AND EMERGENCY ASSISTANCE

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心搏骤停患者心肺复苏院前急救中气管插管、球囊辅助呼吸的应用价值分析

目的:分析心搏骤停患者心肺复苏院前急救中气管插管、球囊辅助呼吸的应用价值。方法:选取2019年1月—2021年1月长沙市中心医院急诊科院前急救的74例心搏骤停患者作为研究对象,根据随机数字表法分为观察组与对照组,各37例。对照组在心肺复苏院前急救中采用气管插管进行辅助呼吸,观察组应用球囊辅助呼吸。比较两组院前急救指标水平、并发症发生情况、血气分析指标水平。结果:观察组建立通气时间短于对照组,差异有统计学意义(P=0.000);两组复苏5 min时血氧饱和度(SaO_(2))、心肺复苏成功率比较,差异无统计学意义(P>0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P=0.032)。急救前后,两组pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、SaO_(2)比较,差异无统计学意义(P>0.05);急救后,两组pH值、PaO_(2)、SaO_(2)水平均高于急救前,PaCO_(2)水平低于急救前,差异有统计学意义(P<0.05)。结论:对于心搏骤停患者心肺复苏院前急救中应用气管插管或球囊进行辅助呼吸,均可获得确切的急救效果,但球囊辅助呼吸更有利于缩短患者的建立通气时间,降低并发症发生率。