Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Performance of a Large-Scale Medical Waste Incinerator in a Referral Hospital

The aim of the study was to analyze the performance of large scale incinerator installed in a referral hospital. The study involved weighing and loading infectious waste of different composition (sharps and other waste), recording temperatures in the primary and secondary chamber with time, fuel used and collecting and weighing the bottom ash for 65 days. The analysis shows that the incinerator on average uses 362 L/day (45 L/h) to incinerate 945 kg of medical waste (40.8 kg/day of sharps waste and 904 kg/day of other waste), generating 51.2 kg of ash daily. The observed fuel consumption rate was too high necessitating corrective action. The average weight reduction was 94.6%. The study shows that the average sharps waste composition for medical waste incinerated was 4.3% and other waste was 95.7%. The incinerator capacity ranged between 100 and 130 kg/h. The fuel effectiveness ranged between 2.0 and 3.0 liters of diesel per kg of waste incinerated. The fuel effectiveness increased linearly with total waste incinerated and incinerator capacity, respectively, depending on the fuel consumption rate.

Hospital-acquired insomnia scale:A validity and reliability study

BACKGROUND Sleep breathing,one of the basic human needs,is a physiological need that affects cardiac functions,body temperature,daily vitality,muscle tone,hormone secretion,blood pressure,and many more.In the international literature,studies reported that patients have had sleep problems in the hospital since the 1990s,but no measurement tool has been developed to determine the causes of hospitalacquired insomnia in individuals.These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing.Although patients generally experience hospital-acquired sleep problems,there is no measurement tool to determine hospital-acquired sleep problems.These features show the originality of the research.AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.METHODS A personal information form,hospital-acquired insomnia scale(HAIS),and insomnia severity index(ISI)were used to collect research data.The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022.The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage.Exploratory factor analysis and confirmatory factor analysis(CFA)analyses were performed using the SPSS 20 package program and the analysis of moment structure(AMOS)package program.Equivalent forms method used.RESULTS The HAIS consisted of 18 items and 5 subscales.The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783.The scale explained 58.269%of the total variance.The items that constitute the factors were examined in terms of content integrity and named as physical environmental,psychological,safety,socioeconomic,and nutritional factors.CFA analysis of the 5-factor structure was performed in the AMOS package program.The fit indices of the obtained structure were examined.It was determined that the values obtained from the fit indices were sufficient.A significant correlation was determined between the HAIS and the ISI,which was used for the equivalent form method.CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients’level of hospitalacquired insomnia.It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

A SUPERLINEARLY CONVERGENT SPLITTING FEASIBLE SEQUENTIAL QUADRATIC OPTIMIZATION METHOD FOR TWO-BLOCK LARGE-SCALE SMOOTH OPTIMIZATION

This paper discusses the two-block large-scale nonconvex optimization problem with general linear constraints.Based on the ideas of splitting and sequential quadratic optimization(SQO),a new feasible descent method for the discussed problem is proposed.First,we consider the problem of quadratic optimal(QO)approximation associated with the current feasible iteration point,and we split the QO into two small-scale QOs which can be solved in parallel.Second,a feasible descent direction for the problem is obtained and a new SQO-type method is proposed,namely,splitting feasible SQO(SF-SQO)method.Moreover,under suitable conditions,we analyse the global convergence,strong convergence and rate of superlinear convergence of the SF-SQO method.Finally,preliminary numerical experiments regarding the economic dispatch of a power system are carried out,and these show that the SF-SQO method is promising.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Characterization of Class 1 Integron Gene Cassettes among Clinical Bacteria Isolated from One Large Hospital in Northern China

The class 1 integron and complex gene cassettes among different species of clinical isolates in northern China were characterized in this study. 383 clinical isolates were obtained from northern China, and class 1 integrons containing gene cassettes widely distributed among gram negative clinical isolates was observed. We find that the class 1 integron showed positive correlation with multidrug resistance phenotype of gram negative bacteria. In addition, we find that isolates belonged to one species harbored different types of gene cassette arrays, while same types of gene cassette arrays were observed in different species of isolates. The diversity of gene cassette arrays among the isolates indicated the complexity of multidrug resistance in clinical isolates in northern China.

Risk Management of Clinical Reference Dosimetry of a Large Hospital Network Using Statistical Process Control

Managing TG-51 reference dosimetry in a large hospital network can be a challenging task. The objectives of this study are to investigate the effectiveness of using Statistical Process Control (SPC) to manage TG-51 workflow in such a network. All the sites in the network performed the annual reference dosimetry in water according to TG-51. These data were used to cross-calibrate the same ion chambers in plastic phantoms for monthly QA output measurements. An energy-specific dimensionless beam quality cross-calibration factor, , was derived to monitor the process across multiple sites. The SPC analysis was then performed to obtain the mean, , standard deviation, σk, the Upper Control Limit (UCL) and Lower Control Limit (LCL) in each beam. This process was first applied to 15 years of historical data at the main campus to assess the effectiveness of the process. A two-year prospective study including all 30 linear accelerators spread over the main campus and seven satellites in the network followed. The ranges of the control limits (±3σ) were found to be in the range of 1.7% - 2.6% and 3.3% - 4.2% for the main campus and the satellite sites respectively. The wider range in the satellite sites was attributed to variations in the workflow. Standardization of workflow was also found to be effective in narrowing the control limits. The SPC is effective in identifying variations in the workflow and was shown to be an effective tool in managing large network reference dosimetry.

Large Scale Fundamental Interactions in the Universe

The author of this paper once attempted to propose a unified framework for gauge fields based on the mathematical and physical picture of the principal fiber bundle: that is, to believe that our universe may have more fundamental interactions than the four, and these fundamental gauge fields are only components on the bottom manifold (i.e. our universe) projected by a unified gauge potential of the principal fiber bundle manifold;these components can satisfy the transformation of gauge potential, or even be transformed from one basic interaction gauge potential to another basic interaction gauge potential, and can be summarized into a unified equation, namely the generalized gauge equation expression, corresponding to gauge transformation invariance;so the invariance of gauge transformation is a necessary condition for unified field theory, and the four (or more) fundamental interaction fields of the universe are unified in a unified gauge field defined by the connection on the principal fiber bundle. In this paper, the author continues to propose a model of large-scale (gravitational) fundamental interactions in the universe based on the mathematical and physical picture of the principal fiber bundle, attempting to explain that dark matter and dark energy are merely reflections of these gravitational fundamental interactions that deviate in intensity from the gravitational fundamental interactions of the solar system at galaxy scales or some cosmic scales which are much larger than the solar system. All these “gravitational” fundamental interactions originate from the unified gauge field of the universe, namely the connection or curvature on the principal fiber bundle. These interactions are their projected representations on the bottom manifold (i.e. our universe) by different cross-sections (gauge transformations). These projection representations of the universe certainly are described by the generalized gauge equation or curvature similarity equation, and under the guidance of curvature gauge transformation factors, oscillate and evolve between the curvatures 1→0→-1→0→1 of the universe.

Novel process for large scale synthesis of N-(4-hydroxyphenyl) retinamide

A method to synthesize anticancer drug N-（ 4- hydroxyphenyl） retinamide （4-HPR）on a large scale is described. It consists of the preferred steps of reacting all-trans retinoic acid with thionyl chloride to form retinoyl chloride and then reacting with triethylamine to generate retinoyl ammonium salt which in turn is reacted with p-aminophenol to eventually produce 4-HPR. This process can overcome many scale-up challenges that exist in the methods reported in the literature and provide an easy, mild and high yield route for large scale synthesis of 4-HPR. Moreover, the effects of the molar ratios of the reagents on the yield are examined. The best molar ratios are a 2.0 molar equivalence of thionyl chloride and a 3.0 molar equivalence of paminophenol to retinoic acid, and the total yield is 80. 7%.

NEW LIMITED MEMORY SYMMETRIC RANK ONE ALGORITHM FOR LARGE-SCALE UNCONSTRAINED OPTIMIZATION

A new limited memory symmetric rank one algorithm is proposed. It combines a modified self-scaled symmetric rank one （SSR1） update with the limited memory and nonmonotone line search technique. In this algorithm, the descent search direction is generated by inverse limited memory SSR1 update, thus simplifying the computation. Numerical comparison of the algorithm and the famous limited memory BFGS algorithm is given. Comparison results indicate that the new algorithm can process a kind of large-scale unconstrained optimization problems.

Large Scale VLSI Module Placement Using LFF Heuristics by Stages

We present a deterministic algorithm for large-scale VLSI module placement. Following the less flexibility first （LFF） principle,we simulate a manual packing process in which the concept of placement by stages is introduced to reduce the overall evaluation complexity. The complexity of the proposed algorithm is （N1 ＋ N2 ） × O（ n^2 ） ＋ N3× O（n^4lgn） ,where N1, N2 ,and N3 denote the number of modules in each stage, N1 ＋ N2 ＋ N3 = n, and N3〈〈 n. This complexity is much less than the original time complexity of O（n^5lgn）. Experimental results indicate that this approach is quite promising.

Large Scale Aspects of India-China Summer Monsoon Rainfall

This study investigates the dominant modes of variability in monthly and seasonal rainfall over the India-China region mainly through Empirical Orthogonal Function (EOF) analysis. The EOFs have shown that whereas the rainfall over India varies as one coherent zone, that over China varies in east-west oriented bands. The influence of this banded structure extends well into India.Relationship of rainfall with large scale parameters such as the subtropical ridge over the Indian and the western Pacific regions, Southern Oscillation, the Northern Hemispheric surface air temperature and stratospheric winds have also been investigated. These results show that the rainfall over the area around 40°N, 110°E over China is highly related with rainfall over India. The subtropical ridge over the Indian region is an important predictor over India as well an over the northern China region. '

Compact Scanning Tunneling Microscope with Large Scale Searching Capability for Mmultidisciplinary Applications

We present the design and performance of a home-built scanning tunneling microscope （STM）, which is compact （66 mm tall and 25 mm in diameter）, yet equipped with a 3D atomic precision piezoelectric motor in which the Z coarse approach relies on a high simplic-ity friction-type walker （of our own invention） driven by an axially cut piezoelectric tube. The walker is vertically inserted in a piezoelectric scanner tube （PST） with its brim laying at on the PST end as the inertial slider （driven by the PST） for the XZ （sample plane） motion. The STM is designed to be capable of searching rare microscopic targets （defects, dopants, boundaries, nano-devices, etc.） in a macroscopic sample area （square millimeters） under extreme conditions （low temperatures, strong magnetic elds, etc.） in which it ts. It gives good atomic resolution images after scanning a highly oriented pyrolytic graphite sample in air at room temperature.

Dendritic cells derived from pluripotent stem cells:Potential of large scale production

Human pluripotent stem cells(hPSCs), including human embryonic stem cells and human induced pluripotent stem cells, are promising sources for hematopoietic cells due to their unlimited growth capacity and the pluripotency. Dendritic cells(DCs), the unique immune cells in the hematopoietic system, can be loaded with tumor specific antigen and used as vaccine for cancer immunotherapy. While autologous DCs from peripheral blood are limited in cell number, hPSC-derived DCs provide a novel alternative cell source which has the potential for large scale production. This review summarizes recent advances in differentiating hPSCs to DCs through the intermediate stage of hematopoietic stem cells. Step-wise growth factor induction has been used to derive DCs from hPSCs either in suspension cultureof embryoid bodies(EBs) or in co-culture with stromal cells. To fulfill the clinical potential of the DCs derived from hPSCs, the bioprocess needs to be scaled up to produce a large number of cells economically under tight quality control. This requires the development of novel bioreactor systems combining guided EB-based differentiation with engineered culture environment. Hence, recent progress in using bioreactors for hPSC lineage-specific differentiation is reviewed. In particular, the potential scale up strategies for the multistage DC differentiation and the effect of shear stress on hPSC differentiation in bioreactors are discussed in detail.

Large scale classification with local diversity AdaBoost SVM algorithm

Local diversity AdaBoost support vector machine（LDAB-SVM） is proposed for large scale dataset classification problems.The training dataset is split into several blocks firstly, and some models based on these dataset blocks are built.In order to obtain a better performance, AdaBoost is used in each model building.In the boosting iteration step, the component learners which have higher diversity and accuracy are collected via the kernel parameters adjusting.Then the local models via voting method are integrated.The experimental study shows that LDAB-SVM can deal with large scale dataset efficiently without reducing the performance of the classifier.

Local and global approaches of affinity propagation clustering for large scale data

Recently a new clustering algorithm called 'affinity propagation' (AP) has been proposed, which efficiently clustered sparsely related data by passing messages between data points. However, we want to cluster large scale data where the similarities are not sparse in many cases. This paper presents two variants of AP for grouping large scale data with a dense similarity matrix. The local approach is partition affinity propagation (PAP) and the global method is landmark affinity propagation (LAP). PAP passes messages in the subsets of data first and then merges them as the number of initial step of iterations; it can effectively reduce the number of iterations of clustering. LAP passes messages between the landmark data points first and then clusters non-landmark data points; it is a large global approximation method to speed up clustering. Experiments are conducted on many datasets, such as random data points, manifold subspaces, images of faces and Chinese calligraphy, and the results demonstrate that the two ap-proaches are feasible and practicable.

A LIMITED MEMORY QUASI-NEWTON METHOD FOR LARGE SCALE PROBLEM

We study how to use the SR1 update to realize minimization methods for problems where the storage is critical. We give an update formula which generates matrices using information from the last m iterations. The numerical tests show that the method is efficent.

Cronbach's a reliability, concurrent validity, and factorial structure of the Death Depression Scale in an Iranian hospital staff sample

Objective: Death depression is an important component in the process of death and dying. Death depression is the second element of death. Depression is one of the important features in death distress. The aim of this study was to explore the performance of the Farsi version of the Death Depression Scale with an Iranian convenience sample of nurses (n =106).Methods: Nurses were selected using a convenience sampling method, and completed the Death Depression Scale (DDS), Death Concern Scale (DCS), Collett-Lester Fear of Death Scale (CLFDS), Reasons for Death Fear Scale (RDFS), Templer's Death Anxiety Scale (DAS), and Death Obsession Scale (DOS). Results: The results of exploratory factor analysis on DDS identified 4 factors (56.16%of variance). Factor 1 labeled"Death sadness", Factor 2 labeled"Death finality/end and Death dread/fear", Factor 3 labeled"Death despair and Death depression", and Factor 4 labeled"Death loneliness". Cronbach's a coefficient was 0.84, Spearman-Brown coefficient 0.85, and Guttman Split-Half coefficient 0.81 The DDS correlated 0.40 with the DCS, 0.39 with the CLFDS, 0.50 with the DAS, 0.35 with the RDFS, and 0.44 with the DOS, indicating good construct and criterion-related validity. Concurrent validity for the DDS with the other scales were significant. Conclusions: The DDS has good validity and reliability, and it can use in clinical and research settings.

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform:Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.

Comparing the reinforcement capacity of welded steel mesh and a thin spray-on liner using large scale laboratory tests

Steel mesh is used as a passive skin confinement medium to supplement the active support provided by rock bolts for roof and rib control in underground coal mines. Thin spray-on liners(TSL) are believed to have the potential to take the place of steel mesh as the skin confinement medium in underground mines.To confirm this belief, large scale laboratory experiments were conducted to compare the behaviour of welded steel mesh and a TSL, when used in conjunction with rock bolts, in reinforcing strata with weak bedding planes and strata prone to guttering, two common rock conditions which exist in coal mines. It was found that while the peak load taken by the simulated rock mass with weak bedding planes acting as the control sample(no skin confinement) was 2494 kN, the corresponding value of the sample with 5 mm thick TSL reinforcement reached 2856 kN. The peak load of the steel mesh reinforced sample was only2321 kN, but this was attributed to the fact that one of the rock bolts broke during the test. The TSL reinforced sample had a similar post-yield behaviour as the steel mesh reinforced one. The results of the large scale guttering test indicated that a TSL is better than steel mesh in restricting rock movement and thus inhibiting the formation of gutters in the roof.