Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Parental Knowledge of Pre-Hospital Management of Avulsed Permanent Tooth in Children at Kath

BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.

Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Current pre-hospital traumatic brain injury management in China

BACKGROUND: Traumatic brain injury(TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure(CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles.RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions.CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

Transshipment Strategy for Managing Supply Disruption Risk

Inventory transshipment among retailers is an effective strategy to manage supply disruption risks. The expected profit functions and the optimal ordering decisions of two newsvendors who adopt transshipment strategy to cope with upstream unreliability are derived. It is proved that transshipment strategy enhances the retailer's profit,improves the service level for customers,and under special conditions improves the supplier's profit as well. It is therefore claimed that transshipment strategy may achieve a Pareto improvement.

Controlling the coal dust at transshipment point: A study of the foam-sol foaming device

In order to effectively control the dust at the transshipment point with foam-sol, this paper attempted to study the characteristics of dust diffusion at transshipment point and the foam-sol foaming device with diffusion outlet was also designed in this paper. To study the diffusion rules of coal dust, fluent discrete phase model was utilized in the numerical simulation, as the coal dust was thrown down at a horizontal velocity of 2.5 m/s. A foam-sol foaming device was designed, through which foaming agent could be automatically sucked into the Venturi by the negative pressure. The automatic controller was also equipped,which could transform the energy of the compressed air into the constant pressure difference so that the gelling agent could be qualitatively added into the gel container. The diffusion outlet that could spray out foam-sol in a continuous, conical and 3D manner was also designed. Moreover, this paper also carried out the contrast experiments on dust removal efficiency among water, aqueous foam and foam-sol. The results clearly show that the symmetrical whirlpools appeared below the inlet where the largest whirlpool diameter was 0.52 m, and the horizontal distance from swirl range to the inlet was approximately0.69 m. By using the self-designed foaming device, the foaming was multiplied by 30 times and the volume ratio with water and foaming agent reached 95%:5%. In this context, the gas pressure was controlled at 0.3 MPa, with gas flow at 15 m3/h and water flow at 0.5 m3/h, with water pressure controlled between0.34 and 0.36 MPa. The foam-sol has the highest dust removal efficiency than other agents.

A Model for Analyzing the Transshipment Competition Relationship Between the Port of Hong Kong and the Port of Kaohsiung

The transshipment is an important issue in the current marine transportation. This paper constructed a mathematical programming model to elaborate the transshipment port selection for the shipping company. This model is tested by the data collected from the ports of Hong Kong and Kaohsiung. The results show that this model can be used to explain the transshipment competition relationship between the ports of Hong Kong and Kaohsiung well. A sensitivity analysis was also executed. The sensitivity analysis results showed that both the port of Hong Kong and Kaohsiung should decrease the charges of port and increase the effi- ciency of loading and discharging. Based on the sensitivity analysis results, some interesting conclusions and helpful suggestions were obtained for the managers of the ports of Hong Kong and Kaohsiung to improve their port management.

Step-wise synthesis of work exchange networks involving heat integration based on the transshipment model

Due to the deterioration of serious energy dilemma,energy-conservation and emission–reduction have been the strategic target in the past decades,thus people have identified the vital importance of higher energy efficiency and the influence of lower carbon development.Since work exchange network is a significant part of energy recovery system,its optima design will have dramatically significant effect on energy consumption reduction in chemical process system.With an extension of the developed transshipment model in isothermal process,a novel step-wise methodology for synthesis of direct work exchange network(WEN)in adiabatic process involving heat integration is first proposed in this paper,where a nonlinear programming(NLP)model is formulated by regarding the minimum utility consumption as objective function and optimizing the initial WEN in accordance with the presented matching rules to get the optimized WEN configuration at first.Furthermore,we focus on the work exchange network synthesis with heat integration to attain the minimal total annual cost(TAC)with the introduction of heat-exchange equipment that is achieved by the following strategies in sequence:introducing heat-exchange equipment directly,adjusting the work quantity of the adjacent utility compressors or expanders,and approximating upper/lower pressure limits consequently to obtain considerable cost savings of expanders or compressors and work utility.Finally,a case taken from the literature is studied to illustrate the feasibility and effectiveness of the proposed method.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

An inventory positioning and location decision model based on centralized storage and lateral transshipment in multi-echelon supply chain

The two-echelon inventory system considered in this work is based on one single supplier, multiple distribution centers, and multiple retailers. In each echelon safety inventory is centralized stored in several centralized storage centers and lateral transshipment of safety stock is permitted between centralized storage site and non-centralized storage sites. The inventory positioning and location decision model developed focuses on safety stock cost, lateral transshipment cost, transportation cost, construction cost and shortage cost in multi-echelon supply chain. Numerical experiments show that: no matter whether in the echelon of distribution centers or retailers the factors which affect the selection from one single centralized storage center or multiple centralized storage centers are distance between distribution centers or retailers, unit transshipment cost and unit inventory carrying cost.

Efficient Heuristic Based Methods for Two-Stage Transshipment Problem

In this article, we propose efficient methods for solving two stage transshipment problems. Transshipment problem is the special case of Minimum cost flow problem in which arc capacities are infinite. We start by proposing a novel problem formulation for a two stage transshipment problem. Later, special structure of our problem formulation is utilized to devise two dual based heuristics solutions with computational complexity of O (n2), and O (n3) respectively. These methods are motivated by the methods developed by Sharma and Saxena [1], Sinha and Sharma [2]. Our methods differ in the initialization and the subsequent variation of the dual variables associated with the transshipment nodes along the shortest path. Lastly, a method is proposed to extract a very good primal solution from the given dual solutions with a computational complexity of O (n2). Efficacy of these methods is demonstrated by our numerical analysis on 200 random problems.

A Transshipment Model of Seven-Up Bottling Company, Benin Plant, Nigeria

This research work seeks to model the distribution of 50 cl Pepsi soft drink as a transhipment problem. The transshipment problem is an extension of the traditional transportation problem which takes into account a multi-phase transport system in which the flows of goods and services are taken through an intermediate point (transhipment points) between the origin and the destination with varying objective functions. The main focus in this research was to obtain the minimum cost of transporting 10,000 crates of the product from the Benin plant (source) through deports (transshipment points) to the Sapele-Warri region (sinks) where the product is demanded. Data collected were analyzed using TORA Windows Version 2.00 software. The analysis shows that the minimum cost of transporting the product can be achieved if the product is shipped directly from the source to the sink. This forms that basis for the conclusions and recommendations of the research.

A HUB FOR TRANSSHIPMENT

One of Dalian Port’s major targets is to push forward the containers traffic in Dalian or even Northeast China as well as become an important international transshipment hub in the region. The Dailian municipal government signed a framework agreement with the China Ocean Shipping (Group) Company (COSCO) on July 21, 2004. Two days later, the municipal government signed a co-operative

Pre-hospital application of REBOA for life-threatening hemorrhage

Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.

石油污染土壤微生物修复技术及机理研究进展

综述了环境微生物技术在石油污染土壤修复中的应用方法,介绍了人为干预提高石油降解微生物治理油污土壤的原位和异位修复技术和微生物去除石油组分的作用机理。针对微生物修复的研究热点多为石油降解微生物的选取及多种微生物的复合菌对石油组分的去除效果,但对微生物技术的实际应用和机理研究相对较少。提出了未来微生物技术修复石油污染土壤的研究和发展方向,包括特定材料对微生物的固定化、利用宏组学与示踪技术进一步明确微生物的降解机理和质粒拼接手段构建高效基因工程菌。

加油站补货管理系统中在途库存的实时转运策略

加油站补货管理系统中的在途库存实时转运问题需要考虑转运时间以及未来不确定的需求,且需要实时响应转运需求。针对该难题,以最大化剩余决策时段内整体收益为目标,提出一种结合需求预测模型和随机需求分布以分段衡量整体收益的方法,解决了加油站补货管理系统中在途库存的实时转运难题。首先,将剩余决策时段划分为两个时段。其次,基于需求预测模型量化第1个时段内的需求,以衡量该时段的利润总和,并确定第2个时段初站点的库存水平;采用随机分布衡量需求的不确定性,基于近似动态规划算法求解库存水平的值函数,以衡量第2个时段的利润总和;设计拟被转运走部分在途库存的站点的选择规则,缩小决策空间以提高策略的响应效率。最后,对比实验验证了本文方法产生的转运策略在不同站点规模和初始库存范围下的有效性,并得出管理启示。本研究可为加油站补货管理系统中在途库存的实时转运提供决策支持,对类似需同时考虑转运时间和未来需求的实时转运问题具有启发意义。