A cross-sectional study on the nurses’attitude towards rapid response system activation for clinically deteriorated patients

Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical deterioration is still largely negative.This is because most RRSs rely on ward nurses to recognise clinical deterioration and manually alert responders through phone calls,hospital communication systems,or face-to-face communication.

Thermosensitive Poly(N-isopropylacrylamide-co-acrylonitrile) Hydrogels with Rapid Response

Acrylonitrile (AN) was copolymerized with N-isopropylacrylamide (NIPA) to synthesize thermosensitive hy-drogels, and the on-off switch behavior of poly(NIPA-co-AN) hydrogels with different fraction of hydrophobic compo-nent (AN) was investigated. It is found that the lower critical solution temperature (LCST), the swelling ratio at certain temperature and the reswelling rate of poly(NIPA-co-AN) hydrogels decreased as AN unit fraction in copolymers in-creased. In order to improve the responsive rate of poly(NIPA-co-AN) hydrogels, they were further treated by surface crosslinking using N, N′-methylene bisacrylamide (BIS) as a crosslinking agent. The swelling and deswelling behaviors of these copolymers were compared with those of the untreated hydrogels. The results indicated that the responsive rate of poly(NIPA-co-AN) hydrogel was improved by surface crosslinking. The resulting hydrogels bearing cyano groups with fast response have potential applications in the field of drug-controlled release and immobilization of biomolecules.

High-quality perovskite MAPbI_3 single crystals for broad-spectrum and rapid response integrate photodetector

Organic–inorganic single-crystalline perovskites have attracted significant attentions due to their exceptional progress in intrinsic properties＇ investigation and applications in photovoltaics and optoelectronics. In this study, the large perovskite CH3NH3PbI3 single crystal with the largest length of 80 mm was prepared through the method of inverse-temperature crystallization. Meanwhile, the mass production of integrate photodetectors have been fabricated on the single-crystalline wafer and the photoresponse performances were investigated. The results show that the single-crystalline photodetectors have broad spectrum response to 900 nm, rapid response speed（〈40 μs） and excellent stability. These findings are of great importance for future promising perovskite single crystalline for integrated photoelectronic application.

Characteristics of In-Hospital Patients with Congenital Heart Disease Requiring Rapid Response System Activations: A Japanese Database Study

Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.

Research on Application Technology Oriented Rapid Response Manufacturing in the Distributed Network Environment

A new chance of developing traditional manufacturing industry comes forth with the development of network technology. Application technology oriented rapid response manufacturing in the distributed network environments, that is, how to take advantage of the Intranet and Internet, combine the numerous manufacturing resources spread around the region, the country and even the globe is the key to the agile design, manufacturing and the buildup of comprehensively competitive power, at the same time, is also an important research direction in the field of advanced manufacturing technology. Rapid response manufacturing in the distributed network environment is a newly manufactory pattern that can be used to implement the conception of agile design and manufacturing, but there are some new problems coming with it, which will directly influence the enterprise’s ability of rapid response in the distributed network manufacturing pattern and lead to the failure of the league and the lost of the given orders. In this paper, we establish some approaches to solve these problems in product development process. The paper then presents the research on key application technologies and solutions includes: network safety strategy which guarantees data transferring among the leaguer members, production data management based on Web/DOT (Distributed Object Technology) and XML criteria which guarantees data exchange in structure-variance characteristic environments, the network platform which provides the conversion service of different types of CAD files each other. All of these solutions are aim for technology problems existing in the distributed network environments and among the league members. Finally, the paper takes one project, that is, the establishment of the online application service system for Shanghai Advance Manufacturing Technology Research Center as a good instance.

A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?

Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with rapid ventricular response (RVR). Both are Class I recommendations from the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support the view that diltiazem is more effective than metoprolol, even though data from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation. However, some recent studies indicate this idea may be unfounded. The aim of this article is to compare the efficacy of diltiazem and metoprolol for rate control in AF with RVR and examine the use of diltiazem in patients with both AF with RVR and HFrEF.

An oxide-based heterojunction optoelectronic synaptic device with wideband and rapid response performance

With the rapid development of science and technology,the emergence of new application scenarios,such as robots,driverless vehicles and smart city,puts forward high requirements for artificial visual systems.Optoelectronic synaptic devices have attracted much attention due to their advantages in sensing,memory and computing integration.In this work,via band structure engineering and heterostructure designing,a heterojunction optoelectronic synaptic device based on Cu doped with n-type SrTiO_(3)(Cu:STO)film combined with p-type CuAlO_(2)(CAO)thin film was fabricated.It is found surprisingly that the optoelectronic device based on Cu:STO/CAO p-n heterojunction exhibits a rapid response of 2 ms,and that it has a wideband response from visible to near-infrared(NIR)region.Additionally,a series of important synaptic functions,including excitatory postsynaptic current(EPSC),paired-pulse facilitation(PPF),shortterm potentiation(STP)to long-term potentiation(LTP)transition,learning experience behavior and image sharpening,have been successfully simulated on the device.More importantly,the performance of the device remains still stable and reliable after several months which were stored at room temperature and atmospheric pressure.Based on these advantages,the optoelectronic synaptic devices demonstrated here provide great potential in the new generation of artificial visual systems.

Rapid Response

Government departments act on proposals put forward by CPPCC members It is the third year Li Lanjuan, an academician of the Chinese Academy of Engineering and a member of the 11th

Prioritizing Indicators for Rapid Response in Global Health Security:A Bayesian Network Approach

This study explored a Bayesian belief networks(BBNs)approach,developing two distinct models for prioritizing the seven indicators related to the“rapid response to and mitigation of the spread of an epidemic”category within the context of both the specifc category and the Global Health Security Index(GHS index).Utilizing data from the 2021 GHS index,the methodology involves rigorous preprocessing,the application of the augmented naive Bayes algorithm for structural learning,and k-fold cross-validation.Key fndings show unique perspectives in both BBN models.In the mutual value of information analysis,“linking public health and security authorities”emerged as the key predictor for the“rapid response to and mitigation of the spread of an epidemic”category,while“emergency preparedness and response planning”assumed precedence for the GHS index.Sensitivity analysis highlighted the critical role of“emergency preparedness and response planning”and“linking public health and security authorities”in extreme performance states,with“access to communications infrastructure”and“trade and travel restrictions”exhibiting varied signifcance.The BBN models exhibit high predictive accuracy,achieving 83.3%and 82.3%accuracy for extreme states in“rapid response to and mitigation of the spread of an epidemic”and the GHS index,respectively.This study contributes to the literature on GHS by modeling the dependencies among various indicators of the rapid response dimension of the GHS index and highlighting their relative importance based on the mutual value of information and sensitivity analyses.

Solution of false alarm and slow response in flame detector

A new flame detector with one ultraviolet and two infrared detectors is designed. The ultraviolet detector is of rapid response(≤10 μs) while the two infrared detectors usually have a response time of more than 5 ms. The ultraviolet detector is applied to deal with the flame of large scales. When facing the flame of mid or small scales, the three detectors cooperate. Employing the high-order derivatives of the sample data of the infrared circuits to improve the sensitivity, the response speed is greatly improved. The data of the temperature sensor is used to adjust circuit parameters in real time, thus reducing the effect of temperature drift. The flame detectors are tested at different distances and the response time is as rapid as 0.65 ms. The test results show that the new flame detector has the characteristics of high speed and a low rate of false alarms.

Occupational Therapy in Cancer Survivorship—A Toolkit for Stimulating Rapid-Research on the Neglected Domain of “Participation” during COVID-19

COVID-19 has disrupted people’s occupational daily activities with detrimental impact on their daily living performances and quality of life. Occupational therapy contributes toward restoring health by remediating limitation in participation in meaningful occupation with lifestyle redesign interventions. However, the research gap on the area of “participation-limitation” for the field of Occupational Therapy in cancer survivorship during the COVID-19 is largely untapped and unknown. This commentary-review paper discussed the PEO-OT (person-environment-occupation) grid as a conceptual toolkit for stimulating research in the domain of occupational participation—an essential aspect in the field of occupational therapy, for cancer survivors. It applies the expertise finding from a large Delphi study on research priority in the fields and integrating these into evidenced methodology, to provide a structure to guide the novice researchers towards rapid reviews, by selecting evidence-based methods to ensure contextually-relevant enquiry to identify the “occupational-participation issues”—i.e., an emerging social determinant of health, affecting the daily self-management of cancer survivors with or without comorbidities.

Recognizing Early Warning Signs (EWS) in Patients Is Critically Important

Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs.

Optimal reconfiguration of constellation using adaptive innovation driven multiobjective evolutionary algorithm

Constellation reconfiguration is a critical issue to recover from the satellite failure,maintain the regular operation,and enhance the overall performance.The constellation reconfiguration problem faces the difficulties of high dimensionality of design variables and extremely large decision space due to the great and continuously growing constellation size.To solve such real-world problems that can be hardly solved by traditional algorithms,the evolutionary operators should be promoted with available domain knowledge to guide the algorithm to explore the promising regions of the trade space.An adaptive innovationdriven multi-objective evolutionary algorithm(MOEA-AI)employing automated innovation(AI)and adaptive operator selection(AOS)is proposed to extract and apply domain knowledge.The available knowledge is extracted from the final or intermediate solution sets and integrated into an operator by the automated innovation mechanism.To prevent the overuse of knowledgedependent operators,AOS provides top-level management between the knowledge-dependent operators and conventional evolutionary operators.It evaluates and selects operators according to their actual performance,which helps to identify useful operators from the candidate set.The efficacy of the MOEAAI framework is demonstrated by the simulation of emergency missions.It was verified that the proposed algorithm can discover a non-dominant solution set with better quality,more homogeneous distribution,and better adaptation to practical situations.

Fast magnitude determination using a single seismological station record implementing machine learning techniques

In this work a Support Vector Machine Regression（SVMR） algorithm is used to calculate local magnitude（MI） using only five seconds of signal after the P wave onset of one three component seismic station. This algorithm was trained with 863 records of historical earthquakes, where the input regression parameters were an exponential function of the waveform envelope estimated by least squares and the maximum value of the observed waveform for each component in a single station. Ten-fold cross validation was applied for a normalized polynomial kernel obtaining the mean absolute error for different exponents and complexity parameters. The local magnitude（MI） could be estimated with 0.19 units of mean absolute error. The proposed algorithm is easy to implement in hardware and may be used directly after the field seismological sensor to generate fast decisions at seismological control centers, increasing the possibility of having an effective reaction.

Hepatitis C virus therapy with peg-interferon and ribavirin in Myanmar: A resource-constrained country

AIM To investigate peg-interferon(peg-IFN) and ribavirin(RBV) therapy in Myanmar and to predict sustained virologic response(SVR).METHODS This single-center, open-label, study was conducted in Myanmar between 2009 and 2014. A total of 288 patients infected with HCV genotypes 1, 2, 3 and 6 were treated with peg-IFN alpha-2a(180 μg/wk) or alpha-2b(50 to 100 μg as a weight-based dose) and RBV as a weight-based dose(15 mg/kg/d). Treatment duration was 48 wk for genotypes 1 and 6, 24 wk for genotype 2, and 24 or 48 wk for genotype 3 based on rapid virologic response(RVR). Those co-infected with hepatitis B received 48 wk of therapy.RESULTS Overall, SVR was achieved for 82% of patients and the therapy was well tolerated. All patients achieved SVR at equivalent rates regardless of HCV genotype(P = 0.314). Low fibrosis scores(P < 0.001), high baseline albumin levels(P = 0.028) and low baseline viral loads(P = 0.029) all independently predicted SVR. On the other hand, IL-28 B TT and CC genotypes were not found to significantly predict SVR(P = 0.634; P = 0.618). Among those who completed treatment, the occurrence of RVR showed a > 96% positive predictive value for achieving SVR. Treatment duration did not significantly impact the likelihood of achieving SVR for patients infected with genotype 3 HCV(P = 0.371). The most common adverse events were fatigue(71%) and poor appetite(60%). Among patients with genotype 3 HCV, more patients in the 48-wk treatment group required erythropoietin than in the 24-wk treatment group(61.1% vs 49.2%).CONCLUSION SVR rates were high with peg-IFN and RBV therapy in Myanmar. Fibrosis scores, baseline albumin, HCV RNA levels and RVR independently predicted SVR.

Inducible protein-10 as a predictive marker of antiviral hepatitis C treatment:A systematic review

To investigate interferon-γ-inducible protein-10’s (IP-10) potential to anticipate rapid (RVR)- and sustained virological responses (SVR) to chronic hepatitis C (CHC) treatment. METHODSWe included case series examining RVR or SVR in relation to 24 or 48 wk treatment for CHC, in patients treatment free for at least six months, with genotype 1 or 4, and in relation to 24 wk treatment for genotype 2 and 3, with pegylated interferon in combination with ribavirin. Patients had to have both a baseline IP-10 level as well as a hepatitis C virus (HCV)-RNA determination 4 wk after treatment initiation or 24 wk after end of treatment. Studies including patients with liver diseases other than CHC, human immunodeficiency virus-infection, treatment with immunosuppresents or cytostatica, alcohol dependency or active intravenous drug-use were excluded. We found 81 articles by searching the MEDLINE and EMBASE databases. Eight studies were eligible for inclusion. Their quality were assesed using an 18 point checklist for case series, developed using a modified Delphi technique. Information was extracted from the articles, and no raw data was requisitioned. The review protocol was registered at the International Prospective Register of Systematic Reviews (reg. number: CRD42014008736). RESULTSThree studies reported on baseline IP-10 level in association with RVR. A signigficant association was found for HCV genotype 1 infection by two studies. Only two studies reported on HCV genotype 4 infected and genotype 2 and 3 infected patients, respectively. A trend was seen for an association between RVR and baseline IP-10 for genotype 4, while no association was found for genotype 2 and 3. Seven studies provided information regarding baseline IP-10 and SVR. Following the pattern regarding rapid virological response all five studies examining SVR in relation to baseline IP-10 levels for HCV, genotype 1 infected patients showed a significant association. Likewise a significant association was seen for HCV, genotype 4 infected, while no association was found for HCV, genotype 2 and 3 infected. Though only two studies examined the assosiation for HCV genotype 4 infected and HCV genotype 2 and 3 infected respectively. CONCLUSIONWe found indications of a possible association between baseline IP-10 level and virological responses in patients with CHC genotype 1 and 4.

Global warming scenarios for the Eastern Adriatic Sea indicate a higher risk of invasiveness of non-native marine organisms relative to current climate conditions

Globally,marine bioinvasions threaten marine ecosystem structure and function,with the Mediterranean Sea being one of the most affected regions.Such invasions are expected to increase due to climate change.We conducted a risk screening of marine organisms(37 fishes,38 invertebrates,and 9 plants),both extant and‘horizon’(i.e.,not present in the area but likely to enter it).Based on expert knowledge for the Eastern Adriatic Sea coasts of Slovenia,Croatia,and Montenegro,screenings were conducted under both current and predicted climate conditions indicating with an increase in sea surface temperature and salinity of the Adriatic Sea together with changes in precipitation regime.Our aims were to:(1)identify non-native extant and horizon marine species that may pose threats to native biodiversity and(2)evaluate the risk of invasiveness of the selected species under current and predicted climate conditions.Of the 84 species screened,there was an increase in those ranked as‘high risk’from 33(39.3%)under current climate conditions and to 47(56.0%)under global warming scenarios.For those ranked as‘very high’risk,the increase was from 6(7.1%)to 21(25.0%).Amongst the screened species,the already established high-risk species Pacific oyster Magallana gigas and Atlantic blue crab Callinectes sapidus represent a threat to ecosystem services.Given the under-representation of marine species in the current European Union List,the species we have ranked as high to very high risk should be included.

Determinants of timing and amplitude in the plant general stress response

Plants have evolved intricate signaling cascades to rapidly and effectively respond to biotic and abiotic challenges. The precise timing of these responses enables optimal resource reallocation to maintain the balance between stress adaptation and growth. Thus, an in-depth understanding of the immediate and long-term mechanisms regulating resource allocation is critical in deciphering how plants withstand environmental challenges. To date however, understanding of this tradeoff has focused on the amplitude of long-term responses, rather than the timing of rapid stress responses. This review presents current knowledge on kinetics of secondary messengers involved in regulation of rapid and general stress responses, followed by rapid stress responsive transduction machinery, and finally the transcriptional response of a functional general stress responsive cis-element. Within this context we discuss the role of timing of initial peak activation and later oscillating peak responses, and explore hormonal and stress signaling crosstalk confounding greater understanding of these cascades.

Progress on intelligent hydrogels based on RAFT polymerization:Design strategy, fabrication and the applications for controlled drug delivery

Although intelligent hydrogels have shown bright potential application in biomedical fields,they were prepared by conventional methods and still face many serious challenges,such as uncontrollable stimulus-response and low response sensitivity.Recently,RAFT polymerization provides a versatile strategy for the fabrication of intelligent hydrogels with improved stimulus-response properties,owing to the ability to efficiently construct hydrogel precursors with well-defined structure,such as block copolymer,graft copolymer,star copolymer.In this review,we summarized the recent progress on intelligent hydrogels based on RAFT polymerization with emphasis on their fabrication strategies and applications for controlled drug delivery.

Large-area flexible and transparent UV photodetector based on cross-linked Ag NW@ZnO NRs with high performance

A series of large-area,flexible and transparent ultraviolet(UV)photodetectors(PDs)based on Ag nanowire(NW)@ZnO nanorods(NRs)are fabricated by an inexpensive,facile and effective approach.These Ag NW@ZnO NRs are successfully synthesized using a two-step method in an oil bath with a high surface-to-volume ratio and good crystallinity.The PDs are fabricated by drop-coating with different drop-coating times on the surface of polyethylene terephthalate(PET)coupled with Au electrodes.By optimizing the cross-linked network of Ag NW@ZnO NRs,PD2 with a size greater than 25 mm exhibits excellent photoresponse under UV light illumination of 365 nm(1.3 m W cm^(-2))with a bias of 5 V:a high sensitivity of over 10^(3),and a much shorter rise/decay time of 2.6 s/2.3 s.Simultaneously,the detector exhibits an average transmittance of more than 70%in the visible light region,as well as good flexibility and excellent mechanical stability under a bending angle of 120°over 1000 circles bending.These integral advantages have significant potential for practical applications and mass production.