Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project

BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.

Ensemble Simulation of Land Evapotranspiration in China Based on a Multi-Forcing and Multi-Model Approach

In order to reduce the uncertainty of offline land surface model （LSM） simulations of land evapotranspiration （ET）, we used ensemble simulations based on three meteorological forcing datasets [Princeton, ITPCAS （Institute of Tibetan Plateau Research, Chinese Academy of Sciences）, Qian] and four LSMs （BATS, VIC, CLM3.0 and CLM3.5）, to explore the trends and spatiotemporal characteristics of ET, as well as the spatiotemporal pattern of ET in response to climate factors over China's Mainland during 1982-2007. The results showed that various simulations of each member and their arithmetic mean （EnsAVlean） could capture the spatial distribution and seasonal pattern of ET sufficiently well, where they exhibited more significant spatial and seasonal variation in the ET compared with observation-based ET estimates （Obs_MTE）. For the mean annual ET, we found that the BATS forced by Princeton forcing overestimated the annual mean ET compared with Obs_MTE for most of the basins in China, whereas the VIC forced by Princeton forcing showed underestimations. By contrast, the Ens_Mean was closer to Obs_MTE, although the results were underestimated over Southeast China. Furthermore, both the Obs_MTE and Ens_Mean exhibited a significant increasing trend during 1982-98; whereas after 1998, when the last big EI Nifio event occurred, the Ens_Mean tended to decrease significantly between 1999 and 2007, although the change was not significant for Obs_MTE. Changes in air temperature and shortwave radiation played key roles in the long-term variation in ET over the humid area of China, but precipitation mainly controlled the long-term variation in ET in arid and semi-arid areas of China.

Hydrological simulation approaches for BMPs and LID practices in highly urbanized area and development of hydrological performance indicator system

Urbanization causes hydrological change and increases stormwater runoff volumes, leading to flooding, erosion, and the degradation of instream ecosystem health. Best management practices （BMPs）, like detention ponds and infiltration trenches, have been widely used to control flood runoff events for the past decade. However, low impact development （LID） options have been proposed as an alternative approach to better mimic the natural flow regime by using decentralized designs to control stormwater runoff at the source, rather than at a centralized location in the watershed. For highly urbanized areas, LID stormwater management practices such as bioretention cells and porous pavements can be used to retrofit existing infrastructure and reduce runoff volumes and peak flows. This paper describes a modeling approach to incorporate these LID practices and the two BMPs of detention ponds and infiltration trenches in an existing hydrological model to estimate the impacts of BMPs and LID practices on the surface runoff. The modeling approach has been used in a parking lot located in Lenexa, Kansas, USA, to predict hydrological performance of BMPs and LID practices. A performance indicator system including the flow duration curve, peak flow frequency exceedance curve, and runoff coefficient have been developed in an attempt to represent impacts of BMPs and LID practices on the entire spectrum of the runoff regime. Results demonstrate that use of these BMPs and LID practices leads to significant stormwater control for small rainfall events and less control for flood events.

“Final all possible steps”approach for accelerating stochastic simulation of coupled chemical reactions

In this paper, we develop a modified accelerated stochastic simulation method for chemically reacting systems, called the ＂final all possible steps＂ （FAPS） method, which obtains the reliable statistics of all species in any time during the time course with fewer simulation times. Moreover, the FAPS method can be incorporated into the leap methods, which makes the simulation of larger systems more efficient. Numerical results indicate that the proposed methods can be applied to a wide range of chemically reacting systems with a high-precision level and obtain a significant improvement on efficiency over the existing methods.

Numerical simulation of recalescence of 3-dimensional isothermal solidification for binary alloy using phase-field approach

A accelerated arithmetic algorithm of the dynamic computing regions was designed,and 3-dimensional numerical simulation of isothermal solidification for a binary alloy was implemented.The dendritic growth and the recalescence of Ni-Cu binary alloy during the solidification at different cooling rates were investigated.The effects of cooling rate on dendritic patterns and microsegregation patterns were studied.The computed results indicate that,with the increment of the cooling rate,the dendritic growth velocity increases,both the main branch and side-branches become slender,the secondary dendrite arm spacing becomes smaller,the inadequate solute diffusion in solid aggravates,and the severity of microsegregation ahead of interface aggravates.At a higher cooling rate,the binary alloy presents recalescence;while the cooling rate is small,no recalescence occurs.

A LEVEL SET APPROACH FOR SIMULATION OF BUBBLE MOTION

A level set approach for computing incompressible two-phase flow is presented with the SIMPLE algorithm incorporated. The motion of gas bubbles in liquid with large density ratio, viscosity ratio and surface tension is numerically simulated and it is found that the computational results are in good agreement with experiments.

A phased approach to enable hybrid simulation of complex structures

Hybrid simulation has been shown to be a cost-effective approach for assessing the seismic performance of structures. In hybrid simulation,critical parts of a structure are physically tested,while the remaining portions of the system are concurrently simulated computationally,typically using a finite element model. This combination is realized through a numerical time-integration scheme,which allows for investigation of full system-level responses of a structure in a cost-effective manner. However,conducting hybrid simulation of complex structures within large-scale testing facilities presents significant challenges. For example,the chosen modeling scheme may create numerical inaccuracies or even result in unstable simulations; the displacement and force capacity of the experimental system can be exceeded; and a hybrid test may be terminated due to poor communication between modules(e.g.,loading controllers,data acquisition systems,simulation coordinator). These problems can cause the simulation to stop suddenly,and in some cases can even result in damage to the experimental specimens; the end result can be failure of the entire experiment. This study proposes a phased approach to hybrid simulation that can validate all of the hybrid simulation components and ensure the integrity largescale hybrid simulation. In this approach,a series of hybrid simulations employing numerical components and small-scale experimental components are examined to establish this preparedness for the large-scale experiment. This validation program is incorporated into an existing,mature hybrid simulation framework,which is currently utilized in the Multi-Axial Full-Scale Sub-Structuring Testing and Simulation(MUST-SIM) facility of the George E. Brown Network for Earthquake Engineering Simulation(NEES) equipment site at the University of Illinois at Urbana-Champaign. A hybrid simulation of a four-span curved bridge is presented as an example,in which three piers are experimentally controlled in a total of 18 degrees of freedom(DOFs). This simulation illustrates the effectiveness of the phased approach presented in this paper.

Performance evaluation from stochastic statecharts representation of flexible reactive systems:a simulation approach

This paper focuses on the performance analysis of flexible reactive systems. The performance analysis consists of two phases： first system modeling, second performance evalua-tion. The paper models the flexible reactive system by the stochas-tic statecharts method, and uses the simulation method to evalu-ate the performance. To make use of the feature of event-triggered state transitions in the statecharts, a new method of simulation is proposed based on the techniques of the discrete-event system simulation. The new method solves the problem of computer imple-mentation of stochastic events, probabilistic transition, concurrent states, paral el actions, and broadcast communication mechanism in the stochastic statecharts. An example of a flexible manufactur-ing system is presented. The simulation result of the example is consistent with the analytical result, which shows the feasibility of the proposed new simulation method.

Vertical impedance functions of pile groups under low-to-high loading amplitudes:numerical simulations and experimental validation

Piles in a group experience additional displacements in soil due to pile-to-pile interactions apart from those resulting from the external loading.The effect of these interactions determined assuming soil as an elastic and/or viscoelastic material on pile head impedance functions of the pile group is studied by relating the group stiffness to the static stiffness of a single pile.However,the prevailing elastic solutions may misestimate the resulting pile group response due to the lack of consideration for either soil(material)and/or soil-pile interface nonlinearities.It is well established that soil behaves nonlinearly under moderate-to-high loading amplitudes,and besides,the soil-pile interface nonlinearity can exist even at small loading amplitudes.This study addresses the effects of these nonlinearities on the vertical impedance functions of a 3×3-pile group using numerical methods by direct analyses and superposition using pile-to-pile interaction factors.The numerical results are validated using scaled model tests under 1 g conditions.The results highlight the overestimation of pile-to-pile interactions in the pile group when assuming elastic soil conditions.The cases either by direct analyses or superposition approach involving soil and soil-pile interface nonlinearities agree well with the experimental pile group responses under close-to-elastic and nonlinear conditions.

基于DDES方法的汽油机进气流动湍流特性

采用基于切应力输运(SST)耦合延迟分离涡模拟(DDES)方法,对某汽油机进行了稳流试验条件下的数值模拟,并采用光学发动机上3D-粒子图像测速(PIV)试验数据对结果进行了验证,在此基础上研究了缸内湍流场的空间域及频域特征.通过与试验及雷诺平均(RANS)数值模拟结果的对比发现,DDES方法对发动机缸内复杂流动模拟有明显优势.结果表明:滚流中心面内高气门升程下缸内流动对称趋势较低气门升程工况更好,三维流动区域主要集中在燃烧室及进气门下方区域.平均流雷诺数决定了缸内流场湍流能谱的整体特征,平均流雷诺数越高的区域,湍流能量进入惯性输运的涡团尺度越小.湍流雷诺数主要影响惯性子区长度,湍流雷诺数越高,湍流发展越充分,惯性子区越明显.湍流脉动强度的平方代表湍流能谱所包围的面积;相对湍流脉动强度则影响低频湍流能量密度的高低.

Ab Initio Molecular Dynamics Simulation of Liquid Water with Fragmentbased Quantum Mechanical Approach under Periodic Boundary Conditions

In this study,we investigated the structural and dynamical properties of liquid water by using ab initio molecular dynamics simulation under periodic boundary conditions based on the fragment-based quantum mechanical approach.This study was carried out using the second-order Møller-Plesset perturbation theory(MP2)with the aug-cc-pVDZ basis set,which has been validated to be sufficiently accurate for describing water interactions.Diverse properties of liquid water,including radial distribution functions,diffusion coefficient,dipole moment,triplet oxygen-oxygen-oxygen angles,and hydrogen-bond structures,were simulated.This ab initio description leads to these properties in good agreement with experimental observations.This computational approach is general and transferable,providing a comprehensive framework for ab initio predictions of properties of condensed-phase matters.

Research on Application of Monte Carlo Simulation in the Income Approach of Asset Valuation A listed Company in China as an Example

The income approach of asset valuation estimates the asset value according to the asset-discounted future earnings or the capitalizing process. As a result, a reasonable prediction of asset-expected future returns has become one of the core contents of the income approach. The forecast on expected future earnings is generally based on many uncertain factors, such as strict conditions of assumption and the complexity of environment. However, the current valuation practice in this aspect varies greatly and sometimes depends on personally experienced judgment of appraisers. Therefore, the obtained valuation results tend to be simplified and absolutized. This paper takes a listed company in China as an example to explore the way of inserting an uncertainty analysis into the prediction of the income approach, and then to obtain a series of valuation results within a certain probability fluctuation range. Finally, it puts forward some suggestions about the Monte Carlo simulation （MCS）.

基于微观连续介质模型的反应溶质运移数值模拟方法

地下环境中流固间的反应溶质运移过程控制着地质介质演化规律,并受岩石固有非均质性的影响,衍生出非线性行为与多尺度效应。为了面向更为复杂化的应用需求,解析微观特征与表观行为间的响应-反馈机制成为了重要的科学与工程命题。本研究系统地介绍了微观连续介质概念与模型框架,以及该模型方法的实现方式,并归纳了其在不同研究体系中的应用实例,最后重点分析了该方法在实验-数值联合研究中的发展前景与预期挑战。数值模拟方法已被广泛应用于反应溶质运移过程的定量研究之中,但单一孔隙或达西尺度数值模型难以应对机理研究与实例应用间的时空尺度跨度。近年来多尺度数值模拟方法体系不断发展,其中将Darcy-Brinkman-Stokes方程作为多流态数学统一表达,以微观连续介质模型作为多尺度信息关联方式的数值模拟框架,在流固界面追踪、高效数值求解等方面展现出一定的方法优势与应用潜力。

混合进近运行下平行跑道进场容量评估

本文以仪表着陆系统(ILS,instrument landing system)和建立要求特殊授权的所需导航性能(RNP AR,required navigation performance authorization required)进近(EoR,established on RNP AR)混合程序为研究对象,探讨混合进近下跑道进场容量。首先,研究了飞机尾流消散和运动规律,提出混合进近条件下安全间距计算方法;其次,根据混合进近运行特征,建立混合进近平行跑道进场容量模型;最后,以昆明长水国际机场为例,构建全空域机场仿真模型,对模型进行验证,并在此基础上,设置多个运行场景对影响混合进近条件下跑道进场容量的因素,包括程序结构、机型和RNP AR能力飞机比例进行分析。研究结果表明:容量评估模型能够对混合进近运行下平行跑道进场容量进行精确、客观的评价;且固定半径转弯(RF,constant radius to fix)航段半径越大,跑道进场容量越大;RF航段半径为4~7 km时,RNP AR能力飞机比例越大,跑道进场容量越大;中型机比例越多,跑道进场容量越大。

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

基坑开挖引起下穿交叉隧道变形效应分析

以某地铁站换乘大厅工程为例,利用FLAC 3D数值模拟软件,分析总结了上跨深大基坑开挖对不同空间距离和分布形式的下穿立体交叉隧道的变形影响规律,并结合现场监测数据与数值模拟结果进行相互验证,结果表明:(1)基坑开挖卸荷对下穿隧道结构变形的影响主要表现为竖向位移,其变形量与基坑的空间位置和基坑岩土体开挖卸荷量密切相关;(2)1号线左、右线隧道全施工周期监测数据与数值模拟结果吻合较好,验证了数值计算方法对施工活动影响判断的准确性;(3)多种应力状态耦合的叠落隧道竖向位移受叠加效应影响显著,最大竖向位移位于影响因素较多的区域,最大竖向位移值为34.84 mm;(4)埋深较浅隧道对施工扰动比深埋隧道更加敏感,不同位置处的变形离散性更强,变形具有一定的整体性和协同性。

大偏角短引渠侧向进水泵站流场流态优化

为了改善大偏角短引渠侧向进水泵站前池、进水池内偏流、回流和漩涡等不良流态,以某大型大偏角短引渠侧向进水泵站工程为研究对象,采用物理模型试验和数值模拟相结合的方式对初步设计方案下的前池、进水池流态进行分析,提出流速偏差系数λ作为评价指标,对工程进行优化,探讨前池的结构性改造对水流的整流效果,得出“弧形隔墩+改变底坡坡度+开设消涡孔”的组合方案为推荐整流方案,有效解决了前池及进水池内原设计存在的不良流态。研究结果表明,该整流方案使各个机组进水池偏差系数分别下降了37.03%、12.99%、22.29%、22.04%,显著改善了前池,进水池流态。研究结果可为类似大偏角短引渠侧向进水泵站前池及进水池流场流态优化提供参考,也可为类似短引渠泵站工程和进水建筑物的设计提供参考。

基于URANS与DDES方法的空腔近场噪声数值研究

采用基于SST(Shear-Stress Transport)湍流模式的URANS(Unsteady Reynolds-Averaged Navier-Stokes)和DDES(Delayed Detached Eddy Simulation)方法开展了马赫数0.85的三维空腔非定常流动数值计算。计算结果表明:两种方法得到的空腔底部静压、脉动压力声压级和功率谱均与实验及参考文献结果具有良好的一致性;DDES在模拟流动失稳、小尺度结构等流动细节方面更具优势,对高频压力脉动的捕捉也要优于URANS。通过对时均流场的分析,确定了模拟的空腔流动类型为过渡式流动,同时发现空腔内存在的复杂三维涡结构,并分析了这些涡结构对空腔流场特性的影响。

面向江豚生境需求的长江干流(铜陵段)生态流量过程研究

长江江豚是长江水生态系统健康的重要指示物种,满足其生境需求的生态流量过程是长江干流生态需水研究的关键。为科学明确保障长江江豚适宜生境的流量需求,采用水文改变指标法和变化范围法评价长江干流(铜陵段)水文情势变化。以水深、流速为限制因子,通过栖息地模拟法获得适宜江豚栖息的生态流量范围,耦合水文学法结果,推荐月尺度的生态流量方案;结合流量组分特征进行高流量脉冲设计,综合确定生态流量过程。结果表明:1)长江干流(铜陵段)水文情势改变度达49.74%,为中度改变,且流量事件主要以枯水流量和高流量脉冲为主,环境流量事件趋向单一化;2)长江江豚栖息地适宜流量范围为19000~31100 m^(3)/s,最佳适宜流量范围为22500~28500 m^(3)/s;丰水期适宜范围为27000~31000 m^(3)/s、35000~45000 m^(3)/s、60000~62000 m^(3)/s;高流量脉冲事件为流量值高于39100 m^(3)/s时,其持续时间至少在3 d以上,并以高流量脉冲峰值上限48000 m^(3)/s作为小洪水发生的初始值。本研究成果可为长江干流江豚生境保护和生态调度提供科学数据支撑,为切实推进长江大保护提供技术支撑。

盾构隧道下穿多股铁路影响分析

地铁盾构隧道近距离下穿铁路施工时,地层扰动会引起上部既有铁路路基沉降及轨道结构的不平顺,对铁路运营安全产生不利影响。为探讨盾构下穿铁路施工对轨道结构的影响规律,结合某地铁区间盾构隧道下穿胶济铁路施工案例,建立考虑盾构隧道-围岩-路基相互作用的数值模型,分析盾构施工过程中铁路路基沉降及多股轨道的变形特征。结果表明:盾构施工引起路基沉降及轨道变形与铁路之间的距离有关,当盾构施工处于铁路正下方时,路基沉降及轨道的变形最大,且路基的最大沉降为3.30mm,轨面的最大高低不平顺和最大水平不平顺分别为0.097 5mm和3.615mm,路基沉降与铁轨变形均处于控制标准范围之内。