Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

BACKGROUND Patients in neurology intensive care units(ICU)are prone to pressure injuries(PU)due to factors such as severe illness,long-term bed rest,and physiological dysfunction.PU not only causes pain and complications to patients,but also increases medical burden,prolongs hospitalization time,and affects the recovery process.AIM To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.METHODS A retrospective study was conducted,and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission,with 30 people in each group.The observation group implemented pressure injury prevention and nursing measures,while the control group adopted routine care.RESULTS Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h(8.3%vs 26.7%),7 d(16.7%vs 43.3%),and 14 d(20.0%vs 50.0%).This suggests a substantial reduction in pressure injury incidence in the observation group,with the gap widening over time.Additionally,patients in the observation group exhibited quicker recovery,with a shorter average time to get out of bed(48 h vs 72 h)and a shorter average length of stay(12 d vs 15 d)compared to the control group.Furthermore,post-intervention,patients in the observation group reported significantly improved quality of life scores,including higher scores in body satisfaction,feeling and function,and comfort(both psychological and physiological),indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.CONCLUSION Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

Influence of vapor pressure deficit on vegetation growth in China

Vapor pressure deficit(VPD)plays a crucial role in determining plant physiological functions and exerts a substantial influence on vegetation,second only to carbon dioxide(CO_(2)).As a robust indicator of atmospheric water demand,VPD has implications for global water resources,and its significance extends to the structure and functioning of ecosystems.However,the influence of VPD on vegetation growth under climate change remains unclear in China.This study employed empirical equations to estimate the VPD in China from 2000 to 2020 based on meteorological reanalysis data of the Climatic Research Unit(CRU)Time-Series version 4.06(TS4.06)and European Centre for Medium-Range Weather Forecasts(ECMWF)Reanalysis 5(ERA-5).Vegetation growth status was characterized using three vegetation indices,namely gross primary productivity(GPP),leaf area index(LAI),and near-infrared reflectance of vegetation(NIRv).The spatiotemporal dynamics of VPD and vegetation indices were analyzed using the Theil-Sen median trend analysis and Mann-Kendall test.Furthermore,the influence of VPD on vegetation growth and its relative contribution were assessed using a multiple linear regression model.The results indicated an overall negative correlation between VPD and vegetation indices.Three VPD intervals for the correlations between VPD and vegetation indices were identified:a significant positive correlation at VPD below 4.820 hPa,a significant negative correlation at VPD within 4.820–9.000 hPa,and a notable weakening of negative correlation at VPD above 9.000 hPa.VPD exhibited a pronounced negative impact on vegetation growth,surpassing those of temperature,precipitation,and solar radiation in absolute magnitude.CO_(2) contributed most positively to vegetation growth,with VPD offsetting approximately 30.00%of the positive effect of CO_(2).As the rise of VPD decelerated,its relative contribution to vegetation growth diminished.Additionally,the intensification of spatial variations in temperature and precipitation accentuated the spatial heterogeneity in the impact of VPD on vegetation growth in China.This research provides a theoretical foundation for addressing climate change in China,especially regarding the challenges posed by increasing VPD.

Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neurocritically ill patients

BACKGROUND Delay in treatment of raised intracranial pressure(ICP)leads to poor clinical outcomes.Optic nerve sheath diameter(ONSD)by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP.However,there is a dearth of data in neuro-medical intensive care unit(ICU)where the spectrum of disease is different.AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.METHODS We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU.US-ONSD was performed according to ALARA principles.A cut-off more than 5.7 mm was taken as significantly raised.Raised ONSD was corelated with raised ICP on radiological imaging.Clinical history,general and systemic examination findings,SOFA and APACHE 2 score and patient outcomes were recorded.RESULTS There was significant association between raised ONSD and raised ICP on imaging(P<0.001).The sensitivity,specificity,positive and negative predictive value at this cut-off was 77.55%,89.06%,84.44% and 83.82% respectively.The positive and negative likelihood ratio was 7.09 and 0.25.The area under the receiver operating characteristic curves was 0.844.Using Youden’s index the best cut off value for ONSD was 5.75 mm.Raised ONSD was associated with lower age(P=0.007),poorer Glasgow Coma Scale(P=0.009)and greater need for surgical intervention(P=0.006)whereas no statistically significant association was found between raised ONSD and SOFA score,APACHE II score or ICU mortality.Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre-and post-treatment or procedures for raised ICP.CONCLUSION ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP.ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.

Multi-model Predictive Control of Ultra-supercritical Coal-fired Power Unit

The control of ultra-supercritical(USC) power unit is a difficult issue for its characteristic of the nonlinearity, large dead time and coupling of the unit. In this paper, model predictive control(MPC) based on multi-model and double layered optimization is introduced for coordinated control of USC unit. The linear programming(LP) combined with quadratic programming(QP) is used in steady optimization for computation of the ideal value of dynamic optimization. Three inputs(i.e. valve opening, coal flow and feedwater flow) are employed to control three outputs(i.e. load, main steam temperature and main steam pressure). The step response models for the dynamic matrix control(DMC) are constructed using the three inputs and the three outputs. Piecewise models are built at selected operation points. Double-layered multi-model predictive controller is implemented in simulation with satisfactory performance.

Exergy Analysis and Thermal Optimization of a Double-Turbine Regeneration System in a Ultra-Supercritical Double-Reheat Unit

Improving the primary steam parameters is one of the most direct ways to improve the cycle efficiency of a powergeneration system. In the present study, the typical problem connected to the excessively high superheat degree ofextraction steam in an ultra-supercritical (USC) double-reheat unit is considered. Using a 1000 MW power plantas an example, two systems (case 1 and case 2) are proposed, both working in combination with a regenerativesteam turbine. The thermal performances of these two systems are compared with that of the original systemthrough a heat balance method and an exergy balance strategy. The results reveal that the two coupled systemscan significantly reduce the superheat degree of extraction steam, turbine heat rate, and coal consumption of theunit and improve the energy utilization efficiency. These results will provide useful theoretical guidance to futureinvestigators wishing to address the general problem relating to energy conservation and modelling of the coupledextraction steam regenerative system of USC double-reheat units.

Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden Q,and Glamorgan scales,and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow,Braden Q,and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital(China)within 24 h of admission from May 2017 to December 2020 in two stages.Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28(10.7%)in the PICU and 5/314(1.6%)in the general pediatric ward.For children in the general ward,the Waterlow,Braden Q,and Glamorgan scales had comparable area under the operating characteristic curve(AUC)of 0.870,0.924,and 0.923,respectively,and optimal cut-off values of 14,14,and 29 points.For PICU,the Waterlow,Braden Q,and Glamorgan scales had slightly lower AUC of 0.833,0.733,and 0.800,respectively,and optimal cut-off values of 13,16,and 27 points.Braden Q demonstrated a satisfactory specificity,and during the second stage of the study for PICU patients,the AUC of the Braden Q scale was 0.810,with an optimal cut-off value of 18.35 points.CONCLUSION The Waterlow,Braden Q,and Glamorgan scales have comparable performance while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.

Pressure control strategy for pump motor energy transfer unit

Multi-level pressure source system is a novel hydraulic system with distinct advantage of energy saving. In order to balance each pressure level of the multi-level pressure source system, a pump motor energy transfer unit is usually equipped. However, the pump motor energy transfer has the characteristics of poor starting and low response, which cause long time of pressure adjustment and large pressure jitter when the transformer is switched to system suddenly and the motor-side pressure has pressure impact when rail of the pump-side is switched. To address these problems, this paper proposes a compound control strategy of feedforward compensation control with Fuzzy-PID to improve the controllability of the multi-level pressure source system. A test rig of the pump motor energy transfer unit is built and the controllability of compound controller and PID controller are compared. The experiment results show that, compared with the traditional PID, the adjustment time and the pressure impact are reduced by 20% and 25% with the proposed compound control strategy. Therefore, the presented compound control strategy can be used to improve starting performance and robustness of the pump motor energy transfer unit control system.

A care bundle for pressure ulcer treatment in intensive care units

Pressure ulcers(PUs)are localized injuries of the skin or underlying tissue caused by prolonged pressure,exposure to shear forces or friction.PUs represent a major concern for hospitalized patients and the health professionals responsible for their wellbeing.intensive care init(ICU)patients are at high risk of PU development,and the development of PUs can significantly extend the length of time a patient must remain in the ICU.Patients with PUs experience significantly increased morbidity,mortality and financial burden.A significant amount of evidence has accumulated indicating that PU prevention is an essential component of patient care.However,standardized guidelines and protocols for PU prevention in ICUs have not been universally implemented.This review aims to describe and analyze an optimized PU prevention care bundle based on the best available evidence and existing national guidelines.We distilled the available information into five main topics important for PU prevention:Risk Assessment,Skin Assessment,Support Surfaces,Nutrition and Repositioning.Further larger scale studies are needed to clinically verify the effectiveness of the care bundle.

Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.

Vibration of 1000-MW Ultra-Supercritical Turbine-Generator Unit with Simens Technology

The layout features of unit shafting and their effects on vibration, as well as evaluation criteria, were introduced for a 1000-MW ultra-supercritical turbine-generator unit with Simens technology. Based on vibration diagnosis and treatment for more than 10 units, some typical vibration faults were summarized, such as the vibration fluctuation of the high pressure (HP) rotor, abnormal vibration increases of the No.3 bearing pedestal and large vibration of the exciter rotor during its critical speed range. The vibration characteristics and the causes of faults and countermeasures were analyzed. Three applications for further illustration were given. The vibration fault identification method, control measures, and applications can provide a reference for vibration diagnoses and treatment of same type units.

Machine learning for pore-water pressure time-series prediction:Application of recurrent neural networks

Knowledge of pore-water pressure(PWP)variation is fundamental for slope stability.A precise prediction of PWP is difficult due to complex physical mechanisms and in situ natural variability.To explore the applicability and advantages of recurrent neural networks(RNNs)on PWP prediction,three variants of RNNs,i.e.,standard RNN,long short-term memory(LSTM)and gated recurrent unit(GRU)are adopted and compared with a traditional static artificial neural network(ANN),i.e.,multi-layer perceptron(MLP).Measurements of rainfall and PWP of representative piezometers from a fully instrumented natural slope in Hong Kong are used to establish the prediction models.The coefficient of determination(R^2)and root mean square error(RMSE)are used for model evaluations.The influence of input time series length on the model performance is investigated.The results reveal that MLP can provide acceptable performance but is not robust.The uncertainty bounds of RMSE of the MLP model range from 0.24 kPa to 1.12 k Pa for the selected two piezometers.The standard RNN can perform better but the robustness is slightly affected when there are significant time lags between PWP changes and rainfall.The GRU and LSTM models can provide more precise and robust predictions than the standard RNN.The effects of the hidden layer structure and the dropout technique are investigated.The single-layer GRU is accurate enough for PWP prediction,whereas a double-layer GRU brings extra time cost with little accuracy improvement.The dropout technique is essential to overfitting prevention and improvement of accuracy.

Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool(the COMHON Index)

Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.

Numerical simulation investigation on pressure loss of diffusion tank of axial main fan

Based on the engineering application, the angle range of rectifying airflow unit attaching diffusion tank is from 2.5° to 7.5°. In the range of average inlet velocity of 25.0 m/s to 55.0 m/s of diffusion tank, numerical simulations of diffusion tank were done. The results of numerical simulations of diffusion tank are shown as follows： ③ In cases of the inlet velocity range from 25.0 m/s to 55.0 m/s, and the angle range of rectifying airflow unit from 2.5° to 7.5°, the average value of pressure losses decreases to the minimum when the angle is 4.5°.② In cases of the inlet velocity of 35.0 m/s, the pressure loss of diffusion tank decreases to the minimum when the angle of rectifying airflow unit is 5.5°. ③ As far as there are different angles of rectifying airflow unit, pressure loss increases gradually along with the addition of inlet velocity.

Assessing the Association between Heart Attack, High Blood Pressure, and Heart Disease Mortality Rates and Particulate Matter and Socioeconomic Status Using Multivariate Geostatistical Model

This study addresses the public concerns of potential adverse health effects from ambient fine particulate matter as well as socioeconomic factors. Heart attack, high blood pressure, and heart disease mortality rates were investigated against fine particulate matter and socioeconomic status, for all counties in the United States in 2013. Multivariate multiple regressions as well as multivariate geostatistical predictions show that these are significant factors towards assessing the causal inferences between exposure to air pollution and socioeconomic status and the three mortality rates.

Numerical Study on the Low-Frequency Pressure Fluctuation Characteristics of Liquid Oxygen Delivery System Based on Acoustic Theory

Aiming at the low-frequency pressure fluctuation phenomena in certain liquid oxygen delivery systems during dual engine operation,a numerical study on the intrinsic frequency of the liquid oxygen delivery system was conducted by adopting an acoustic unit in Abaqus.Factors such as condensation characteristics of the oxygen-enriched gas gas in the liquid oxygen’s pipeline between pumps,flexibility of the accumulator,and cavitation flexibility of the engine were considered in the simulation models.The simulation results show that the second order frequency of the liquid oxygen delivery system is 8.77 Hz,and the phase difference of the corresponding acoustic modal is 180°,which is the liquid circuit frequency of the small loop between the two branches of the tee.This is consistent with the low-frequency fluctuation phenomenon during flight.Moreover,the simulation results were consistent with the liquid circuit frequency solved via the transfer matrix,which also verified the effectiveness of the frequency analysis method based on acoustic theory.

Performance of Structured Packing in High Pressure Distillation

Performance of Mellapak 250Y and 350Y corrugated structured packing in distillation applications at pressures ranging from 0.3 to 2.0MPa is analysed by using HTU-NTU method. These data are obtained in a distillation column with 0.15 m diameter op-erated with n-butane/n-pentane system at total reflux. In considering the axial backmixing effects, the height of an overall gas phase transfer unit, HTUOG , is divided into two parts. One part represents the height of an overall gas phase transfer unit, without backmixing, designated as*OGHTU, and the other part, designated as the height of a backmixing unit (HBUO), accounts for the backmixing effects. The HTUOG is evaluated from the measured concentration profile of n-butane in liquid phase. The HBUO obtained experimentally is correlated in terms of the properties of the materials being separated and the equivalent diameter of the structured packing. Our result shows that HBUO varies from 0.12 to 0.34 m as pressure increases from 1.0 to 1.9 MPa. It indicates that the overall efficiency of the structured packing decreases gradually at high pressure, as a result of the vapor backmixing.

Management of sepsis in a cirrhotic patient admitted to the intensive care unit:A systematic literature review

BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection,leading to life-threatening organ dysfunction.The"Third international consensus definitions for sepsis and septic shock(Sepsis-3)"defines sepsis as an increase in sequential organ failure assessment score of 2 points or more,with a mortality rate above 10%.Sepsis is a leading cause of intensive care unit(ICU)admissions,and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes.Therefore,it is critical to recognize and manage sepsis promptly by administering fluids,vasopressors,steroids,and antibiotics,and identifying and treating the source of infection.AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method.The search for relevant studies was conducted across multiple databases,including PubMed,Embase,Base,and Cochrane,using predefined search terms.One reviewer conducted the initial search,and the eligibility criteria were applied to the titles and abstracts of the retrieved articles.The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections,resulting in higher mortality rates ranging from 18%to 60%.Early identification of the infection source followed by timely administration of antibiotics,vasopressors,and corticosteroids has been shown to improve patient outcomes.Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients.Moreover,presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis,with similar diagnostic performance compared to procalcitonin.CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality.Therefore,early detection of infection using procalcitonin test and other biomarker as presepsin and resistin,associated with early management with antibiotics,fluids,vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.

Role of proning and positive end-expiratory pressure in COVID-19

The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.

配置吸收式热泵的热电联产机组厂级智能运行优化

为提高配置吸收式热泵的热电联产机组的全厂运行经济性,基于案例电厂的运行历史数据,使用滑动窗口法进行数据预处理并提取稳态工况,建立配置吸收式热泵的热电联产机组煤耗预测数学模型。以全厂热电联产机组总煤耗最小为适应度函数,利用粒子群优化算法求解得出配置吸收式热泵的热电机组最佳背压和各台热电机组最佳抽汽量。基于以上研究设计了供热系统智能优化软件,实现供热系统在线监测与优化调节,对各供热单元分别提出优化指导,使机组运行经济性最佳,进而降低整体煤耗。计算结果表明:实行供热系统智能优化策略可为案例电厂供热系统平均每小时节省标准煤约1.81 t,节能效果显著。