Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and ...Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and flammability,causing a spectrum of hazards to human health and environmental safety.Neoteric solvents have been recognized as potential alternatives to these harmful organic solvents.In the past two decades,several neoteric solvents have been proposed,including ionic liquids(ILs)and deep eutectic solvents(DESs).DESs have gradually become the focus of green solvents owing to several advantages,namely,low toxicity,degradability,and low cost.In this critical review,their classification,formation mechanisms,preparation methods,characterization technologies,and special physicochemical properties based on the most recent advancements in research have been systematically described.Subsequently,the major separation and purification applications of DESs in critical metal metallurgy were comprehensively summarized.Finally,future opportunities and challenges of DESs were explored in the current research area.In conclusion,this review provides valuable insights for improving our overall understanding of DESs,and it holds important potential for expanding separation and purification applications in critical metal metallurgy.展开更多
Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS)...Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS),microglia display a unique molecular homeostatic signature(i.e.,Tmem119,P2ry12,Sall1,Siglech,Gpr34,and Hexb)(Figure 1A).展开更多
Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypog...Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.展开更多
BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring except...BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.展开更多
Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly recognised.Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promis...The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly recognised.Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promise.While changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain uncertain.Dietary fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI microbiota.The aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical illness.Randomised controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were identified.Studies show dietary fibres have an impact on faecal microbiota in health and disease.The fibre,inulin,has a marked and specific effect on increasing the abundance of faecal Bifidobacteria.Short chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient populations.Very few trials have evaluated the effect of dietary fibre on the GI microbiota during critical illness.More research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.展开更多
Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall ...Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall working experience.This study aimed to assess job burnout and determine the factors that contribute to it among critical care nurses in the Eastern Province of Saudi Arabia.Methods:This study employed a descriptive,exploratory,cross-sectional research design.A total of 220 nurses employed in the critical care units of 5 private hospitals in the eastern region were selected for participation in this study using a convenience sample method.An electronic survey was distributed to critical care nurses in the Eastern Province who satisfied the specified inclusion criteria.The job burnout questionnaire utilized in this study was derived from previously conducted research,which has been established as a reliable and valid survey instrument.The process of data analysis was conducted utilizing the SPSS program.The scientific research conducted on human subjects adhered rigorously to all ethical considerations.Results:The highest percentage of nurses at the critical care units reported experiencing moderate levels of job burnout.Nurses exhibiting greater levels of professional experience demonstrated a statistically significant reduction in overall burnout scores when compared to their less experienced counterparts.Furthermore,within the realm of sociodemographic factors,it was found that the only significant independent predictor for job burnout was the level of experience among critical care nurses.Conclusions:The prevalence of burnout among nurses in critical care settings was found to be significant,with most participants reporting moderate levels of burnout which can yield significant ramifications for nurses and healthcare professionals.Consequently,healthcare organizations must accord primacy to the welfare of their staff and adopt proactive strategies to mitigate job burnout.展开更多
Objective:This study aims to identify the prevalence of bullying in the workplace and to examine its association with turnover(TO)intention and secondary traumatic stress(STS)among Jordanian nurses employed in Emergen...Objective:This study aims to identify the prevalence of bullying in the workplace and to examine its association with turnover(TO)intention and secondary traumatic stress(STS)among Jordanian nurses employed in Emergency Departments(EDs)and critical care units(CCUs).Nurses employed in the EDs and CCUs are exposed to high levels of bullying behaviors that may contribute to STS,leading to high rates of TO.Methods:A descriptive cross-sectional design was used.A sample of 150 Jordanian nurses working in CCUs and EDs completed the study.Data collection was performed using the Demographical Questionnaire,the Negative Acts Questionnaire-Revised(NAQ-R),ProQOL scale,and TO scale.The IBM SPSS software was used to analyze data.Results:About 10.7%and 89.3%were categorized as“occasionally bullied”and“victims of workplace bullying”subsequently.Workplace bullying was positively associated with TO intention(r=0.46,P<0.001)and STS(r=0.36,P<0.001).TO was positively associated with STS(r=0.36,P<0.001).Bullying was a unique significant predictor of TO intention(t=4.59,B=0.34,P<0.001)and STS(t=4.15,B=0.34,P<0.001).Conclusions:Bullying behavior has negative adversarial effects on TO and the experience of STS.The prevalence of bullying behavior in the EDs and CCUs remains high despite the increasing awareness of its negative impacts.Healthcare organizations should put systems in place to ensure that zero-tolerance policy are monitored in terms of the effectiveness of its implementation.展开更多
BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effective...BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.展开更多
The NIST Cybersecurity Framework (NIST CSF) serves as a voluntary guideline aimed at helping organizations, tiny and medium-sized enterprises (SMEs), and critical infrastructure operators, effectively manage cyber ris...The NIST Cybersecurity Framework (NIST CSF) serves as a voluntary guideline aimed at helping organizations, tiny and medium-sized enterprises (SMEs), and critical infrastructure operators, effectively manage cyber risks. Although comprehensive, the complexity of the NIST CSF can be overwhelming, especially for those lacking extensive cybersecurity resources. Current implementation tools often cater to larger companies, neglecting the specific needs of SMEs, which can be vulnerable to cyber threats. To address this gap, our research proposes a user-friendly, open-source web platform designed to simplify the implementation of the NIST CSF. This platform enables organizations to assess their risk exposure and continuously monitor their cybersecurity maturity through tailored recommendations based on their unique profiles. Our methodology includes a literature review of existing tools and standards, followed by a description of the platform’s design and architecture. Initial tests with SMEs in Burkina Faso reveal a concerning cybersecurity maturity level, indicating the urgent need for improved strategies based on our findings. By offering an intuitive interface and cross-platform accessibility, this solution aims to empower organizations to enhance their cybersecurity resilience in an evolving threat landscape. The article concludes with discussions on the practical implications and future enhancements of the tool.展开更多
We discuss the findings of Wu et al on the utility of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and systemic immune-inflammatory index as diagnostic markers for gastric carcinoma(GC).We commend the s...We discuss the findings of Wu et al on the utility of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and systemic immune-inflammatory index as diagnostic markers for gastric carcinoma(GC).We commend the study's contributions to the field and suggest a prospective study to validate these markers'sensitivity and specificity for early GC detection.We also propose developing surveillance protocols that incorporate these markers with other diagnostic methods to enhance clinical decision-making.Furthermore,we highlight the need for a more diverse patient cohort to assess the generalizability of these markers across different ethnic groups and demographic factors.Our suggestions aim to refine the application of these markers in clinical practice and to understand their potential in diverse clinical scenarios.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
In this paper,we study high energy normalized solutions for the following Schr?dinger equation{-Δu+V(x)u+λu=f(u),in R^(2),∫_(R^(2))|u|^(2)dx=c,where c>0,λ∈R will appear as a Lagrange multiplier,V(x)=ω|x|2 rep...In this paper,we study high energy normalized solutions for the following Schr?dinger equation{-Δu+V(x)u+λu=f(u),in R^(2),∫_(R^(2))|u|^(2)dx=c,where c>0,λ∈R will appear as a Lagrange multiplier,V(x)=ω|x|2 represents a trapping potential,and f has an exponential critical growth.Under the appropriate assumptions of f,we have obtained the existence of normalized solutions to the above Schr?dinger equation by introducing a variational method.And these solutions are also high energy solutions with positive energy.展开更多
The deformation energy(Wd)of soil-like tectonic coal is crucial for investigating the mechanism of coal and gas outbursts.Tectonic coal has a significant nonlinear constitutive relationship,which makes traditional ela...The deformation energy(Wd)of soil-like tectonic coal is crucial for investigating the mechanism of coal and gas outbursts.Tectonic coal has a significant nonlinear constitutive relationship,which makes traditional elastic-based models for computing Wdunsuitable.Inspired by critical state soil mechanics,this study theoretically established a new calculation model of Wdsuitable for the coal with nonlinear deformation characteristics.In the new model,the relationship between energy and stress no longer follows the square law(observed in traditional linear elastic models)but exhibits a power function,with the theoretical value of the power exponent ranging between 1 and 2.Hydrostatic cyclic loading and unloading experiments were conducted on four groups of tectonic coal samples and one group of intact coal samples.The results indicated that the relationship between Wdand stress for both intact and tectonic coal follows a power law.The exponents for intact and tectonic coal are close to 2 and 1,respectively.The stress-strain curve of intact coal exhibits small deformation and linear characteristics,whereas the stress-strain curves of tectonic coal show large deformation and nonlinear characteristics.The study specifically investigates the role of coal viscosity in the cyclic loading/unloading process.The downward bending in the unloading curves can be attributed to the time-dependent characteristics of coal,particularly its viscoelastic behavior.Based on experimental statistics,the calculation model of Wdwas further simplified.The simplified model involves only one unknown parameter,which is the power exponent between Wdand stress.The measured Wdof the coal samples increases with the number of load cycles.This phenomenon is attributed to coal's viscoelastic deformation.Within the same stress,the Wdof tectonic coal is an order of magnitude greater than that of intact coal.The calculation model of Wdproposed in this paper provides a new tool for studying the energy principle of coal and gas outbursts.展开更多
BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological ...BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.展开更多
In the real world,one of the most common problems in project management is the unpredictability of resources and timelines.An efficient way to resolve uncertainty problems and overcome such obstacles is through an ext...In the real world,one of the most common problems in project management is the unpredictability of resources and timelines.An efficient way to resolve uncertainty problems and overcome such obstacles is through an extended fuzzy approach,often known as neutrosophic logic.Our rigorous proposed model has led to the creation of an advanced technique for computing the triangular single-valued neutrosophic number.This innovative approach evaluates the inherent uncertainty in project durations of the planning phase,which enhances the potential significance of the decision-making process in the project.Our proposed method,for the first time in the neutrosophic set literature,not only solves existing problems but also introduces a new set of problems not yet explored in previous research.A comparative study using Python programming was conducted to examine the effectiveness of responsive and adaptive planning,as well as their differences from other existing models such as the classical critical path problem and the fuzzy critical path problem.The study highlights the use of neutrosophic logic in handling complex projects by illustrating an innovative dynamic programming framework that is robust and flexible,according to the derived results,and sets the stage for future discussions on its scalability and application across different industries.展开更多
This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patie...This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.展开更多
Multimodal monitoring(MMM)in the intensive care unit(ICU)has become increasingly sophisticated with the integration of neurophysical principles.However,the challenge remains to select and interpret the most appropriat...Multimodal monitoring(MMM)in the intensive care unit(ICU)has become increasingly sophisticated with the integration of neurophysical principles.However,the challenge remains to select and interpret the most appropriate combination of neuromonitoring modalities to optimize patient outcomes.This manuscript reviewed current neuromonitoring tools,focusing on intracranial pressure,cerebral electrical activity,metabolism,and invasive and noninvasive autoregulation moni-toring.In addition,the integration of advanced machine learning and data science tools within the ICU were discussed.Invasive monitoring includes analysis of intracranial pressure waveforms,jugular venous oximetry,monitoring of brain tissue oxygenation,thermal diffusion flowmetry,electrocorticography,depth electroencephalography,and cerebral microdialysis.Noninvasive measures include transcranial Doppler,tympanic membrane displacement,near-infrared spectroscopy,optic nerve sheath diameter,positron emission tomography,and systemic hemodynamic monitoring including heart rate variability analysis.The neurophysical basis and clinical relevance of each method within the ICU setting were examined.Machine learning algorithms have shown promise by helping to analyze and interpret data in real time from continuous MMM tools,helping clinicians make more accurate and timely decisions.These algorithms can integrate diverse data streams to generate predictive models for patient outcomes and optimize treatment strategies.MMM,grounded in neurophysics,offers a more nuanced understanding of cerebral physiology and disease in the ICU.Although each modality has its strengths and limitations,its integrated use,especially in combination with machine learning algorithms,can offer invaluable information for individualized patient care.展开更多
Background: Critical Thinking (CT) dispositions in nursing are prominent predictors of competence in delivering high-quality care, and of professionalism, in newly graduated nurses. CT skills, in isolation of CT dispo...Background: Critical Thinking (CT) dispositions in nursing are prominent predictors of competence in delivering high-quality care, and of professionalism, in newly graduated nurses. CT skills, in isolation of CT dispositions, do not guarantee success in the workplace, because Critical Thinking Dispositions (CTD) are important elements of intellectual reasoning that simulate a person towards using the CT skills. Therefore, nursing educational programs should promote lifelong learning rather than focusing on transferring the content of nursing knowledge only. And for this purpose, quality education is the key. Education should focus on teaching from diverse perspectives, incorporating various teaching learning strategies that are congruent with the modern era. Purpose: The purpose of this study is to explore critical thinking dispositions among final year Baccalaureate Nursing students of various military colleges of nursing, in Pakistan. Methodology: A descriptive qualitative exploratory study design was used to investigate the CTD of BSc final year nursing students. The study population included twelve willing nursing students, from six military colleges across the country. Demographic information and consent was taken from the participants of the study. In-depth interviews, through a semi structured interview guide, and probes were used to obtain data related to personal experiences of CTD amongst the nursing students. Results: Data analysis showed two broad themes: 1) Perceptions of CT, and 2) Experiences of CT dispositions. In theme one, the emerging category was: Clarity of CT;whereas in theme two, the categories that emerged were: a) Truth Seeking, b) Open Mindedness, c) Inquisitiveness, and d) Self Organization. Conclusion: The findings of the study revealed positive dispositions towards truth seeking, open mindedness, and self-organization, whereas disposition towards inquisitiveness was weak. Self-confidence and maturity also emerged as positive factors that the students possessed. This study recommends that faculty and learners should extend their concept of CTD, and emphasizes its application in daily routine. Additionally, faculty should modify their instructional strategies and focus on the cultivation of dispositions of inquisitiveness, curiosity, and allow questioning by students in the class.展开更多
基金financially supported by the Original Exploration Project of the National Natural Science Foundation of China(No.52150079)the National Natural Science Foundation of China(Nos.U22A20130,U2004215,and 51974280)+1 种基金the Natural Science Foundation of Henan Province of China(No.232300421196)the Project of Zhongyuan Critical Metals Laboratory of China(Nos.GJJSGFYQ202304,GJJSGFJQ202306,GJJSGFYQ202323,GJJSGFYQ202308,and GJJSGFYQ202307)。
文摘Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and flammability,causing a spectrum of hazards to human health and environmental safety.Neoteric solvents have been recognized as potential alternatives to these harmful organic solvents.In the past two decades,several neoteric solvents have been proposed,including ionic liquids(ILs)and deep eutectic solvents(DESs).DESs have gradually become the focus of green solvents owing to several advantages,namely,low toxicity,degradability,and low cost.In this critical review,their classification,formation mechanisms,preparation methods,characterization technologies,and special physicochemical properties based on the most recent advancements in research have been systematically described.Subsequently,the major separation and purification applications of DESs in critical metal metallurgy were comprehensively summarized.Finally,future opportunities and challenges of DESs were explored in the current research area.In conclusion,this review provides valuable insights for improving our overall understanding of DESs,and it holds important potential for expanding separation and purification applications in critical metal metallurgy.
基金supported by NIH grants(R01NS125074,R01AG083164,and R21NS127177)(to YL).
文摘Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS),microglia display a unique molecular homeostatic signature(i.e.,Tmem119,P2ry12,Sall1,Siglech,Gpr34,and Hexb)(Figure 1A).
基金generously supported by the faculty startup funds from Auburn University at Montgomery (to SSVPS)。
文摘Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.
文摘BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
文摘The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly recognised.Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promise.While changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain uncertain.Dietary fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI microbiota.The aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical illness.Randomised controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were identified.Studies show dietary fibres have an impact on faecal microbiota in health and disease.The fibre,inulin,has a marked and specific effect on increasing the abundance of faecal Bifidobacteria.Short chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient populations.Very few trials have evaluated the effect of dietary fibre on the GI microbiota during critical illness.More research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.
文摘Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall working experience.This study aimed to assess job burnout and determine the factors that contribute to it among critical care nurses in the Eastern Province of Saudi Arabia.Methods:This study employed a descriptive,exploratory,cross-sectional research design.A total of 220 nurses employed in the critical care units of 5 private hospitals in the eastern region were selected for participation in this study using a convenience sample method.An electronic survey was distributed to critical care nurses in the Eastern Province who satisfied the specified inclusion criteria.The job burnout questionnaire utilized in this study was derived from previously conducted research,which has been established as a reliable and valid survey instrument.The process of data analysis was conducted utilizing the SPSS program.The scientific research conducted on human subjects adhered rigorously to all ethical considerations.Results:The highest percentage of nurses at the critical care units reported experiencing moderate levels of job burnout.Nurses exhibiting greater levels of professional experience demonstrated a statistically significant reduction in overall burnout scores when compared to their less experienced counterparts.Furthermore,within the realm of sociodemographic factors,it was found that the only significant independent predictor for job burnout was the level of experience among critical care nurses.Conclusions:The prevalence of burnout among nurses in critical care settings was found to be significant,with most participants reporting moderate levels of burnout which can yield significant ramifications for nurses and healthcare professionals.Consequently,healthcare organizations must accord primacy to the welfare of their staff and adopt proactive strategies to mitigate job burnout.
文摘Objective:This study aims to identify the prevalence of bullying in the workplace and to examine its association with turnover(TO)intention and secondary traumatic stress(STS)among Jordanian nurses employed in Emergency Departments(EDs)and critical care units(CCUs).Nurses employed in the EDs and CCUs are exposed to high levels of bullying behaviors that may contribute to STS,leading to high rates of TO.Methods:A descriptive cross-sectional design was used.A sample of 150 Jordanian nurses working in CCUs and EDs completed the study.Data collection was performed using the Demographical Questionnaire,the Negative Acts Questionnaire-Revised(NAQ-R),ProQOL scale,and TO scale.The IBM SPSS software was used to analyze data.Results:About 10.7%and 89.3%were categorized as“occasionally bullied”and“victims of workplace bullying”subsequently.Workplace bullying was positively associated with TO intention(r=0.46,P<0.001)and STS(r=0.36,P<0.001).TO was positively associated with STS(r=0.36,P<0.001).Bullying was a unique significant predictor of TO intention(t=4.59,B=0.34,P<0.001)and STS(t=4.15,B=0.34,P<0.001).Conclusions:Bullying behavior has negative adversarial effects on TO and the experience of STS.The prevalence of bullying behavior in the EDs and CCUs remains high despite the increasing awareness of its negative impacts.Healthcare organizations should put systems in place to ensure that zero-tolerance policy are monitored in terms of the effectiveness of its implementation.
文摘BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.
文摘The NIST Cybersecurity Framework (NIST CSF) serves as a voluntary guideline aimed at helping organizations, tiny and medium-sized enterprises (SMEs), and critical infrastructure operators, effectively manage cyber risks. Although comprehensive, the complexity of the NIST CSF can be overwhelming, especially for those lacking extensive cybersecurity resources. Current implementation tools often cater to larger companies, neglecting the specific needs of SMEs, which can be vulnerable to cyber threats. To address this gap, our research proposes a user-friendly, open-source web platform designed to simplify the implementation of the NIST CSF. This platform enables organizations to assess their risk exposure and continuously monitor their cybersecurity maturity through tailored recommendations based on their unique profiles. Our methodology includes a literature review of existing tools and standards, followed by a description of the platform’s design and architecture. Initial tests with SMEs in Burkina Faso reveal a concerning cybersecurity maturity level, indicating the urgent need for improved strategies based on our findings. By offering an intuitive interface and cross-platform accessibility, this solution aims to empower organizations to enhance their cybersecurity resilience in an evolving threat landscape. The article concludes with discussions on the practical implications and future enhancements of the tool.
文摘We discuss the findings of Wu et al on the utility of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and systemic immune-inflammatory index as diagnostic markers for gastric carcinoma(GC).We commend the study's contributions to the field and suggest a prospective study to validate these markers'sensitivity and specificity for early GC detection.We also propose developing surveillance protocols that incorporate these markers with other diagnostic methods to enhance clinical decision-making.Furthermore,we highlight the need for a more diverse patient cohort to assess the generalizability of these markers across different ethnic groups and demographic factors.Our suggestions aim to refine the application of these markers in clinical practice and to understand their potential in diverse clinical scenarios.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
基金Supported by National Natural Science Foundation of China(Grant Nos.11671403 and 11671236)Henan Provincial General Natural Science Foundation Project(Grant No.232300420113)。
文摘In this paper,we study high energy normalized solutions for the following Schr?dinger equation{-Δu+V(x)u+λu=f(u),in R^(2),∫_(R^(2))|u|^(2)dx=c,where c>0,λ∈R will appear as a Lagrange multiplier,V(x)=ω|x|2 represents a trapping potential,and f has an exponential critical growth.Under the appropriate assumptions of f,we have obtained the existence of normalized solutions to the above Schr?dinger equation by introducing a variational method.And these solutions are also high energy solutions with positive energy.
基金supported by the Fundamental Research Funds for the Central Universities(No.2024QN11072)National Natural Science Foundation of China(Nos.52404264 and 52174217)State Key Program of the National Natural Science Foundation of China(No.52034008)。
文摘The deformation energy(Wd)of soil-like tectonic coal is crucial for investigating the mechanism of coal and gas outbursts.Tectonic coal has a significant nonlinear constitutive relationship,which makes traditional elastic-based models for computing Wdunsuitable.Inspired by critical state soil mechanics,this study theoretically established a new calculation model of Wdsuitable for the coal with nonlinear deformation characteristics.In the new model,the relationship between energy and stress no longer follows the square law(observed in traditional linear elastic models)but exhibits a power function,with the theoretical value of the power exponent ranging between 1 and 2.Hydrostatic cyclic loading and unloading experiments were conducted on four groups of tectonic coal samples and one group of intact coal samples.The results indicated that the relationship between Wdand stress for both intact and tectonic coal follows a power law.The exponents for intact and tectonic coal are close to 2 and 1,respectively.The stress-strain curve of intact coal exhibits small deformation and linear characteristics,whereas the stress-strain curves of tectonic coal show large deformation and nonlinear characteristics.The study specifically investigates the role of coal viscosity in the cyclic loading/unloading process.The downward bending in the unloading curves can be attributed to the time-dependent characteristics of coal,particularly its viscoelastic behavior.Based on experimental statistics,the calculation model of Wdwas further simplified.The simplified model involves only one unknown parameter,which is the power exponent between Wdand stress.The measured Wdof the coal samples increases with the number of load cycles.This phenomenon is attributed to coal's viscoelastic deformation.Within the same stress,the Wdof tectonic coal is an order of magnitude greater than that of intact coal.The calculation model of Wdproposed in this paper provides a new tool for studying the energy principle of coal and gas outbursts.
基金Supported by Beijing Ditan Hospital Affiliated to Capital Medical University“Sailing Plan”,No.DTQH-202405.
文摘BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.
文摘In the real world,one of the most common problems in project management is the unpredictability of resources and timelines.An efficient way to resolve uncertainty problems and overcome such obstacles is through an extended fuzzy approach,often known as neutrosophic logic.Our rigorous proposed model has led to the creation of an advanced technique for computing the triangular single-valued neutrosophic number.This innovative approach evaluates the inherent uncertainty in project durations of the planning phase,which enhances the potential significance of the decision-making process in the project.Our proposed method,for the first time in the neutrosophic set literature,not only solves existing problems but also introduces a new set of problems not yet explored in previous research.A comparative study using Python programming was conducted to examine the effectiveness of responsive and adaptive planning,as well as their differences from other existing models such as the classical critical path problem and the fuzzy critical path problem.The study highlights the use of neutrosophic logic in handling complex projects by illustrating an innovative dynamic programming framework that is robust and flexible,according to the derived results,and sets the stage for future discussions on its scalability and application across different industries.
文摘This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.
文摘Multimodal monitoring(MMM)in the intensive care unit(ICU)has become increasingly sophisticated with the integration of neurophysical principles.However,the challenge remains to select and interpret the most appropriate combination of neuromonitoring modalities to optimize patient outcomes.This manuscript reviewed current neuromonitoring tools,focusing on intracranial pressure,cerebral electrical activity,metabolism,and invasive and noninvasive autoregulation moni-toring.In addition,the integration of advanced machine learning and data science tools within the ICU were discussed.Invasive monitoring includes analysis of intracranial pressure waveforms,jugular venous oximetry,monitoring of brain tissue oxygenation,thermal diffusion flowmetry,electrocorticography,depth electroencephalography,and cerebral microdialysis.Noninvasive measures include transcranial Doppler,tympanic membrane displacement,near-infrared spectroscopy,optic nerve sheath diameter,positron emission tomography,and systemic hemodynamic monitoring including heart rate variability analysis.The neurophysical basis and clinical relevance of each method within the ICU setting were examined.Machine learning algorithms have shown promise by helping to analyze and interpret data in real time from continuous MMM tools,helping clinicians make more accurate and timely decisions.These algorithms can integrate diverse data streams to generate predictive models for patient outcomes and optimize treatment strategies.MMM,grounded in neurophysics,offers a more nuanced understanding of cerebral physiology and disease in the ICU.Although each modality has its strengths and limitations,its integrated use,especially in combination with machine learning algorithms,can offer invaluable information for individualized patient care.
文摘Background: Critical Thinking (CT) dispositions in nursing are prominent predictors of competence in delivering high-quality care, and of professionalism, in newly graduated nurses. CT skills, in isolation of CT dispositions, do not guarantee success in the workplace, because Critical Thinking Dispositions (CTD) are important elements of intellectual reasoning that simulate a person towards using the CT skills. Therefore, nursing educational programs should promote lifelong learning rather than focusing on transferring the content of nursing knowledge only. And for this purpose, quality education is the key. Education should focus on teaching from diverse perspectives, incorporating various teaching learning strategies that are congruent with the modern era. Purpose: The purpose of this study is to explore critical thinking dispositions among final year Baccalaureate Nursing students of various military colleges of nursing, in Pakistan. Methodology: A descriptive qualitative exploratory study design was used to investigate the CTD of BSc final year nursing students. The study population included twelve willing nursing students, from six military colleges across the country. Demographic information and consent was taken from the participants of the study. In-depth interviews, through a semi structured interview guide, and probes were used to obtain data related to personal experiences of CTD amongst the nursing students. Results: Data analysis showed two broad themes: 1) Perceptions of CT, and 2) Experiences of CT dispositions. In theme one, the emerging category was: Clarity of CT;whereas in theme two, the categories that emerged were: a) Truth Seeking, b) Open Mindedness, c) Inquisitiveness, and d) Self Organization. Conclusion: The findings of the study revealed positive dispositions towards truth seeking, open mindedness, and self-organization, whereas disposition towards inquisitiveness was weak. Self-confidence and maturity also emerged as positive factors that the students possessed. This study recommends that faculty and learners should extend their concept of CTD, and emphasizes its application in daily routine. Additionally, faculty should modify their instructional strategies and focus on the cultivation of dispositions of inquisitiveness, curiosity, and allow questioning by students in the class.
