Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with s...Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.展开更多
In most of the emergency circumstances,the aircrew leaves the aircraft under unsatisfied conditions,such as too high relative velocity to the ambient air or low partial oxygen pressure.The aircrew must pass through th...In most of the emergency circumstances,the aircrew leaves the aircraft under unsatisfied conditions,such as too high relative velocity to the ambient air or low partial oxygen pressure.The aircrew must pass through this area as quickly as possible before opening the parachute safely,viz.,free-fall.Numerical simulations are conducted in this paper to explore the major characteris-tics of the aircrew free-fall process by using a commercial computational fluid dynamic（CFD） software,FLUENT.Coupled with the classical pressure-altitude and temperature-altitude relations,Navier-Stokes（N-S） equations for compressible flow are solved by using finite volume method.The body velocity and the attitude are predicted with six-degree of freedom（6DOF） module.The evolution of velocities,including horizontal,vertical components and angular velocity,is obtained.It is also analyzed further according to the particle kinetic theories.It is validated that the theories can predict the process qualitatively well with a modi-fied drag effect,which mainly stems from the velocity pressure.An empirical modification factor is proposed according to the fitting results.展开更多
Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury.Improved outcomes have been previously associated with single,timely interventions.The aim of...Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury.Improved outcomes have been previously associated with single,timely interventions.The aim of this study was to assess the association between multiple timely life-saving interventions(LSIs)and outcomes of traumatic haemorrhagic shock patients.Methods:A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency&Trauma Centre between July 01,2010 and July 31,2014.LSIs studied included chest decompression,control of external haemorrhage,pelvic binder application,transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention.The primary exposure variable was timely initiation of≥50%of the indicated interventions.The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis.The association between total pre-hospital times and pre-hospital care times(time from ambulance at scene to trauma centre),in-hospital mortality and timely initiation of≥50%of the indicated interventions were assessed.Results:Of the 168 patients,54(32.1%)patients had≥50%of indicated LSI completed within the specified time period.Timely delivery of LSI was independently associated with improved survival to hospital discharge(adjusted odds ratio(OR)for in-hospital death 0.17;95%confidence interval(CI)0.03–0.83;p=0.028).This association was independent of patient age,pre-hospital care time,injury severity score,initial serum lactate levels and coagulopathy.Among patients with pre-hospital time of≥2 h,2(3.6%)received timely LSIs.Pre-hospital care times of≥2 h were associated with delayed LSIs and with in-hospital death(unadjusted OR 4.3;95%CI 1.4–13.0).Conclusions:Timely completion of LSI when indicated was completed in a small proportion of patients and reflect展开更多
As more people donate blood, the government is working to ensure that the nation's blood supply is safe, for both donors and recipients After a long winter, shopping areas in downtown Beijing began to revive their...As more people donate blood, the government is working to ensure that the nation's blood supply is safe, for both donors and recipients After a long winter, shopping areas in downtown Beijing began to revive their festive weekend atmosphere in March, as spring returned. Sun Ying joined the hustle and bustle to window shop in Xidan, a commercial dis-展开更多
This descriptive-correlational study was conducted to determine the relationship between the knowledge and skills of the BSMT (Bachelor of Science in Maritime Transportation) students in PE (Physical Education) 2 (Adv...This descriptive-correlational study was conducted to determine the relationship between the knowledge and skills of the BSMT (Bachelor of Science in Maritime Transportation) students in PE (Physical Education) 2 (Advanced Swimming and Life-saving Techniques). The respondents of the study were the 40 second year BSMT students that were taken through purposive sampling. The study utilized a researcher-made questionnaire for both knowledge and skills that had undergone validity and reliability-testing. Descriptive and inferential statistics were used to analyze the data such as mean, standard deviation, and Spearman’s rho. Results revealed that their knowledge on Advanced Swimming and Life-saving Techniques was “Fair” while the skills of the second year BSMT students were “Very good”. Furthermore, the knowledge of the BSMT students had a positive correlation (substantial) with their skills on Advanced Swimming and Life-saving Techniques. The second year BSMT students are encouraged to undergo trainings and upgrading to enhance their knowledge and skills in Advanced Swimming and Life-saving Techniques in order for them to become life-long learners.展开更多
Under-five mortality remains a major concern in the world and in Senegal. It is mainly due to preventable and treatable diseases with priority life-saving medicines for under-five children. This study evaluated the av...Under-five mortality remains a major concern in the world and in Senegal. It is mainly due to preventable and treatable diseases with priority life-saving medicines for under-five children. This study evaluated the availability, management and use of these drugs in two health districts in Senegal. A descriptive cross-sectional study was conducted in the health districts of Guediawaye and Pete from 01 November 2018 to 31 January 2019. The health district of Guediawaye is in the region hosting the Senegalese capital while that of Pete is located in the region of Saint Louis, northern Senegal. Nine drugs that can prevent and treat malaria, diarrhea, pneumonia and malnutrition were selected. An inventory form and a self-administered questionnaire were used to collect data that was analyzed with SPSS and expressed as a percentage and average. Drug availability was 50.4% and 54.3% in Guediawaye and in Pete, respectively. Average stock-out duration in the past three months was estimated at 22.6 and 26 days, respectively. The drug management was marked, on the one hand, by a good availability of stock cards in the two districts with proportions equal to 100% and 94.1%, respectively, and on the other hand, by the presence of expired stocks in Pete (12.2%). About 79% and 88% of prescribers reported prescribing the basket drug, respectively. These results show that access to priority life-saving medicines for children remains a challenge. Measures to be taken should include improving the distribution channels and training of health professionals. Further studies should be conducted in other health districts to better understand the barriers to access to child health services.展开更多
This descriptive study aimed to determine the level of acceptability of the Instructional Guide in Physical Education 2(Advanced Swimming Skills and Life-Saving Techniques).The respondents of the study were the conten...This descriptive study aimed to determine the level of acceptability of the Instructional Guide in Physical Education 2(Advanced Swimming Skills and Life-Saving Techniques).The respondents of the study were the content experts currently teaching PE(Physical Education)in other universities in Iloilo and Bacolod City,Philippines together with the BSMT(Bachelor of Science Marine Transportation)students who used the instructional guide throughout the duration of the study.The instrument used to evaluate the materials was adopted from Terunez(2008)and included seven evaluation criteria to include physical aspect,language,content,objectives,instructions,learning activities,and evaluation measures.The statistical tools employed were mean,standard deviation,and rank.The results of the study revealed that the level of acceptability of the instructional guide in physical aspect was“High”which means that the material was suited to the level of the intended users.No significant difference was noted in the evaluation result of the content experts and student users.It can be concluded that the development of Instructional Guide in Physical Education 2 is deemed to be highly beneficial in enhancing learning.It is recommended that this instructional material will be utilized by other maritime institutions offering courses in Advanced Swimming and Life-Saving Techniques.展开更多
Background:Triage trauma scores are utilised to determine patient disposition,interventions and prognostication in the care of trauma patients.Heart rate variability(HRV)and heart rate complexity(HRC)reflect the auton...Background:Triage trauma scores are utilised to determine patient disposition,interventions and prognostication in the care of trauma patients.Heart rate variability(HRV)and heart rate complexity(HRC)reflect the autonomic nervous system and are derived from electrocardiogram(ECG)analysis.In this study,we aimed to develop a model incorporating HRV and HRC,to predict the need for life-saving interventions(LSI)in trauma patients,within 24 h of emergency department presentation.Methods:We included adult trauma patients(≥18 years of age)presenting at the emergency department of Singapore General Hospital between October 2014 and October 2015.We excluded patients who had non-sinus rhythms and larger proportions of artefacts and/or ectopics in ECG analysis.We obtained patient demographics,laboratory results,vital signs and outcomes from electronic health records.We conducted univariate and multivariate analyses for predictive model building.Results:Two hundred and twenty-five patients met inclusion criteria,in which 49 patients required LSIs.The LSI group had a higher proportion of deaths(10,20.41%vs 1,0.57%,p<0.001).In the LSI group,the mean of detrended fluctuation analysis(DFA)-α1(1.24 vs 1.12,p=0.045)and the median of DFA-α2(1.09 vs 1.00,p=0.027)were significantly higher.Multivariate stepwise logistic regression analysis determined that a lower Glasgow Coma Scale,a higher DFA-α1 and higher DFA-α2 were independent predictors of requiring LSIs.The area under the curve(AUC)for our model(0.75,95%confidence interval,0.66–0.83)was higher than other scoring systems and selected vital signs.Conclusions:An HRV/HRC model outperforms other triage trauma scores and selected vital signs in predicting the need for LSIs but needs to be validated in larger patient populations.展开更多
基金Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and 25461035
文摘Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.
基金University Foundation for Fundamental Research of NWPU
文摘In most of the emergency circumstances,the aircrew leaves the aircraft under unsatisfied conditions,such as too high relative velocity to the ambient air or low partial oxygen pressure.The aircrew must pass through this area as quickly as possible before opening the parachute safely,viz.,free-fall.Numerical simulations are conducted in this paper to explore the major characteris-tics of the aircrew free-fall process by using a commercial computational fluid dynamic（CFD） software,FLUENT.Coupled with the classical pressure-altitude and temperature-altitude relations,Navier-Stokes（N-S） equations for compressible flow are solved by using finite volume method.The body velocity and the attitude are predicted with six-degree of freedom（6DOF） module.The evolution of velocities,including horizontal,vertical components and angular velocity,is obtained.It is also analyzed further according to the particle kinetic theories.It is validated that the theories can predict the process qualitatively well with a modi-fied drag effect,which mainly stems from the velocity pressure.An empirical modification factor is proposed according to the fitting results.
文摘Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury.Improved outcomes have been previously associated with single,timely interventions.The aim of this study was to assess the association between multiple timely life-saving interventions(LSIs)and outcomes of traumatic haemorrhagic shock patients.Methods:A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency&Trauma Centre between July 01,2010 and July 31,2014.LSIs studied included chest decompression,control of external haemorrhage,pelvic binder application,transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention.The primary exposure variable was timely initiation of≥50%of the indicated interventions.The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis.The association between total pre-hospital times and pre-hospital care times(time from ambulance at scene to trauma centre),in-hospital mortality and timely initiation of≥50%of the indicated interventions were assessed.Results:Of the 168 patients,54(32.1%)patients had≥50%of indicated LSI completed within the specified time period.Timely delivery of LSI was independently associated with improved survival to hospital discharge(adjusted odds ratio(OR)for in-hospital death 0.17;95%confidence interval(CI)0.03–0.83;p=0.028).This association was independent of patient age,pre-hospital care time,injury severity score,initial serum lactate levels and coagulopathy.Among patients with pre-hospital time of≥2 h,2(3.6%)received timely LSIs.Pre-hospital care times of≥2 h were associated with delayed LSIs and with in-hospital death(unadjusted OR 4.3;95%CI 1.4–13.0).Conclusions:Timely completion of LSI when indicated was completed in a small proportion of patients and reflect
文摘As more people donate blood, the government is working to ensure that the nation's blood supply is safe, for both donors and recipients After a long winter, shopping areas in downtown Beijing began to revive their festive weekend atmosphere in March, as spring returned. Sun Ying joined the hustle and bustle to window shop in Xidan, a commercial dis-
文摘This descriptive-correlational study was conducted to determine the relationship between the knowledge and skills of the BSMT (Bachelor of Science in Maritime Transportation) students in PE (Physical Education) 2 (Advanced Swimming and Life-saving Techniques). The respondents of the study were the 40 second year BSMT students that were taken through purposive sampling. The study utilized a researcher-made questionnaire for both knowledge and skills that had undergone validity and reliability-testing. Descriptive and inferential statistics were used to analyze the data such as mean, standard deviation, and Spearman’s rho. Results revealed that their knowledge on Advanced Swimming and Life-saving Techniques was “Fair” while the skills of the second year BSMT students were “Very good”. Furthermore, the knowledge of the BSMT students had a positive correlation (substantial) with their skills on Advanced Swimming and Life-saving Techniques. The second year BSMT students are encouraged to undergo trainings and upgrading to enhance their knowledge and skills in Advanced Swimming and Life-saving Techniques in order for them to become life-long learners.
文摘Under-five mortality remains a major concern in the world and in Senegal. It is mainly due to preventable and treatable diseases with priority life-saving medicines for under-five children. This study evaluated the availability, management and use of these drugs in two health districts in Senegal. A descriptive cross-sectional study was conducted in the health districts of Guediawaye and Pete from 01 November 2018 to 31 January 2019. The health district of Guediawaye is in the region hosting the Senegalese capital while that of Pete is located in the region of Saint Louis, northern Senegal. Nine drugs that can prevent and treat malaria, diarrhea, pneumonia and malnutrition were selected. An inventory form and a self-administered questionnaire were used to collect data that was analyzed with SPSS and expressed as a percentage and average. Drug availability was 50.4% and 54.3% in Guediawaye and in Pete, respectively. Average stock-out duration in the past three months was estimated at 22.6 and 26 days, respectively. The drug management was marked, on the one hand, by a good availability of stock cards in the two districts with proportions equal to 100% and 94.1%, respectively, and on the other hand, by the presence of expired stocks in Pete (12.2%). About 79% and 88% of prescribers reported prescribing the basket drug, respectively. These results show that access to priority life-saving medicines for children remains a challenge. Measures to be taken should include improving the distribution channels and training of health professionals. Further studies should be conducted in other health districts to better understand the barriers to access to child health services.
基金the Commission on Higher Education(CHED),K to 12 Transition Program of the Office of Planning,Research,and Knowledge Management(OPRKM)Republic of the Philippines for funding this research through the DARE To (Discovery Applied Research and Extension Trans/Inter-Disciplinary Opportunities)Research Grant with Project ID:DARETO1-071.
文摘This descriptive study aimed to determine the level of acceptability of the Instructional Guide in Physical Education 2(Advanced Swimming Skills and Life-Saving Techniques).The respondents of the study were the content experts currently teaching PE(Physical Education)in other universities in Iloilo and Bacolod City,Philippines together with the BSMT(Bachelor of Science Marine Transportation)students who used the instructional guide throughout the duration of the study.The instrument used to evaluate the materials was adopted from Terunez(2008)and included seven evaluation criteria to include physical aspect,language,content,objectives,instructions,learning activities,and evaluation measures.The statistical tools employed were mean,standard deviation,and rank.The results of the study revealed that the level of acceptability of the instructional guide in physical aspect was“High”which means that the material was suited to the level of the intended users.No significant difference was noted in the evaluation result of the content experts and student users.It can be concluded that the development of Instructional Guide in Physical Education 2 is deemed to be highly beneficial in enhancing learning.It is recommended that this instructional material will be utilized by other maritime institutions offering courses in Advanced Swimming and Life-Saving Techniques.
文摘Background:Triage trauma scores are utilised to determine patient disposition,interventions and prognostication in the care of trauma patients.Heart rate variability(HRV)and heart rate complexity(HRC)reflect the autonomic nervous system and are derived from electrocardiogram(ECG)analysis.In this study,we aimed to develop a model incorporating HRV and HRC,to predict the need for life-saving interventions(LSI)in trauma patients,within 24 h of emergency department presentation.Methods:We included adult trauma patients(≥18 years of age)presenting at the emergency department of Singapore General Hospital between October 2014 and October 2015.We excluded patients who had non-sinus rhythms and larger proportions of artefacts and/or ectopics in ECG analysis.We obtained patient demographics,laboratory results,vital signs and outcomes from electronic health records.We conducted univariate and multivariate analyses for predictive model building.Results:Two hundred and twenty-five patients met inclusion criteria,in which 49 patients required LSIs.The LSI group had a higher proportion of deaths(10,20.41%vs 1,0.57%,p<0.001).In the LSI group,the mean of detrended fluctuation analysis(DFA)-α1(1.24 vs 1.12,p=0.045)and the median of DFA-α2(1.09 vs 1.00,p=0.027)were significantly higher.Multivariate stepwise logistic regression analysis determined that a lower Glasgow Coma Scale,a higher DFA-α1 and higher DFA-α2 were independent predictors of requiring LSIs.The area under the curve(AUC)for our model(0.75,95%confidence interval,0.66–0.83)was higher than other scoring systems and selected vital signs.Conclusions:An HRV/HRC model outperforms other triage trauma scores and selected vital signs in predicting the need for LSIs but needs to be validated in larger patient populations.
