Diurnal temperature range and emergency room admissions for chronic obstructive pulmonary disease in Taiwan

The objective of this study was to assess the relationship between diurnal temperature range (DTR) and emergency room (ER) admissions for chronic obstructive pulmonary disease (COPD) in an ER in Taichung City, Taiwan. The design was a longitudinal study in which DTR was related to COPD admissions to the ER of the city’s largest hospital. Daily ER admissions for COPD and ambient temperature were collected from 1 January 2001 to 31 December 2002. There was a significant negative association between the average daily temperature and ER admissions for COPD (r =  −0.95). However, a significant positive association between DTR and COPD admissions was found (r = 0.90). Using the Poisson regression model after adjusting for the effects of air pollutants and the day of the week, COPD admissions to the ER increased by 14% when DTR was over 9.6°C. COPD patients must be made aware of the increased risk posed by large DTR. Hospitals and ERs should take into account the increased demand of specific facilities during periods of large temperature variations.     

基于FMEA法的结肠癌根治术风险识别研究

目的 探讨结肠癌根治术的高危风险以及引起风险的主要原因,提出有效的干预策略。方法 应用失效模式与效应分析法对结肠癌根治术进行风险识别研究。 结果 分析得出结肠癌根治术共计8项流程,26项失效环节,排在前10位的高危风险分别为：观察患者药物反应失误、设备仪器准备不充分、检查时间过长、术前宣教不佳、麻醉前核对失误、手术时间过长、排药错误、术后注意事项告知有误、护士术后核对失误、手术者术后核对失误。结论 FMEA法可以有效地识别高危风险,据此有针对性地制定措施、采取策略,能够最终从源头上避免风险的发生。     

内支架对大肠癌急性梗阻一期切除吻合疗效的探讨

目的:探讨内支架对大肠癌急性梗阻一期切除吻合的疗效。方法:选择2010年7月至2012年7月来我院急诊治疗确诊为大肠癌导致急性肠梗阻的患者98例,随机分为观察组和对照组各49例,观察组患者植入内支架,一周后行一期吻合切除术,对照组行急诊切除手术。观察和比较两者患者一期切除率、治疗效果和并发症的情况。结果:观察组一期切除率为95.7%(47例)较对照组分71.4%(35例)高;两组比较差异均有统计学意义(x2=22.9,P0.05);实验组症状缓解48例(缓解率98%),对照组症状缓解33例(缓解率67.3%),两组临床疗效比较有显著性差异(x2=33.3,P0.001),实验组术后并发症发生率(10.2%)要明显小于对照组(26.5%)(x2=9.6,P0.01)。结论:大肠癌急性梗阻术前植入内支架能有效提高患者的一期手术吻合率和治疗效果,降低术后并发症,值得在临床推广。     

Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease

Background

Little is known about patients who frequently visit the emergency department (ED) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to quantify the proportion and characteristics of patients with frequent ED visits for AECOPD and associated healthcare utilization.

Methods

We conducted a retrospective cohort study of adults aged ≥40 years with at least one ED visit for AECOPD between 2010 and 2011, derived from population-based all-payer data of State ED and Inpatient Databases for two large and diverse states: California and Florida. Outcome measures were frequency of ED visits for AECOPD, 30-day ED revisits, subsequent hospitalizations, near-fatal events (AECOPD involving mechanical ventilation), and charges for both ED and inpatient services (available only for Florida) during the year after the first ED visit.

Results

The analytic cohort comprised 98,280 unique patients with 154,736 ED visits for AECOPD. During the 1-year period, 29.4% (95% CI, 29.1%-29.7%) of the patients had two or more (frequent) visits, accounting for 55.2% (95% CI, 54.9%-55.4%) of all ED visits for AECOPD. In the multivariable model, significant predictors of frequent ED visits were age 55–74 years (vs. 40–54 years), male sex, non-Hispanic white or black race, Medicaid insurance (vs. private), and lower median household income (all P < 0.001). At the visit-level, 12.3% of ED visits for AECOPD were 30-day revisit events (95% CI, 12.1%-12.4%). Additionally, 62.8% of ED visits for AECOPD (95% CI, 62.6%-63.0%) resulted in a hospitalization; patients with frequent ED visits comprised 55.5% (95% CI, 55.2%-55.8%) of all hospitalizations. Furthermore, 7.3% (95% CI, 7.3%-7.5%) of ED visits for AECOPD led to a near-fatal event; patients with frequent ED visits accounted for 64.4% (95% CI, 63.5%-65.3%) of all near-fatal events. Total charges for AECOPD were $1.94 billion (95% CI, $1.90-1.97 billion) in Florida; patients with frequent ED visits accounted for $1.07 billion (95% CI, $1.04-1.09 billion).

Conclusions

In this large cohort study, we found that 29% had frequent ED visits for AECOPD and that lower socioeconomic status was significantly associated with a higher frequency of ED visits. Individuals with frequent ED visits for AECOPD accounted for a substantial amount of healthcare utilization and financial burden.     

A型肉毒毒素联合眼袋整形术对眼周皮肤松弛患者的疗效观察

目的:探讨A型肉毒毒素联合眼袋整形术对眼周皮肤松弛患者的治疗效果和对患者满意度的影响,为临床提供参考。方法:选取2015年6月至2016年6月间因眼周皮肤松弛来我院治疗的患者60例。患者根据自身意愿选择治疗方式,按其选择的治疗方式分组为对照组(n=28)和治疗组(n=32)。对照组采用单纯眼袋整形术进行治疗,治疗组采用A型肉毒毒素联合眼袋整形术治疗。治疗后对两组患者均随访6个月。观察记录患者手术后鱼尾纹的改善效果、眼袋减轻的情况和眼周皮肤光泽的改善效果。观察患者并发症的发生情况。随访结束时采用自制的满意度调查问卷对患者满意度进行调查。结果:经过治疗,治疗组鱼尾纹改善率为100.00%,明显高于对照组的60.71%;治疗组眼袋改善率为96.88%,明显高于对照组的32.14%;治疗组皮肤光泽改善率为87.50%,明显高于对照组的53.57%,差异均具有统计学意义(均P0.05)。治疗后,两组患者切口红肿、少量分泌物、小血肿的发生率比较无明显差异(P0.05),治疗组术眼红肿与外眦部切口瘀痕发生率明显少于对照组(P0.05)。治疗组总满意率为93.75%(30/32),明显高于对照组的67.86%(19/28),差异具有统计学意义(P0.05)。结论:A型肉毒毒素与眼袋整形术联合应用在眼周皮肤松弛的治疗上有较好的疗效和安全性,能明显降低患者术眼红肿与外眦部切口瘀痕的发生,并提高患者满意率,值得在临床上推广应用。     

Limnology of a Warm Hypertrophic Wastewater Reservoir in Israel I. The Physical Environment

This paper deals with stratification in a small reservoir (50 000 m³ volume, 5.5 m depth) receiving wastewater with a BOD of 80 mg/1 during the winter in order to irrigate agricultural areas during the dry summer. The reservoir goes through three partially overlapping annual cycles: solar radiation, water temperature and reservoir operation. It presents both permanent (deep) and ephemeral (shallow) stratification during the summer in spite of the strong breeze, due to both thermal and biogenic chemical gradients. There are stratified and non-stratified wastewater reservoirs in Israel. Stratification in hypertrophic impoundments seems to depend also on parameters derived from the chemical composition of hypertrophic waters. (e. g., turbidity, biogenic gradients, wind/water friction coefficient, viscosity).     

节点控制在手术安全管理中的运用与实践

运用节点控制理念,对围手术期患者高危环节进行风险评估,确定从患者手术申请至术后回病房或重症监护室等8个影响手术质量与安全的关键节点,运用信息化和人工辅助相结合的方式,实施节点控制和流程管控,实现手术全程流程化、可控化安全监管和无缝对接,从而确保医疗核心制度的规范执行,降低围手术期差错发生率、提高手术运行效率,实现手术患者安全管理的目标。

     

Sampling inspection to prevent the invasion of alien pests: statistical theory of import plant quarantine systems in Japan

The establishment of appropriate import quarantine systems is the best known method for preventing the unintentional introduction of invasive alien pests. However, quarantine systems are sometimes judged as non-tariff barriers against trade by the World Trade Organization. The construction of a common scientific theory for quarantine systems is thus extremely important to prevent invasion without causing international conflict. We explain several statistical theories that have been adopted in import plant quarantine systems in Japan. Quarantine systems include three major components: (1) import sampling inspection, (2) early detection procedures, and (3) emergency control. We first explain the principle of risk management that was commonly adopted in these components. Then, we explain the method for calculating the required sample size in the import sampling inspection. We then explain hierarchical sampling inspection for detecting alien pests inside Japan. We further explain the theory for declaring the eradication of invasive alien pests as an emergency control. Actual examples of quarantine actions against the invasion of plum pox virus disease and citrus huanglongbing are discussed.     

From Lithium‐Oxygen to Lithium‐Air Batteries: Challenges and Opportunities

Lithium ‐ air batteries have become a focus of research on future battery technologies. Technical issues associated with lithium‐air batteries, however, are rather complex. Apart from the sluggish oxygen reaction kinetics which demand efficient oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) catalysts, issues are also inherited from the nature of an open battery system and the use of reactive metal lithium as anode. Lithium‐air batteries, which exchange oxygen directly with ambient air, face more challenges due to the additional oxidative agents of moisture, carbon dioxide, etc. which degrade the metal lithium anode, deteriorating the performance of the batteries. In order to improve the cycling performance one must hold a full picture of lithium‐oxygen electrochemistry in the presence of carbon dioxide and/or moisture and fully understand the fundamentals of chemistry reactions therein. Recent advances in the exploration of the effect of moisture and CO₂ contaminants on Li‐O₂ batteries are reviewed, and the mechanistic understanding of discharge/charge process in O₂ at controlled level of moisture and/or CO₂ are illustrated. Prospects for development opportunities of Li‐air batteries, insight into future research directions, and guidelines for the further development of rechargeable Li‐air batteries are also given.     

Process development of a New Haemophilus influenzae type b conjugate vaccine and the use of mathematical modeling to identify process optimization possibilities

Vaccination is one of the most successful public health interventions being a cost‐effective tool in preventing deaths among young children. The earliest vaccines were developed following empirical methods, creating vaccines by trial and error. New process development tools, for example mathematical modeling, as well as new regulatory initiatives requiring better understanding of both the product and the process are being applied to well‐characterized biopharmaceuticals (for example recombinant proteins). The vaccine industry is still running behind in comparison to these industries. A production process for a new Haemophilus influenzae type b (Hib) conjugate vaccine, including related quality control (QC) tests, was developed and transferred to a number of emerging vaccine manufacturers. This contributed to a sustainable global supply of affordable Hib conjugate vaccines, as illustrated by the market launch of the first Hib vaccine based on this technology in 2007 and concomitant price reduction of Hib vaccines. This paper describes the development approach followed for this Hib conjugate vaccine as well as the mathematical modeling tool applied recently in order to indicate options for further improvements of the initial Hib process. The strategy followed during the process development of this Hib conjugate vaccine was a targeted and integrated approach based on prior knowledge and experience with similar products using multi‐disciplinary expertise. Mathematical modeling was used to develop a predictive model for the initial Hib process (the ‘baseline’ model) as well as an ‘optimized’ model, by proposing a number of process changes which could lead to further reduction in price. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:568–580, 2016