Comprehensive Assessment Strategy Research Articles

Frailty and Its Associated Factors in Patients With Atrial Fibrillation: A Cross-Sectional Study.

This study aimed to investigate the prevalence of frailty and its predictors among Taiwanese patients with atrial fibrillation (AF). A cross-sectional study was conducted, enrolling 188 AF patients aged over 20 years from a medical center in northern Taiwan. Participants were recruited from September 1 to December 30, 2022. Structured questionnaires were used to gather data on demographics, disease characteristics, Study of Osteoporotic Fractures Index, Short Portable Mental Status Questionnaire, Mini Nutritional Assessment Short-Form, Chinese Version Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Among Taiwanese AF patients, over two-thirds were at risk of frailty, with susceptibility increasing with age. Key potential predictors included sex, cognitive function, nutritional status, sleep quality, and depression, jointly explaining 47.6% of the variation, with nutritional status being the most significant. These findings underscore the importance of comprehensive assessment and management strategies to address frailty in AF patients and improve overall health outcomes.

METHODS OF ASSESSING STUDENTS' KNOWLEDGE IN ENGLISH LANGUAGE LESSONS

Assessing students' knowledge in English language lessons is a crucial aspect of language education, impacting both teaching effectiveness and student outcomes. This article explores a variety of methods used to evaluate English language proficiency, considering both traditional and modern assessment techniques. Traditional methods such as written and oral exams are examined alongside performance-based assessments like portfolios and project-based learning. Additionally, the article delves into formative assessments, including quizzes and classroom activities, and the growing role of technology-enhanced assessments through computer-based testing and language learning apps. By examining the effectiveness, advantages, and limitations of each method, the article provides valuable insights into how these diverse tools can be integrated into a comprehensive assessment strategy. The ultimate aim is to offer educators a detailed understanding of assessment practices to enhance language teaching and learning outcomes, ensuring that students are accurately and fairly evaluated in their English language proficiency.

Hemorrhagic stroke and atherogenic markers – is there any relation?

ABSTRACT Background: The triglyceride/high-density lipoprotein (TG/HDL) ratio emerges as a promising marker for cardiovascular risk. However, the relationship between overall serum lipid levels and hemorrhagic stroke (HS) remains uncertain. Therefore, our study aims to explore the association between this novel index and mortality in HS patients. Methods: Utilizing a retrospective-prospective framework from January 2020 to August 2023, we scrutinized data from 104 hospitalized patients diagnosed with HS, with particular attention to their medical backgrounds and lipid profiles. Results: Age (odds ratio [OR], 1.078; 95% confidence interval [CI], 1.032–1.125; P = 0.001), atrial fibrillation (OR, 0.237; 95% CI, 0.074–0.760; P = 0.015), glucose level (OR, 1.121; 95% CI, 1.007–1.247; P = 0.037), and TG/HDL index (OR, 0.368; 95% CI, 0.173–0.863; P = 0.020) emerged as independent predictors for in-hospital mortality, as determined by both univariable and multivariable logistic regression analyses. Conclusion: Our results add weight to the growing evidence backing the utility of the TG/HDL index in assessing cardiovascular risk among HS patients. They emphasize the necessity of adopting a comprehensive risk assessment and management strategy that incorporates both traditional markers and novel indicators.

Risk Profiles of Avoidable and Unavoidable Hospitalizations: a Swedish population-based study

Abstract Background Older adults frequently experience multiple hospitalizations, owing to their complex health and social needs. This study aims to comprehensively characterize the risk factors associated with avoidable and unavoidable hospitalization among older adults. Specific emphasis is placed on avoidable/unavoidable hospitalization originating from chronic or acute causes. Methods Data on 3,166 individuals aged ≥60 years were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), linked to the Swedish National Patient Register. Multistate models were used to investigate the risk profiles of participants experiencing their first and recurrent hospitalizations over 15 years. The Swedish National Board of Health and Welfare criteria were used to define avoidable/unavoidable hospitalizations. Results Women had a lower hazard of avoidable hospitalizations for chronic conditions as well as unavoidable hospitalizations (HR range 0.46-0.84). However, receiving informal care was associated with 88% increased hazard of avoidable hospitalizations due to chronic causes (95%CI 1.18-2.99), while receiving formal care was associated with 44% increasing hazard of avoidable hospitalization due to acute causes (95%CI1.04-1.98). Factors such as slow walking speed, multimorbidity, and polypharmacy were associated with a high risk of avoidable hospitalizations due to both acute (HR range1.27-3.03) and chronic (HR range1.63-2.54) causes. Conclusions Both clinical and functional factors have emerged as key predictors of avoidable hospitalization, underscoring the importance of comprehensive risk assessment and proactive healthcare management strategies to reduce the burden of hospital utilization in older adults. Key messages • Targeted interventions are essential to improve healthcare outcomes among older adults at risk of avoidable hospitalizations due to chronic and acute conditions. • The study identified predictors such as slow walking speed, multimorbidity, and polypharmacy, underscoring the need for comprehensive risk assessment to prevent avoidable hospitalization.

Clinical Profile and Echocardiographic Evaluation of COPD Patients Admitted in a Tertiary Care Hospital

Introduction: Chronic obstructive pulmonary disease (COPD) ranks as the fourth leading cause of global mortality, with anticipated increases in prevalence and mortality in the future. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlights the importance of considering COPD diagnosis in patients with relevant symptoms or risk factors, confirmed through spirometry. While COPD is preventable and treatable, it often presents with significant extra-pulmonary effects, particularly cardiac manifestations. Echocardiography offers a rapid, noninvasive method to assess these cardiac complications. Objective: This study aimed to investigate the clinical profiles and echocardiographic changes in COPD patients and their correlation with disease severity. Method: Conducted as an observational cross-sectional study, the research took place in the indoor departments of Medicine and Respiratory Medicine at Sir Salimullah Medical College & Mitford Hospital, Dhaka, between May 25th, 2017, and November 24th, 2017; enrolling 105 diagnosed COPD patients aged e”18 years. Data collection involved a structured questionnaire covering socio-demographic details, risk behavior, and respiratory complaints. Physical examinations, spirometry, and echocardiography were conducted for diagnosis, severity grading, and cardiac evaluation, respectively. Statistical analysis employed SPSS software (version-22), presenting results through frequency, percentage, tables, graphs, and figures. Result: The study population was predominantly male (88.6%) with a mean age of 64.1 years. Most patients (94.2%) were smokers with a mean pack-year history of 22.03. All patients presented with cough and shortness of breath, and 88.5% had wheezing. Spirometry revealed moderate COPD in 40% of patients, with a distribution across all severity grades. Echocardiography showed abnormalities in 52.4% of patients, with tricuspid regurgitation, pulmonary hypertension, and right ventricular dilatation being the most frequent findings. A significant correlation was observed between C OPD severity and the presence of these echocardiographic abnormalities. Conclusion: Clinical examination unveiled common respiratory findings, while echocardiography demonstrated diverse cardiac manifestations in COPD patients. A significant proportion of patients exhibited normal findings on X-ray and echocardiography. The study highlights the prevalence of moderate COPD severity and the association between very severe COPD and specific cardiac complications, emphasizing the importance of comprehensive assessment and management strategies for COPD patients. J MEDICINE 2024; 25: 115-120

Prevalence of Seizures in Children Diagnosed With Neurodevelopmental Disorders.

Introduction Neurodevelopmental disorders (NDDs) typically emerge in early childhood and have a profound impact on the development of the nervous system, leading to various neurological challenges in cognition, communication, social interaction, motor skills, and behavior. These disorders arise from disruptions in brain development mechanisms. NDDs include conditions such as cerebral palsy (CP), global developmental delay (GDD), intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), with ADHD and ASD being the most prevalent. However, there is a lack of comprehensive research on the causes of NDDs in children receiving care at tertiary hospitals in Saudi Arabia. Therefore, in this study, we aimto investigate the characteristics of patients with NDDs and explore the association between NDDs and seizures. It also focuses on identifying specific risk factors that may influence the relationship between NDDs and seizures. Methods We conducted a retrospective cross-sectional study at the pediatric neurology and developmental assessment clinic of King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The study involved a review of electronic medical records from January 2021 to May 2023 for 200 pediatric patients who attended the clinic for NDD and seizures. Descriptive statistics summarized the data, using frequencies and percentages for categorical variables, and mean ± standard deviation for quantitative variables. The chi-square test identified differences between qualitative variables, with a significance threshold of p < 0.05. Results The study sample comprised 200 children ranging in age from one month to 14 years, with the majority of patients being from Jeddah city. Participants were categorized into four age groups: 17.0% (n=34) were aged between one month and three years, 18.5% (n=37) were aged between three and six years, 55.0% (n=110) were aged between six and 12 years old, and 9.5% (n=19) were aged between 12 and 14 years. The NDD subtypes identified were ASD 9.5%, ADHD 16.0%, CP 8.5%, GDD 30.5%, ID 5.5%, and 30% had multiple types of NDD. Generalized tonic-clonic seizures were the most common type observed. Conclusion Children with NDDs exhibit a high prevalence of seizures, with the age of the patient and consanguinity emerging as significant influencing factors in this correlation. Among the key findings is an emphasis on the importance of early detection and intervention for children with NDDs at higher risk of developing seizures. Overall, the study sheds light on the characteristics of NDD patients and their association with seizures, contributing to a better understanding of the complex relationship between NDDs and seizure occurrence. It also emphasizes the need for comprehensive assessment and management strategies that consider seizures in children with NDDs.

Longitudinal Analysis of Predictive Factors for Stroke and Bleeding Events in Atrial Fibrillation Patients: Insights From a Tertiary Care Center Cohort.

Atrial fibrillation (AF) represents a prevalent cardiac arrhythmia associated with increased risks of stroke and bleeding events, necessitating comprehensive risk assessment and management strategies. This retrospective cohort research aimed to longitudinally analyze risk factors associated with stroke and bleeding incidents in patients diagnosed with AF, focusing on identifying predictive factors and their impact on patient outcomes. The research enrolled 480 AF patients from a tertiary care center over an 18-month period (2021-2022). Baseline demographic, clinical, and medication data were collected from electronic health records. Patients were monitored for occurrences of stroke and bleeding events during follow-up. Cox proportional hazards models and Kaplan-Meier estimates were utilized to assess risk factor associations and cumulative event incidences, respectively. A cohort of 480 AF patients, with a meanage of 65.4 years, wasobserved over 18 months. Stroke patients tended to be older (72.1 years),and bleeders slightly younger (68.8 years). Cox models revealed higher stroke risk in >70-year-olds (hazard ratio (HR): 1.85, 95% confidence interval (95% CI): 1.21-2.78, p < 0.001) and with prior stroke history (HR: 2.13, 95% CI: 1.45-3.12, p < 0.001). Prior stroke linked to bleeding risk (HR: 1.88, 95% CI: 1.26-2.81, p = 0.003). At six months, stroke incidence was 5.2%, bleeding 3.8%; at 18 months, 12.5% experienced strokes, 9.3% bleeding. These findings underscore age and prior stroke as vital predictors of adverse outcomes in AF patients. This research reaffirms age and prior stroke as pivotal risk factors for adverse outcomes in AF patients. The findings emphasize the necessity for tailored risk stratification and interventions to mitigate stroke and bleeding risks, thereby enhancing patient care and prognosis in AF management.

Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects.

As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.

Reducing falls among residents of retirement homes: A DNP project.

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

Pesticide contamination pattern from Morocco, insights into the surveillance situation and health risk assessment: a review.

The widespread application of pesticides in Morocco's agriculture renders their monitoring in food and environmental samples very necessary. Recent years have witnessed a growing interest in reporting studies related to the monitoring of pesticide residues in food, water, groundwater, and soil as well as their quantitative health risk assessment. Most published studies have been done by university researchers. However, the lack of research reproducibility remains a problem that considerably limits the possibility of exploiting data from the literature. Our study involves an extensive literature review utilizing search engines with keywords like "pesticide residues," "monitoring," "vegetables and fruits," "water and soil," "risk assessment," and "Morocco" from 2009 to 2023. Analysis of pesticide residues in foodstuffs and environmental samples highlights concerns over compliance with EU regulations, the health risks associated with pesticide exposure, and the necessity for comprehensive monitoring and risk assessment strategies. This paper could help influence policies to develop a strategy and action plan for the sound management of pesticides, including measures to reduce their use, raise awareness, and monitor compliance. Also, this paper could be useful for scientists interested in understanding the current situation and challenges regarding pesticide residues in Morocco, as well as countries with which commercial links exist.

Assessment of cardiovascular functioning following sport-related concussion: A physiological perspective

There is still much uncertainty surrounding the approach to diagnosing and managing a sport-related concussion (SRC). Neurobiological recovery may extend beyond clinical recovery following SRC, highlighting the need for objective physiological parameters to guide diagnosis and management. With an increased understanding of the connection between the heart and the brain, the utility of assessing cardiovascular functioning following SRC has gained attention. As such, this review focuses on the assessment of cardiovascular parameters in the context of SRC. Although conflicting results have been reported, decreased heart rate variability, blood pressure variability, and systolic (ejection) time, in addition to increased spontaneous baroreflex sensitivity and magnitude of atrial contraction have been shown in acute SRC. We propose that these findings result from the neurometabolic cascade triggered by a concussion and represent alterations in myocardial calcium handling, autonomic dysfunction, and an exaggerated compensatory response that attempts to maintain homeostasis following a SRC. Assessment of the cardiovascular system has the potential to assist in diagnosing and managing SRC, contributing to a more comprehensive and multimodal assessment strategy.

Assessing cross-boundary wildfire hazard, transmission, and exposure to communities in the Italy-France Maritime cooperation area

The growing threats posed by wildfires in Southern Europe are calling for the development of comprehensive and sound management and risk assessment strategies. In this work, we present the application of wildfire simulation modeling based on the minimum travel time (MTT) algorithm to assess fine-scale (100-m resolution) wildfire hazard, transmission, and exposure to communities in the Italy-France Maritime cooperation area (Sardinia, Corsica, Tuscany, Liguria and Provence-Alpes-Côte d’Azur), which cover about 72,000 km2 of land. We simulated thousands of wildfires considering the current landscape and characterized and measured fine-scale wildfire risk factors and profiles by taking into account historical fire regimes, fuels, winds and fuel moisture conditions associated with the occurrence of the largest wildfires (&amp;gt;100 ha) that affected the study area in the last 20 years. Individual fires were simulated at 100-m resolution, consistent with the input files. Modeled annual burn probability and ignition probability revealed that Sardinia was the Region most affected by wildfires. The wildfire simulation outputs were then combined with main land uses and building footprint locations to characterize wildfire transmission and exposure to communities, and were summarized for main vegetation types and Regions. This study presents a cross-boundary and standardized approach based on wildfire spread modeling to analyze and quantify wildfire risk profiles in Southern Europe. The stochastic wildfire modeling systems we implemented used harmonized sets of data for a vast, fire-prone Mediterranean area, where previous similar studies were conducted at coarser resolutions and covered lower extent of lands. The approach presented in this work can be used as a reference pillar for the development and implementation of a common wildfire risk monitoring, management, and governance plan in the study area. The methods and findings of this study can be replicated in neighboring Mediterranean and other regions threatened by wildfires.

Quality control and evaluation of Xiaozhong Zhitong tincture by multi-wavelength fingerprint combined with electrochemical fingerprint

Xiaozhong Zhitong tincture (XZZTT), a prominent Traditional Chinese Medicine (TCM) formulation comprising 21 intricate herbal components, poses a challenge in terms of quality control due to its complex composition and the interplay of diverse chemical constituents. To address this issue, a comprehensive assessment strategy was devised by integrating chromatographic and electrochemical techniques to construct a multidimensional fingerprint for XZZTT samples. This study encompassed the evaluation of 42 XZZTT samples through a systematic quantitative fingerprinting method (SQFM), while also quantifying the concentrations of four specific compounds—Geniposide, Palmatine hydrochloride, Paeonol, and Chlorogenic acid. The experimental approach encompassed the establishment of fingerprints using High-Performance Liquid Chromatography (HPLC), Gas Chromatography (GC), and GC-HPLC tandem fingerprints methods. Furthermore, electrochemical fingerprints (ECFP) were established using the B-Z oscillation system, and eight characteristic parameters in the oscillation system were recorded and compared among samples. Hierarchical Clustering Analysis (HCA) was subsequently employed to classify the distinct fingerprints and compare outcomes from one-dimensional spectroscopy, GC-HPLC tandem chromatography, and the fusion fingerprints. Finally, Grey Relation Analysis (GRA) was harnessed to unravel the relationship between ECFP outcomes and peak areas in fusion fingerprints, facilitating predictions regarding the substances' reducing potency. In conclusion, the rational combination of multidimensional fingerprinting and multidimensional analysis provides a reliable and comprehensive method for the evaluation of XZZTT and its related products.

The Risk Analysis Index Has Superior Discrimination Compared With the Modified Frailty Index-5 in Predicting Worse Postoperative Outcomes for the Octogenarian Neurosurgical Patient

BACKGROUND AND IMPORTANCE: Healthcare systems continuously strive to improve quality and value of care. Advances in surgical technologies, enhanced perioperative surgical planning, and multidisciplinary care strategies are increasing the number of elective procedures in the geriatric population. However, frail older adults are still more likely to have poor postoperative outcomes. We examined the impact of frailty on postoperative outcomes, we compared the discriminative thresholds for the Risk Analysis Index (RAI), modified Frailty Index-5 (mFI-5), and increasing patient age. CLINICAL PRESENTATION: Octogenarian patients undergoing spine, cranial, and other procedures captured in the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2020 were included. We used receiver operating characteristic curve to examine discriminative thresholds of RAI, mFI-5, and increasing patient age. Multivariable analyses were performed. Our primary outcomes were 30-day mortality, extended length of stay (eLOS [≥75th percentile]), and continued inpatient care &gt;30 days (pLOS). Secondary outcomes were skilled care facility (skilled nursing facility [SNF]) discharges and readmissions. DISCUSSION: In total, 20 710 octogenarians were included, with a mean age of 83 years (SD, 2.5) and a men (52.7%) and White (79.8%) majority. The RAI had higher predictive discriminative thresholds for 30-day mortality (C-statistic of 0.743), eLOS (C-statistic: 0.692), and pLOS (C-statistic: 0.697) compared with the mFI-5 (C-statistic: 0.574, 0.556, and 0.550, respectively), and increasing patient age (C-statistic: 0.577, 0.546, and 0.504, respectively), P &lt; .001. On multivariable analyses, RAI showed a larger effect size with adverse postoperative outcomes by increasing frailty strata than mFI-5 and increasing patient age. Nonetheless RAI showed decreased risk for SNF discharges. CONCLUSION: We found that RAI was a more accurate predictor than mFI-5 and increasing patient age for 30-day mortality, eLOS, and pLOS in octogenarian neurosurgery patients. More research is needed on RAI's performance in different specialized neurosurgical populations. Moreover, it is increasingly clear that comprehensive risk assessment strategies tailored to optimize perioperative care should be prioritized to potentially improve outcomes for this at-risk population.

Effect of Training on Chemistry Teachers’ Attitude toward the Comprehensive Assessment System in Secondary Schools of Gakenke District, Rwanda

This study sought to establish the effect of training on chemistry teachers’ attitude toward the comprehensive assessment system in secondary schools of Gkenke District in Rwanda. This study adopted the descriptive research design. Data was collected through questionnaire. Analysis of data was done through descriptive statistics. Furthermore, chi-square test was used to establish the existing relationship between the variables. The study concludes that the majority of teachers were trained on how the comprehensive assessment is implemented. Also most of respondents involved in this study showed a positive attitude towards the CAS and its implementation. Furthermore, the positive attitudes and effective use of CAS in teaching and learning chemistry were found to be associated with training received by teachers. The trained teachers in CBC implementation and its assessment strategies supported the relevance and importance of this assessment strategy compared to those who didn’t receive the training. The study recommends that the districts should organize adequate trainings related to comprehensive assessment strategies to all teachers. There is a need to enhance teachers’ continuous professional development (CPD) at school level to promote good understanding of CAS. There is also a need to enhance the culture of peer collaboration among teachers (learning by experience where strong teachers may help weak ones) in CAS implementation.

The insufficiency of a simple stress question in assessing stress for chronic daily headache in clinical practice

BackgroundIn managing chronic daily headaches (CDH), a comprehensive approach is necessary to evaluate stress, a closely linked factor. However, limited time and costs often lead to the use of a simple stress question in clinical settings. This study aims to assess the validity of using a simple stress question for CDH patients and explore its implications for clinical practice. MethodsWe recruited 103 patients with CDH who completed structured self-administered questionnaires, including a simple stress question ("Have you had any stress or concerns in the last 4 weeks?") and validated Korean versions of questionnaires for depression, anxiety, insomnia, and the Brief Encounter Psychosocial Instrument (BEPSI). A headache specialist conducted clinical interviews. The stress group consisted of patients who acknowledged overt stress (answering "yes" to the simple question) and covert stress (initially answering "no" but later admitting during the interview). Results showed no statistical difference between the subgroups, so they were combined as the "acknowledged stress" group. ResultsOut of 103 patients, 54.4% had chronic migraine, 45.6% had chronic tension-type headache, and 66 patients (64.1%) acknowledged experiencing stress. No significant differences were found in demographic and clinical characteristics, BEPSI stress assessment, or depression, anxiety, and insomnia profiles between patients with overt stress (n = 51) and covert stress (n = 15). The average BEPSI score was 2.3 ± 0.9, with 45.6% of patients exceeding the criteria (>2.4). Two (5.4%) patients in denial of stress had scores above the BEPSI criteria. Among patients below the criteria of BEPSI, 21 acknowledged stress, while 35 denied stress, with no significant differences observed. ConclusionsThis study suggests the limitations of relying solely on a simple stress question for assessing stress in patients with CDH in clinical practice. It is possible to encounter covert stress, include individuals who do not exhibit noticeable stress, and misclassify stress levels. To overcome these limitations, it is necessary to foster a supportive environment for open communication on stress and implement a comprehensive assessment strategy when needed.

Insight into the influence of water leaching on ash fusion behavior and alkali metal migration for corn and rice straw

Alkali-induced slagging and silicate melt-induced slagging are the two mechanisms of the ash-related problem for herbaceous plants and agricultural residues. Water leaching changes ash-forming composition and mitigates the risk of alkali-induced slagging, but the fusion behavior and the related melt-induced slagging after water leaching are seldom studied. In this study, a comprehensive assessment strategy, including systematic experiments, optimized ash fusion test and equilibrium calculations, was used to study the influence of water leaching on alkali metal migration and fusion behavior of corn straw (CS) and rice straw (RS). The total potassium released in biomass after water leaching accounted for approximately 15% of the raw materials. Although water leaching increased the fusion temperatures of CS and RS, the residual potassium still induced the same lowest eutectic melting of K-Ca-Mg silicate, causing them to start sintering at around 700 °C. However, the changes in fusion behavior obtained from optimized ash fusion test showed that water leaching effectively mitigated the risks of deposition and slagging of RS. The characteristic of fusion behavior for RS transformed from the “melting-dissolution” mechanism to the “softening-melting” mechanism, which indicated a low risk of deposition after water leaching. The fusion behavior of CS after water leaching was less apparent due to the different mineral compositions and characteristics of the two types of biomass, as Ca and Mg in CS acted as modifiers for the silicate structure. Water-leaching is recommended for pretreating biomass with a predominance of K. For biomass with substantial alkaline earth metals, water leaching combined with other countermeasures is required. These findings can help promote the thermochemical utilization of agricultural residues on an industrial scale.

Timing of Complications Following Surgery for Distal Femur Fractures in Older Adults.

The purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied. A total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14days after surgery, except for SSI, which occurred between post-op days 11 and 24. Distal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.

Critical Device Reliability Assessment in Healthcare Services.

Medical device reliability is the ability of medical devices to endure functioning and is indispensable to ensure service delivery to patients. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) technique was employed in May 2021 to evaluate existing reporting guidelines on medical device reliability. The systematic searching is conducted in eight different databases, including Web of Science, Science Direct, Scopus, IEEE Explorer, Emerald, MEDLINE Complete, Dimensions, and Springer Link, with 36 articles shortlisted from the year 2010 to May 2021. This study aims to epitomize existing literature on medical device reliability, scrutinize existing literature outcomes, investigate parameters affecting medical device reliability, and determine the scientific research gaps. The result of the systematic review listed three main topics on medical device reliability: risk management, performance prediction using Artificial Intelligence or machine learning, and management system. The medical device reliability assessment challenges are inadequate maintenance cost data, determining significant input parameter selection, difficulties accessing healthcare facilities, and limited age in service. Medical device systems are interconnected and interoperating, which increases complexity in assessing their reliability. To the best of our knowledge, although machine learning has become popular in predicting medical device performance, the existing models are only applicable to selected devices such as infant incubators, syringe pumps, and defibrillators. Despite the importance of medical device reliability assessment, there is no explicit protocol and predictive model to anticipate the situation. The problem worsens with the unavailability of a comprehensive assessment strategy for critical medical devices. Therefore, this study reviews the current state of critical device reliability in healthcare facilities. The present knowledge can be improved by adding new scientific data emphasis on critical medical devices used in healthcare services.

Ensuring the Authenticity of the Conservation and Reuse of Modern Industrial Heritage Architecture: A Case Study of the Large Machine Factory, China

The Large Machine Factory (LMF) was built in the complex historical context of the late Qing Dynasty (1840–1912). Its space and construction faithfully record the architectural and cultural fusion between Chinese and western traditions and mark the beginning of modern architectural techniques in China. Through historical data and empirical studies, the historical background and architectural characteristics of the LMF were analyzed, and interventions aimed at ensuring authenticity were established. The cultural significance and results of construction were considered two crucial elements in terms of outstanding characteristics. Comprehensive inspection and assessment strategies were discussed, with minimal intervention and interpretation principles. Preventive reinforcement of the foundation, complementary reinforcement of the main structures, restoration of the historic façade and environment, and adaptive spatial interventions were found to be effective ways to ensure authenticity. The principles of minimal intervention and interpretability, which include prevention, recognizability, invisibility, subsidiarity, and intertextuality, were proposed through a comparison with the literature and practical experience. This study provides an appropriate technical reference for ensuring authenticity in the conservation and reuse of modern historic buildings with complex contexts. We propose a new understanding of intervention principles and suggest a guiding intervention path that avoids the complexities arising from the generalized interpretations of authenticity.