bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study on the Influence of Geographic Differences in China on Ancient Chinese Literary Creation in the Context of Deep Learning
Authors: Wang Shiyi
Published: June 2024

In recent years, the examination of literary creation through the lens of the natural geographic environment has emerged as a focal point in literary studies. This study designates China’s geographic environment as the independent variable and ancient Chinese literary creation as the dependent variable. We employ Pearson’s correlation coefficient to assess the appropriateness of the selected variables. Following this, a linear regression model is constructed using the least squares method to explore the relationship between geographic and environmental differences and ancient literary creation. The findings demonstrate significant positive correlations between the characteristics of topography, climate, and soil and the thematic content of ancient Chinese literature, with significance levels below 0.05. Specifically, the Pearson correlation coefficients are 0.509 for topographic features, 0.366 for climatic features, and 0.418 for soil features. Furthermore, the overall regression model exhibits an adjusted R² value of 0.235 and an F-value of 80.759. This research delineates the regional attributes that impact literary creation, thereby enhancing our understanding of the interplay between geography and literary output in ancient China.
An Intervention Study on Foreign Language Learning Anxiety of College Students Based on the Positive Psychology PDCA Teaching Model
Authors: Zou Xiaolei
Published: June 2024

The teaching model of positive psychology integrated with the PDCA model impacts traditional classroom teaching and revitalizes college students’ foreign language learning. This study employs both quantitative and qualitative research methods to examine the anxiety experienced by college students in foreign language learning, analyzing it from six dimensions. Utilizing the positive thinking teaching framework of the positive psychology PDCA cycle teaching model, the Lasso algorithm regression was used to screen the teaching satisfaction index and implement foreign language learning under the PDCA teaching model. Comparing the students’ theoretical and practical skills scores with traditional teaching, as well as their anxiety level, we propose targeted strategies to alleviate the anxiety of foreign language learning. In the application environment of the Positive Psychology PDCA teaching model, the overall anxiety, communication anxiety, classroom anxiety, and academic anxiety of foreign language learning at university were reduced compared with the traditional teaching model, with the mean values of 10.485, 11.125, and 10.562, respectively. The positive teaching thinking advocated by the PDCA teaching model can influence the students’ foreign language learning mindset and improve their anxiety about foreign language learning.
Innovation and Practice of Public Relations Teaching Models in the Digital Media Era
Authors: Zheng Yangheng
Published: June 2024

Constructing a teaching model that meets the professional requirements and market demand has become an urgent task of teaching reform and innovation breakthrough. This paper proposes a PPCA teaching model for public relations based on the current and potential demand for public relations talent in the digital media era. Based on the proposed teaching model, the teaching practice is carried out at O University of H City. The research data was collected through questionnaires, and then the experimental data was statistically analyzed using two independent samples of t-tests and regression analysis to verify the effectiveness of the proposed model. The results show that the evaluation of the learning process based on the PPCA teaching model is between “good” and “excellent”, and the class that applies this model improves 3.64% more than the class that applies the traditional model in terms of the overall grade, learning attitude and interest, class participation, learning ability, and ability to acquire knowledge. Classes applying this model have higher scores in terms of overall achievement, learning attitude and interest, class participation, learning ability, and ability to acquire knowledge than classes in the traditional model by 3.646-17.856 points, which is superior to some extent. Meanwhile, the student’s active learning initiative (0.147) has the greatest influence on the teaching effectiveness of the PPCA teaching model in public relations. The study provides data that supports the innovation and practice of teaching public relations studies.
Big Data Simulation Analysis of the Impact of China’s Carbon Tax Levy on Carbon Emission Behavior under the Background of “Dual Carbon”
Authors: Lin Guojian
Published: June 2024

This study focuses on the impact of China’s carbon tax on carbon emission behavior under the background of “double carbon”, using big data simulation analysis. The study utilizes the DICE model, combined with general equilibrium theory, to conduct in-depth theoretical analysis and numerical simulation of the carbon tax policy. It is found that the optimal carbon tax rate should be flexibly adjusted in combination with social and economic development and technological progress, and the optimal tax rate gradually rises from RMB 2.83/tonne of carbon dioxide to RMB 17.62/tonne from 1997 to 2023. Simulation results show that increasing the carbon tax rate can effectively promote the low-carbon emission reduction behavior of enterprises and thus achieve the emission reduction target. Under the fixed carbon tax policy, a 50% tax rate can significantly improve environmental quality and economic output. In contrast, steady-state values of output and carbon emissions decrease with the increase of tax rates. At the same time, the combination of carbon trading and carbon tax can more effectively incentivize enterprises to reduce carbon emissions. The results of the study show that a flexible and reasonable carbon tax policy can significantly affect carbon emission behavior, which is of great significance for realizing China’s “double carbon” goal.
Ethnic Clothing Design Based on the Perspective of Fine Arts in the Context of Digitalisation
Authors: Jia Minghui
Published: June 2024

This study digitizes ethnic clothing design from the perspective of fine arts. The female human body data obtained is uploaded to the corresponding design platform of Style3D, and the design resources are precipitated to form a corresponding database. The virtual fabric drape parameters and virtual fabric control parameters are utilized to achieve 3D virtual fabric drape simulation. Combined with the results of the ethnic style recommendation configuration to obtain virtual samples and evaluate satisfaction. The results show that the bust, abdominal, and hip circumferences of the acquired female body data are within the ranges of 42-52cm, 40-57cm, and 47-49cm, respectively. The results of the draping simulation experiment showed a smooth state after 90 minutes for six different fabrics. The highest similarity between length and width between the upper and lower bodice and pants was found for lapel bodices (0.9) and slouchy bodices (0.88), respectively. These correspond to long gowns with large lapel bodices and pants. Designer B’s highest mean value of 4.67 indicates that designers are highly satisfied with the ethnic clothing design function of Style3D, as the mean values of the six styles are above 4. To sum up, this paper advocates for the application of ethnic clothing design using Style3D technology.
Rural agricultural products e-commerce selling and cross-border logistics platform construction based on scale yield function
Authors: Tang Yuzang , Zhang Fangfang
Published: June 2024

The scale yield function has a great influence on the study of cross-border logistics platform building and rural agricultural products e-commerce selling. This paper analyzes the main factors affecting the effect of cross-border logistics platform construction through factor analysis. Among them, platform content construction, platform service level, platform user management, platform supply chain construction, and platform development potential are the most important factors of cross-border logistics platform construction. The linear combination is used to construct a cross-border logistics platform integrating content, service, management, supply, and development. The regression method is applied to calculate the factor scores, and the assumed return to scale is applied to calculate the relevant data after the construction of the cross-border logistics platform. Seeking the maximum scale return rate is greater than 80%, the return is higher. The experiment proves that the construction of a cross-border logistics platform can expand the rural agricultural products e-commerce sales market from mainly China to parallel sales in China and European and American countries, etc., and improve the scale gain. Relying on the construction of a cross-border logistics platform, the total sales of rural agricultural products and e-commerce sales in foreign countries increased by more than 10 million, and the revenue was higher than 4.5 times of previous years. Thus, the construction of a cross-border logistics platform is conducive to expanding the market of rural agricultural products e-commerce sales and increasing rural agricultural products e-commerce sales.
3D Finite Element Modelling of FRP Confined Concrete Column
Authors: Ahmmad Bakhtyar Saleh , Horvath-Kalman Eszter , Mohammed Kamaran
Published: June 2024

Modelling concrete columns confined with fiber-reinforced polymer (FRP) using finite element (FEM) analysis is a difficult task due to the need for precise definition of material and interaction parameters. The inclusion of FRP confinement in composites introduces complexities in representing the volumetric behavior of concrete under triaxle stress conditions. The behavior of confined concrete differs from that of non-confined concrete due to the passive nature of FRP confinement, requiring consideration of flow rules, damage parameters, strain hardening/softening constitutive relationships, and a pressure-dependent yield criterion. This project aims to address these challenges by proposing a modified plastic damage model, a concrete dilation model, and a new set of concrete hardening/softening rules using the advanced FE program ABAQUS CAE. The FE model’s strengths and limitations are evaluated by comparing it with experimental results from this project, as well as other findings from literature, including both experimental and analytical studies.
Biomimicry Architecture Between Fame and Reality
Authors: Kenza Belkhiri
Published: June 2024

As a highly interdisciplinary subject, architecture is influenced by many natural and social science subjects. Although seemingly distant from architecture, biology is currently a scientific field that fits into design practices that have evolved and shifted towards a new hybrid framework. Architecture is a complex negotiated cultural practice that encompasses all aesthetic, technical, economic, and political issues of social production itself. For architects, the integration of academic knowledge and design practice can be a difficult activity to define, but it can be the intellectual fuel that drives innovation and growth in architectural practice. The relationship and connection between architecture and nature have generated many questions, criticisms, and solutions. Today, a new form of design was introduced a few years ago, forcing the modern man to be inspired by decades of natural processes, but whose true potential has only recently been revealed.
Relationships between the Built Environment and Environmental Pollution, Issues of Megacities
Authors: Paládi-Kovács Ádám
Published: June 2024

The first part of the article discusses the natural environment of humans and its evolution over the past centuries. It examines the changes that have occurred in just the last 100 years and how they have impacted human habitats. It explores how architects and engineers shaping our settlements have influenced the environment, as well as how the model developed during economic growth affects and presents challenges to our society, particularly regarding the interconnection between climate change and the development of our cities.

The second part of the writing addresses the issue of megacities, exploring where the almost endless growth of our metropolises has led, the problems it causes, the differences observed between the growth of megacities in developed and developing countries, the reasons behind it, and the additional difficulties it poses to their residents.
Review of Construction Risks in a Nuclear Power Plant Environment
Authors: Horváth-Kálmán Eszter , Ahmmad Bakhtyar Saleh
Published: June 2024

Everything in the world is about risk, from individual decisions to global manipulations, which is of fundamental importance in a nuclear power plant environment. The question is whether, in a given situation, this risk is acceptable or no longer acceptable. In some respects, the risk analysis applied to construction projects differs from the risk analysis applied to nuclear installations. For nuclear installations, the risk as such is primarily nuclear risk. In view of this, for investments involving a nuclear installation, the risk analysis to be carried out must be carried out at two separate levels. The first level is the traditional construction risk analysis, and then as a second level, each risk item should be classified from a nuclear risk point of view. In this study, the nuclear exposure of construction risks will be presented.
Energy and Environmental Load Reduction, Optimization on Pile Foundation Design
Authors: Kaczvinszki-Szabó Vera , Telekes Gábor
Published: June 2024

Design methods must also be improved in order to reduce energy costs and environmental impact. When designing pile foundations, the costs and environmental impact of construction are far from being irrelevant.

At present, the most widely accepted method for determining the load capacity is the pile load test, which is considered the most realistic result, and therefore great emphasis should be placed on ensuring that these are evaluated as effectively as possible. By replacing the pile load test, its environmental impact and cost could be avoided. The aim of our research is to estimate a mathematical function that, from the wide range of soil physical and/or mechanical parameters, gives a formula that can be used to plot the curve without the need to produce a pile load test. By showing the relationship between different soil parameters and load capacities. In order for this to be possible later with a new theory, we examined the feasibility of this by evaluating the results of several measurements.

Climate change will also bring a transformation in the course of planning, because there may be changes in the load capacity on the soil and the use of materials. Soil composition and structure will also be affected by warming. The environmental impact of building materials and increased costs demands also bring about changes in the design of pile foundations.
Multidisciplinary Nature of the AEC Industry, and the Potential Distribution of AEC Firms
Authors: Altamimi Motasem , Zagorácz Márk Balázs , Halada Miklós
Published: June 2024

The Architecture, Engineering, and Construction (AEC) sector is diverse. The industry’s market is run by businesses of different sizes, specialties, and subordinations, and each active company indirectly participates in adding value to the sector. This paper focuses on the functional distribution of local AEC firms in Southern Hungary, mainly in the South Transdanubia region. The work systematically gathers data about multidisciplinary AEC firms based in the region, introduces the main activities of the collected companies, and reveals the potential AEC divisions, by analyzing the popularity, net revenue, and number of employee factors for each professional division within the industry at the studied region.
Researching By Design: Methodologies to Explore Design-Based Instruction for Youth Resilience to Environmental Challenges
Authors: Passos Rosa Tayana , Boromisza Zsombor , Cuesta Tabares Mayte Alejandra
Published: June 2024

Environmental education is not aligning with the sustainability and educational needs of the 21st century. Design-based learning emerges as a viable solution, fostering problem-solving and experiential learning in the environment. With its constructivist approach, it has the potential to improve environmental literacy across diverse social contexts. This research explores the use of research by design and design-based learning to develop extracurricular programs in schools in Brazil and Hungary. The analytical framework is developed through a literature review and systematic case analysis. The program’s objective is to engage the school community in redesigning their environment, following the design-based instruction framework, and incorporating the community’s context and landscape architecture and design principles. Program efficacy will be assessed through participant production, outcome analysis, observation, surveys, and performance on the design activities. The findings will contribute to understanding and evaluating program effectiveness in improving environmental education.
The Architectural Aesthetic Order of Fire Protection
Authors: Érces Gergő
Published: June 2024

Nowadays, the damaging effects on humanity, such as extreme weather caused by climate change, the pandemic-induced isolation, or the drastic increase in the cost of energy carriers, etc., have led to the need to change the design of our buildings. The need to design buildings for safety, prevention and sustainability requires a change in our design thinking.

The damaging effects of these extremes all have an impact on the fire safety situation of a building. The conclusions of fire investigation procedures suggest that a disorderly state of the built environment typically develops prior to fire starts.

As stated above, the researchers are investigating the degree of orderliness in the research, for which they are using network science methods. Based on the hypothesis, tidiness is also an aesthetic value, whose high level of appearance determines the appropriate fire safety situation.

The high aesthetic value of architectural fire protection correlates with the degree of orderliness, i.e. it is a significant determinant of the long-term sustainable stable fire safety situation of a building.
The Significance of Human Individual and Crowd Movement Research in Built Environment, with Emphasis on its Function in Retail Spaces
Authors: Edelmann Dóra , Őszi Arnold , Goda Tibor
Published: June 2024

Understanding the movements of crowds offers more and more opportunities in the field of architecture, in both active and passive methods of implementation.

The study briefly describes crowd dynamics, the new field of research as well as the levels of investigation of human mass movements. Due to its expected large-scale spread, it particularly describes the need for and the possibilities of individual human body motion detection in retail facilities while emphasizing the architectural aspects of the rise of innovative commercial facilities. It details and compares the operational processes of modern-day queue-free “convenience” stores, Amazon Go with JWO technology, and Żabka Nano units operating according to AiFi, highlighting their architectural features.
Urban Housing Typologies Through Modern History
Authors: Tomajian Haik , Gyergyák János
Published: June 2024

Urban housing typologies refer to different ways of designing and constructing various types of housing that exist in urban areas. They can be classified by function, form, shape, construction type, and materials. Several residential building models, typologies, and different solutions have emerged with the aim of solving the problems arising from overpopulation. Some of these have succeeded, while others have failed miserably. As the twenty-first century progresses, the world is facing major housing and environmental challenges; the increase of the population and the lack of resources and housing areas constitute a direct threat to human wellbeing, and to the “health” of the planet. This has already started to have a major effect on architecture in general, and on housing design in particular, with new sustainable models and typologies. This paper focuses on the historical development of urban housing, and investigates its shaping factors, and the most important theories and movements which had an impact on urban housing. Furthermore, the paper asks questions about what is driving change in contemporary urban housing design, and what the new directions in the field are, searching for solutions on demand. It also investigates urban housing typologies and classifications and their relations to the surrounding built environment.
A Proposal for Utilization of Vaults as Floor-slab Structures in Contemporary Architecture
Authors: Badik-Szabó Daniel
Published: June 2024

Vaults are among the oldest known engineering structures, and have escorted the history of architecture through thousands of years. Nowadays, construction industry rarely uses them, and doesn’t consider them as a general option to be used for floorslab structures, although they offer several opportunities. The presentation aims to re-introduce vaults into everyday usage, emphasizing their efficient shape, building technology and aesthetic values.

The following aspects are featured in the paper:

-mathematical definition of vaults,

-main technical terms considering vault constructions,

-main features of the statics of vaults,

-connection of the force-trajectory and the central core,

-importance of shape for ideal material distribution,

-a proposal for a contemporary floorslab structure featuring beams and narrow vaultzones,

-pros and cons of the proposed floorslab structure
Sudden Deterioration of a Young Patient During Elective Cesarean Section. Amniotic Fluid Embolism… or Else? – A Case Report
Authors: Codru Ioana Roxana , Codru Marian Valeriu , Vintilă Bogdan Ioan , Gherman Ioana , Popescu Dragoș
Published: June 2024

Sudden respiratory and circulatory collapse during or immediately after delivery, vaginal or surgical, can have many causes that can lead to poor maternal outcomes. A pregnancy-induced amniotic fluid embolism and anaphylaxis are two distinct medical conditions that appear similar clinically but have very different underlying mechanisms and treatment approaches. Amniotic fluid embolism is a rare but life-threatening obstetric emergency that leads to a systemic inflammatory response that can be easily confounded with an anaphylactic reaction. We report the case of a patient with no comorbidities or allergies before the current pregnancy that was proposed for delivery by C-Section under spinal anesthesia. After delivery of the placenta and administering the test dose of antibiotic, the patient developed sudden circulatory collapse, altered neurological status, and critical respiratory distress. At that point, the two presumed diagnoses were amniotic fluid embolism and anaphylaxis. Concurrently with the diagnostic pathway, supportive measures (intubation, mechanical ventilation, hemodynamic support) were taken. The clinical evolution was favorable, and after day three, the patient was discharged from the hospital. Our case highlights the significance of promptly distinguishing between anaphylaxis and amniotic fluid embolism to facilitate the timely management of the critical situation.
Comparison of Critical Illness Score in Patients Admitted to Intermediate Care Units of a Tertiary Care Hospital: A Comparative Cross-Sectional Study from Karachi, Pakistan
Authors: Ahmed Amber Sabeen , Iqbal Madiha , Sethi Sher Muhammad , Sabir Sania , Almas Aysha
Published: June 2024

Introduction

Intermediate care units (IMCUs) serve as step-up units for emergency department patients and as step-down units for critically ill patients transferred from intensive care units. This study compares four critical illness scores for assessment of acutely ill patients and their accuracy in predicting mortality in patients admitted to IMCU.

Methods

A comparative cross-sectional study on patients aged ≥18 admitted to IMCU of Aga Khan University Hospital from 2017 to 2019. All patients admitted to IMCU from the emergency room were included in the study. Patient’s record were reviewed for demographic data, physiological and laboratory parameters. Critical illness scores were calculated from these variables for each patient.

Results

A total of 1192 patients were admitted to the IMCU, of which 923 (77.4%) medical records were finally analyzed. The mean (SD) age of participants was 62 years (± 16.5) and 469 (50.8%) were women. The overall hospital mortality rate of patients managed in IMCU was 6.4% (59/923 patients). The median scores of APACHE II, SOFA, SAPS II and MEWS were 16 (IQR 11–21), 4 (IQR 2–6), 36 (IQR 30–53) and 3 (IQR 2–4) points respectively. AUC for SAPS II was 0.763 (95% CI: 0.71–0.81), SOFA score was 0.735 (95% CI: 0.68–0.79) and MEWS score was 0.714 (95% CI: 0.66–0.77). The lowest ROC curve was 0.584 (95% CI: 0.52–0.64) for APACHE II.

Conclusion

In conclusion, our study found that SAPS II, followed by SOFA and MEWS scores, provided better discrimination in stratifying critical illness in patients admitted to IMCU of a tertiary care hospital in Pakistan.
Posterior Reversible Encephalopathy Syndrome, not so Uncommon in Pediatric Patients with Renal Involvement: A Case Series
Authors: Koller Ana-Maria Roxana , Man Alexandra , Muntean Carmen
Published: June 2024

Introduction

Posterior reversible encephalopathy syndrome (PRES) primarily shows neurological symptoms and is more frequent in males, often occurring in oncological patients. It can also be associated with renal conditions like post-streptococcal glomerulonephritis, a common cause of pediatric hypertension. Management involves blood pressure and seizure treatment. In some cases, it may lead to irreversible and severe complications. Early treatment is essential for prevention.

Presentation of case series

In the past six months, we have documented the cases of two patients, aged 15 and 10, both of whom presented with PRES and renal disease. These patients were admitted because of general malaise, headaches, nausea, vomiting, visual disturbances, and elevated blood pressure. Subsequently, both patients experienced epileptic episodes. Only the first patient required transfer to the Pediatric Intensive Care Unit (PICU). Cerebral magnetic resonance imaging (MRI) scans revealed distinct PRES lesions in both cases. Following comprehensive investigations, both cases were diagnosed with PRES in the context of acute post-streptococcal glomerulonephritis.

Conclusions

The patients showed improvement following the administration of antihypertensive and anticonvulsant medications, along with treatment for the underlying renal condition.
Simplified Diagnosis of Urosepsis by Emergency Ultrasound Combined with Clinical Scores and Biomarkers
Authors: Dragoescu Alice Nicoleta , Dragoescu Petru Octavian , Stanculescu Andreea Doriana , Padureanu Vlad , Dop Dalia , Radu Mihai Alexandru , Florescu Mirela Marinela , Maria Daniela Teodora , Florescu Dan Nicolae , Mitroi George
Published: June 2024

Background

Urosepsis is a life-threatening medical condition due to a systemic infection that originates in the urinary tract. Early diagnosis and treatment of urosepsis are critical to reducing mortality rates and preventing complications. Our study was aimed at identifying a fast and reliable method for early urosepsis diagnosis and severity assessment by combining prognostic scores such as SOFA and NEWS with ultrasound examination and serum markers PCT and NLR.

Methods

We performed a single-center prospective observational study in the Craiova Clinical Emergency Hospital. It initially analysed 204 patients admitted for sepsis of various origins in our hospital between June and October 2023. Those with urological conditions that were suspected to have urosepsis have been selected for the study so that finally 76 patients were included as follows: the severe cases with persistent hypotension requiring vasopressor were enrolled in the septic shock group (15 patients - 19.7%), while the rest were included in the sepsis group (61 patients - 80.3%). Mortality rate in our study was 10.5% (8/76 deaths due to sepsis).

Results

Both prognostic scores SOFA and NEWS were significantly elevated in the septic shock group, as were the sepsis markers PCT and NLR. We identified a strong significant positive correlation between the NEWS and SOFA scores (r = 0.793) as well as PCT and NLR (r=0.417). Ultrasound emergency evaluation proved to be similar to CT scan in the diagnosis of urosepsis (RR = 0.944, p=0.264). ROC analysis showed similar diagnostic performance for both scores (AUC = 0.874 for SOFA and 0.791 for NEWS), PCT and NLR (AUC = 0.743 and 0.717).

Conclusion

Our results indicate that an accurate and fast diagnosis of urosepsis and its severity may be accomplished by combining the use of simpler tools like emergency ultrasound, the NEWS score and NLR which provide a similar diagnosis performance as other more complex evaluations.
Feeding Intolerance in Critically Ill Patients with Enteral Nutrition: A Meta-Analysis and Systematic Review
Authors: Xu Jing , Shi Wenyu , Xie Liying , Xu Jing , Bian Lanzheng
Published: June 2024

Background

Feeding intolerance is a common yet serious complication in critically ill patients undergoing enteral nutrition. We aimed to conduct a meta-analysis to evaluate the risk factors of feeding intolerance in critically ill patients undergoing enteral nutrition, to provide insights to the clinical enteral nutrition treatment and care.

Methods

Two researchers systematically searched PubMed, Medline, Web of Science, Cochrane Library, Chinanews. com, Wanfang and Weipu databases about the studies on the risk factors of feeding intolerance in severe patients with enteral nutrition up to August 15, 2023. Literature screening, data extraction and quality evaluation were carried out independently by two researchers, and Meta analysis was carried out with RevMan 5.3 software and Stata 15.0 software.

Results

18 studies involving 5564 enteral nutrition patients were included. The results of meta-analyses showed that age < 2 years old, age > 60 years old, APACHE II score ≥ 20, Hypokalemia, starting time of enteral nutrition > 72 hours, no dietary fiber, intra-abdominal pressure > 15mmHg, central venous pressure > 10cmH2O and mechanical ventilation were the risk factors of feeding intolerance in critically ill patients undergoing EN (all P<0.05). No publication biases were found amongst the included studies.

Conclusion

The incidence of feeding intolerance in critically ill patients undergoing enteral nutrition is high, and there are many influencing factors. Clinical medical workers should take effective preventive measures according to the risk and protective factors of patients to reduce the incidence of feeding intolerance and improve the prognosis of patients.
Weaning Outcome is Associated with ELWI and Impaired Diastolic Function
Authors: Bagka Dimitra , Zakynthynos George , Tsolaki Vasiliki , Papanikolaou Jonh , Vazgiourakis Vasilis , Baka Maria , Pratsas Konstantinos , Makris Demosthenes
Published: June 2024

Objectives

To evaluate hemodynamic profiles of critical care patients undergoing spontaneous t-piece trial (SBT) and present weaning failure.

Methods

Prospective observational study conducted in ready-to-wean non-cardiac ICU patients. Clinical, echocardiographic and thermodilution-derived variables were recorded before and after a 2-hour SBT. Weaning from mechanical ventilation was defined as preservation of spontaneous breathing for 48 hours following successful SBT.

Results

Fourteen patients succeeded weaning, five manifested T-trial-failure and six late-failure. Weaning outcome was significantly associated with ELWI(Extravascular lung-water index), global-end-diastolic index and impaired diastolic function, as indicated by pre-T Doppler early wave velocities (E/Em); Fifty-six percent of participants presented ELWI≥7mL/kg when fulfilling predetermined criteria for weaning. ELWI, impaired pulmonary permeability and left ventricular diastolic dysfunction were independent determinants of ELWI.

Conclusions

ELWI before SBT and impaired diastolic function (as indicated by pre-T E/Em) might be weaning outcome determinants and their assessment may allow better risk stratification in weaning decision making.
Retrospective Study of the Use of Heparins in Pregnant Women and in vitro Testing on the HCT 116 Colorectal Carcinoma Cell Line
Authors: Fiat Felicia , Arnautu Diana-Aurora , Bernad Brenda Cristina , Anton Alina , Marcovici Iasmina , Semenescu Alexandra-Denisa , Bernad Elena Silvia
Published: June 2024

Introduction

Pregnant women manifest an increased risk of developing coagulation disorders. Unfractionated heparin (HEP) and low-molecular-weight heparin (LMWHep) are considered as selective medication in the case of pregnancy which needs anticoagulant treatment. In addition to anticoagulant properties, HEP and its derivatives manifest other properties including anti-cancer potential. According to Globocan’s latest data, colorectal cancer (CRC) is the second most encountered form of malignancy in the case of women, manifesting some special particularities, as confusion of symptoms from cancer with symptoms encountered normally in pregnant women (such as constipation or rectal bleeding), delayed diagnosis because of limitations imposed both for the fetus and for the mother, and the need for special treatment.

Aim

The aim of the present work is to follow the incidence and safety of consumption of HEP and LMWHep in the case of pregnant women and to analyze their potential on the HCT 116 colorectal carcinoma cells.

Results

Analyzing the consumption of heparins in case of pregnant women hospitalized from 01.01.2022 to 31.12.2022 at the Pius Brînzeu” Emergency Clinical Hospital from Timisoara, Obstetrics and Gynecology Clinic I, it was observed that 44,6% of the patients were administered the following medication and no administration risks were observed. When tested on HCT 116 cells, heparins manifested a significant anti-migratory effect (with wound healing rates of 2,6%, when tested with HEP 100 UI concentration and 14.52% wound healing rates in case of fraxiparine 100 UI). In addition, different signs of apoptosis were observed, suggesting the pro-apoptotic potential of the tested substances.

Conclusions

Heparins remain the preferred medication to be administered to pregnant women with the potential for coagulation disorders, showing a high safety profile. Testing on the cancerous line of colorectal carcinoma highlights important properties that stimulate future studies, to establish the anti-tumor potential and the exact mechanism of action.
Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS)
Authors: Cucerea Manuela , Simon Marta , Stoicescu Silvia Maria , Blaga Ligia Daniela , Galiș Radu , Stamatin Maria , Olariu Gabriela , Ognean Maria Livia
Published: June 2024

Introduction

This study is part of a European survey on delivery room practices endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Romanian Association of Neonatology (ANR). The aim of our study was to evaluate the current neonatal resuscitation practices in Romanian maternity hospitals and to compare the results between level III and level II centers.

Material and Methods

The questionnaire was distributed through ANR by email link to heads of neonatal departments of 53 Romanian maternity hospitals with more than one thousand of births per year between October 2019 and September 2020, having 2018 as the reference year for data collection.

Results

The overall response rate to the questionnaire was 62.26% (33/53), 83.33% (15/18) for level-III centers and 51.43% (18/35) for level-II centers. Of the responding centers, 18 (54,54%) were academic hospitals, 15 (83,33%) were level III and 3 (16,67%) level II hospitals. In 2018, responding centers reported 81.139 births representing 42.66% of all Romanian births (190.170). There were significant differences between level-III and level-II maternity hospitals regarding the number of births in 2018 (3028.73±1258.38 vs 1983.78±769.99; P=0.006), lowest GA of routinely assisted infants in delivery room (25.07±3.03 weeks vs 30.44±3.28, P<0.001), inborn infants with BW<1500 admitted to neonatal intensive care unit (NICU) in 2018 (66.86±39.14 g vs 22.87±31.50 g; P=0.002), and antenatal counseling of parents before the delivery of a very preterm infant or an infant with expected problems (60% vs 22.2%; P=0.027). There were no significant differences of thermal and umbilical cord management, positive pressure delivery, heart rate assessment between responding centers.

Conclusion

The adherence to new guidelines was high among responding centers regarding thermal and umbilical cord management, initial FiO2, but aspects like antenatal counseling, EKG monitoring, laryngeal mask, and heated/humidified gases availability and administration, and simulation-based training require further implementation.
User’s Search for Information: A Multi-Language Cross-Sectional Assessment of Websites about Healthcare-Associated Infections
Authors: Nădășan Valentin , Kasza Dalma , Kiss Konrád-Ottó , Maior David , Mărușteri Marius
Published: June 2024

Introduction

Healthcare-associated infections have a significant impact on public health, and many patients and their next-of-kin are seeking information on the internet. The study aimed to assess the quality of online written content about healthcare-associated infections available in English, Romanian, and Hungarian languages.

Materials and methods

The study sample included 75 websites, 25 for each language subgroup. The assessment involved examining the general characteristics, adherence to established credibility criteria, and the completeness and accuracy of informational content. The evaluation was conducted using a topic-specific, evidence-based benchmark. Two evaluators independently graded completeness and accuracy; scores were recorded on a scale from 0 to 10. A comparative analysis of websites was performed, considering pertinent characteristics, and potential factors influencing information quality were subjected to testing. The statistical significance was set at 0.05.

Results

For the overall study sample, the average credibility, completeness, and accuracy scores were 5.1 (SD 1.7), 2.4 (SD 1.5), and 5.9 (SD 1.0), respectively. Pairwise comparison tests revealed that English websites rated significantly higher than Romanian and Hungarian websites on all three quality measures (P<0.05). Website specialization, ownership, and main goal were not associated with credibility or content ratings. However, conventional medicine websites consistently scored higher than alternative medicine and other websites across all three information quality measures (P<0.05). Credibility scores were positively but weakly correlated with completeness (rho=0.273; P=0.0176) and accuracy scores (rho=0.365; P=0.0016).

Conclusions

The overall quality ratings of information about healthcare-associated infections on English, Romanian, and Hungarian websites ranged from intermediate to low. The description of information regarding the symptoms and prevention of healthcare-associated infections was notably unsatisfactory. The study identified website characteristics possibly associated with higher-quality online sources about healthcare-associated infections, but additional research is needed to establish robust evidence.
Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia
Authors: Anand Abhijeet , Kodamanchili Sai Teja , Joshi Ankur , Joshi Rajnish , Sharma Jai Prakash , Abhishek Goyal , Pakhare Abhijit P , Niwariya Yogesh , Panda Rajesh , Karna Sunaina T , Khurana Alkesh K , Saigal Saurabh
Published: June 2024

Introduction

NIV (Non-invasive ventilation) and HFNC (High Flow nasal cannula) are being used in patients with acute respiratory failure. HACOR score has been exclusively calculated for patients on NIV, on other hand ROX index is being used for patients on HFNC. This is first study where ROX index has been used in patients on NIV to predict failure.

Aim of the study

This study investigates the comparative diagnostic performance of HACOR score and ROX index to predict NIV failure.

Methods

We performed a retrospective cohort study of non-invasively ventilated COVID-19 patients admitted between 1st April 2020 to 15th June 2021 to ICU of a tertiary care teaching hospital located in Central India. We assessed factors responsible for NIV failure, and whether these scores HACOR/ROX index have discriminative capacity to predict risk of invasive mechanical ventilation.

Results

Of the 441 patients included in the current study, 179 (40.5%) recovered, while remaining 262 (59.4%) had NIV failure. On multivariable analysis, ROX index > 4.47 was found protective for NIV-failure (OR 0.15 (95% CI 0.03–0.23; p<0.001). Age > 60 years and SOFA score were other significant independent predictors of NIV-failure. The AUC for prediction of failure rises from 0.84 to 0.94 from day 1 to day 3 for ROX index and from 0.79 to 0.92 for HACOR score in the same period, hence ROX score was non-inferior to HACOR score in current study. DeLong's test for two correlated ROC curves had insignificant difference expect day-1 (D1: 0.03 to 0.08; p=3.191e-05, D2: −0.002 to 0.02; p = 0.2671, D3: −0.003 to 0.04; p= 0.1065).

Conclusion

ROX score of 4.47 at day-3 consists of good discriminatory capacity to predict NIV failure. Considering its non-inferiority to HACOR score, the ROX score can be used in patients with acute respiratory failure who are on NIV.
Weekend Effect and Mortality Outcomes in Aortic Dissection: A Prospective Analysis
Authors: Banceu Cosmin Marian , Harpa Marius , Brinzaniuc Klara , Neagu Nicolae , Szabo Dan Alexandru , Banceu Diana Mariana , Al Hussein Hussam , Cristutiu Daiana , Puscas Alexandra , Stan Alexandru , Oprean Marvin , Popentiu Adrian , Halic Marius Neamtu , Suciu Horatiu
Published: June 2024

Background

Aortic dissection (AD) is a critical heart condition with potentially severe outcomes. Our study aimed to investigate the existence of a “weekend effect” in AD by examining the correlation between patient outcomes and whether their treatment occurred on weekdays versus weekends.

Methods

Specifically, we prospectively analysed the effect of weekday and weekend treatment on acute AD patient outcomes, both before surgical intervention and during hospitalization, for 124 patients treated from 2019–2021, as well as during 6 months of follow-up.

Results

The mean age of the study population was 62.5 years, and patient age exhibited a high degree of variability. We recorded a mortality rate before surgery of 8.65% for the weekend group and 15% for the weekday group, but this difference was not statistically significant. During hospitalization, mortality was 50% in the weekend group and 25% in the weekday group, but this difference was not statistically significant. Discharge mortality was 9.61% in the weekend group and 5% in the weekday group.

Conclusions

Our findings suggest that there was no significant difference in mortality rates between patients admitted to the hospital on weekends versus weekdays. Therefore, the period of the week when a patient presents to the hospital with AD appears not to affect their mortality.
Ventilator-Associated Events Cost in ICU Patients Receiving Mechanical Ventilation: A Multi-State Model
Authors: Kafazi Alkmena , Apostolopoulou Eleni , Benetou Vasiliki , Kourlaba Georgia , Stylianou Christos , Pavlopoulou Ioanna D
Published: June 2024

Introduction

Cost analysis is complicated by the fact that patients acquire infections during their hospital stay, having already spent time at risk without having an infection. Multi-state models (MSM) accounts for this time at risk treating infections as time-dependent exposures from ICU admission.

Aim of the study

To estimate ventilator-associated events (VAEs) direct additional cost in ICU patients.

Material and Methods

This was a prospective, observational study carried out for a two-year period in four medical-surgical ICUs of Athens, Greece. The sample consisted of adult patients who received mechanical ventilation for ≥4 days and were followed until discharge from the ICU or until death. CDC standard definitions were used to diagnose VAEs. To estimate VAEs additional length of stay (LOS), we used a four-state model that accounted for the time of VAEs. The direct hospital cost was calculated, consisting of the fixed and variable cost. The direct additional cost per VAEs episode was calculated by multiplying VAEs extra LOS by cost per day of ICU hospitalization.

Results

In the final analysis were included 378 patients with 9,369 patient-days. The majority of patients were male (58.7%) with a median age of 60 years. Of 378 patients 143 (37.8%) developed 143 episodes of VAEs. VAEs crude additional LOS was 17 days, while VAE mean additional LOS after applying MSM was 6.55±1.78 days. The direct cost per day of ICU hospitalization was € 492.80. The direct additional cost per VAEs episode was € 3,227.84, € 885.56 the fixed and € 2,342.28 the variable cost. Antibiotic cost was € 1,570.95 per VAEs episode. The total direct additional cost for the two-year period was € 461,581.12.

Conclusions

These results confirm the importance of estimating VAEs real cost using micro-costing for analytical cost allocation, and MSM to avoid additional LOS and cost overestimation.
Extracorporeal Membrane Oxygenation as Circulatory Support in Adult Patients with Septic Shock: A Systematic Review
Authors: Khan Muhammad Faisal , Nazir Mohsin , Khan Muhammad Khuzzaim , Rajendram Raj Kumar , Shamim Faisal
Published: June 2024

Introduction

The utilization of extracorporeal membrane oxygenation (ECMO) in adult patients experiencing septic shock is a subject of ongoing debate within the medical community. This study aims to comprehensively address this issue through a systematic review conducted in accordance with the PRISMA guidelines.

Aim of Study

The primary objective of this study is to assess the outcomes of ECMO utilization in adult patients diagnosed with septic shock, thereby providing insights into the potential benefits and uncertainties associated with this treatment modality.

Materials and Methods

Our research encompassed a thorough search across electronic databases for relevant English-language articles published up until April 2023. The inclusion criteria were based on studies reporting on ECMO usage in adult patients with septic shock. Among the eligible studies meeting these criteria, a total of eleven were included in our analysis, involving a cohort of 512 patients. The mean age of the participants was 53.4 years, with 67.38% being male.

Results

In the pooled analysis, the mean survival rate following ECMO treatment was found to vary significantly across different ECMO modalities. Patients receiving venovenous-ECMO (VV-ECMO) and veno-venous-arterial ECMO (VVA-ECMO) demonstrated higher survival rates (44.5% and 44.4%, respectively) compared to those receiving venoarterial-ECMO (VA-ECMO) at 25% (p<0.05). A chi-square test of independence indicated that the type of ECMO was a significant predictor of survival (χ2(2) = 6.63, p=0.036). Additionally, patients with septic shock stemming from respiratory failure demonstrated survival rates ranging from 39% to 70%. Predictors of mortality were identified as older age and the necessity for cardiopulmonary resuscitation (CPR).

Conclusions

In septic shock patients, ECMO outcomes align with established indications like respiratory and cardiogenic shock. VV-ECMO and VVA-ECMO suggest better prognoses, though the optimal mode remains uncertain. Patient selection should weigh age and CPR need. Further research is vital to determine ECMO's best approach for this population.