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Evaluation of hand infections in the emergency department using point-of-care ultrasound

World Journal of Emergency Medicine 2024年第4期15卷 283-288页

作者： David Ahmad Haidar David Mintz Brandon M Wubben Omar Rizvi Srikar Adhikari department of Emergency Medicine Michigan MedicineAnn Arbor 48109-1382USA University of Arizona College of Medicine Tucson 85724USA department of Emergency Medicine University of IowaIowa City 52242-1009USA department of Surgery University of Arizona College of MedicineTucson 85724USA department of Emergency Medicine University of Arizona College of MedicineTucson 85724USA

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient ***:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December *** trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the *** then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final ***:We included a total of 50 cases(28 male,22 female)in the final *** most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 ***:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

关键词： Ultrasound Point-of-care ultrasound Cellulitis Abscess Flexor tenosynovitis

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Emergency department management of acute agitation in the reproductive age female and pregnancy

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World Journal of Emergency Medicine 2024年第2期15卷 83-90页

作者： Ariella Gartenberg Kayla Levine Alexander Petrie department of Emergency Medicine Jacobi Medical Center and Montefiore Medical CenterNY 10461USA department of Psychiatry and Behavioral Sciences Albert Einstein College of Medicine and Montefiore Medical CenterNY 10461USA department of Emergency Medicine Jacobi Medical Center and North Central Bronx HospitalNY 10461USA

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and *** safety of psychotropic medications in the reproductive age female has not been well *** review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during ***:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant ***:While nonpharmacological management is preferred,ED visits for agitation often require medical *** should be selected based on the etiology of agitation and the clinical setting to avoid major adverse *** effects are common in pregnant *** mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse *** moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on *** has become the most frequently utilized psychotropic for agitation during *** generation psychotropics are often utilized as second-line therapy,including *** and ketamine have demonstrated adverse fetal ***:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in *** the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

关键词： Agitation Pregnancy Haloperidol Ketamine Benzodiazepines

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Phanerozoic co-evolution of O2-CO2 and ocean habitability

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National Science Review 2024年第6期11卷 18-21页

作者： Zunli Lu Rosalind E.M.Rickaby Jonathan L.Payne Ashley N.Prow department of Earth & Environmental Sciences Syracuse University department of Earth Sciences University of Oxford department of Earth and Planetary Sciences Stanford University

Atmospheric carbon dioxide and oxygen concentrations are partially linked via the geological cycle of organic carbon （Fig. 1A–C; e.g. CO2+H2O■CH2O+O2）. The history of these two biologically active components, controls on their concentrations, and implications for the complexity of the biosphere and habitability of Earth have been hotly debated, but are generally considered independently.

关键词： CO2-CONCENTRATING MECHANISM OXYGEN EVOLUTION ANOXIA

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Constrained reinforcement learning with statewise projection: a control barrier function approach

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Science China(Information Sciences) 2024年第3期67卷 136-154页

作者： Xinze JIN Kuo LI Qingshan JIA department of Automation Tsinghua University

Safety is a critical issue for reinforcement learning(RL), as it may be risky for some actual applications if the learning process involves unsafe exploration. Instead of formulating constraints as expectationbased in constrained RL, considering statewise safety in constrained RL is more meaningful. This work aims to address the issue of safe projection in RL by introducing a control barrier function that inherently learns a safe policy through a set certificate. We seek to analyze some theoretical properties of safe projection in the learning process, including convergence and performance bound, and extend the discussion into ensembles and guided controllers. Moreover, we approach analytical solutions for deterministic and stochastic system dynamics. Experimental results in different tasks show that the proposed method achieves better effects in terms of both performance and safety.

关键词： reinforcement learning safe projection control barrier function

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Quantitative assessment of the impact of a triage physician on the Accreditation Council for Graduate Medical Education resident milestones in the emergency department

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World Journal of Emergency Medicine 2024年第3期15卷 220-222页

作者： Julie Cueva Duncan Grossman Vishnu Muppala Arlene Chung Mahlaqa Butt Jefferson Drapkin Antonios Likourezos Errel Khordipour department of Emergency Medicine Maimonides Medical CenterNew York 11219USA

The “door-to-doctor” time for patients to be seen by a physician is an increasingly studied *** may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across *** put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further *** the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains *** implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

关键词： physician doctor treatment

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Hydrogen Spillover Effect in Electrocatalysis:Delving into the Mysteries of the Atomic Migration

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Energy & Environmental Materials 2024年第5期7卷 185-209页

作者： Ashish Gaur Jatin Sharma HyukSu Han department of Energy Science Sungkyunkwan University Institute of Nano Science and Technology department of Energy Sungkyunkwan University

Hydrogen spillover effect has recently garnered a lot of attention in the field of electrocatalytic hydrogen evolution reactions. A new avenue for understanding the dynamic behavior of atomic migration in which hydrogen atoms moving on a catalyst surface was opened up by the setup of the word"hydrogen spillover."However, there is currently a dearth of thorough knowledge regarding the hydrogen spillover effect. Currently, the advancement of sophisticated characterization procedures offers progressively useful information to enhance our grasp of the hydrogen spillover effect. The understanding of material fabrication for hydrogen spillover effect has erupted. Considering these factors, we made an effort to review most of the articles published on the hydrogen spillover effect and carefully analyzed the aspect of material fabrication. All of our attention has been directed toward the molecular pathway that leads to improve hydrogen evolution reactions performance. In addition, we have attempted to elucidate the spillover paths through the utilization of DFT calculations. Furthermore, we provide some preliminary research suggestions and highlight the opportunities and obstacles that are still to be confronted in this study area.

关键词： electrocatalysis hydrogen evolution reaction hydrogen spillover effect interfacial atomic migration metal–support interaction

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Displacement-pressure biparametrically regulated softness sensory system for intraocular pressure monitoring

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National Science Review 2024年第6期11卷 159-168页

作者： Yu Cheng Yifei Zhan Fangyi Guan Junli Shi Jingxiao Wang Yi Sun Muhammad Zubair Cunjiang Yu Chuan Fei Guo department of Materials Science and Engineering Southern University of Science and Technology department of Engineering Science and Mechanics Pennsylvania State University department of Biomedical Engineering Pennsylvania State University department of Materials Science and Engineering Materials Research Institute Pennsylvania State University

High intraocular pressure(IOP) is one of the high-risk pathogenic factors of glaucoma. Existing methods of IOP measurement are based on the direct interaction with the cornea. Commercial ophthalmic tonometers based on snapshot measurements are expensive, bulky, and their operation requires trained *** contact lenses are easy to use, but they may block vision and cause infection. Here, we report a sensory system for IOP assessment that uses a soft indentor with two asymmetrically deployed iontronic flexible pressure sensors to interact with the eyelid-eyeball in an eye-closed situation. Inspired by human fingertip assessment of softness, the sensory system extracts displacement-pressure information for soft evaluation, achieving high accuracy IOP monitoring(>96%). We further design and custom-make a portable and wearable ophthalmic tonometer based on the sensory system and demonstrate its high efficacy in IOP screening. This sensory system paves a way towards cost-effective, robust, and reliable IOP monitoring.

关键词： intraocular pressure tonometer deep learning softness iontronic sensor

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Artificial light at night(ALAN) pollution alters bat lunar chronobiology:insights from broad-scale long-term acoustic monitoring

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Ecological Processes 2024年第1期13卷 176-187页

作者： Han Li Pauline Allen Saige Boris Samantha Lagrama Jade Lyons Christina Mills Pauline Moussi Casey Nichols Carter Tacosik Mc Kenzie Tsaousis Nyzaya Livingston Wilson John F.Grider Kevin A.Parker Matina C.Kalcounis-Rueppell department of Biology University of Nebraska Omaha department of Biology University of North Carolina Greensboro Colorado Parks and Wild-life Parker Ecology LLC department of Biological Sciences University of Alberta

Background The timing of behavior and habitat use of nocturnal animals can be influenced by the lunar cycle in nature. The prevalence of artificial light at night(ALAN) has been recognized as a source of environmental pol-lution. The interaction between ALAN and the lunar cycle on bat behavior is important for understanding anthro-pogenic effects on bats. We utilized a decade(2012–2022) of acoustic monitoring data collected in North Carolina, United States, to investigate the relationship between bat activity, lunar cycle, and light pollution. We examined whether the amount of lunar illumination affected species-specific nightly activity and whether hourly bat activity patterns varied between nights with different moon phases. We further investigated if the relationship between bat activity and the lunar cycle might be altered by light *** We found that seven bat species showed activity variation across nights in relation to the amount of moon illumination when ALAN was absent. In general, bats were less active on full moon nights compared to new moon nights. Light pollution interacted with the bat–lunar relationship in five of the seven species, masking the effect of the lunar cycle. We identified delayed bat activity patterns on nights with a full or waxing moon in seven species, and light pollution altered that pattern in four species. Overall, ALAN was associated with decreased bat activity inde-pendent of lunar cycle *** Our study demonstrated that at a broad spatial scale, ALAN negatively affected many North American temperate bat species and altered their lunar chronobiology. As light pollution is spreading to historically dark areas and habitats, ALAN might couple with other threats, such as the white-nose syndrome or climate change, to cause cascading damage in the environment that depends on ecosystem services such as pest control provided by bats. We argue that further research and conservation actions are needed to mitigate

关键词： Artificial light at night ALAN Bats Chiroptera Chronobiology Light pollution Lunar cycle Moonlight

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Are hydrides under high-pressure-high-temperature superconductors?

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National Science Review 2024年第7期11卷 9-12页

作者： J.E.Hirsch department of Physics University of California

Contrary to the current consensus, I argue that the existing evidence for high-temperature superconductivity in hydrides under high pressure is not compelling. I suggest that the focus of the field should urgently shift to establish unequivocally experimentally whether or not superconductivity in pressurized hydrides exists, instead of continuing to search for new materials that might show elusive signals of unproven superconductivity at ever higher temperatures. The implications of a negative finding for the theoretical understanding of superconductivity are discussed.

关键词： Hydrides

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Stretchable fiber strain sensors for wearable biomonitoring

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National Science Review 2024年第7期11卷 70-71页

作者： Shumao Xu Xiao Xiao Jun Chen department of Bioengineering University of California

Wearable bioelectronics have gained significant attention since they may play a role in transforming current healthcare from a reactive and disease-centric model to a personalized one with a focus on disease preventio...

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