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

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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The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country:A pilot study

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Chinese Journal of Traumatology 2024年第2期27卷 77-82页

作者： Dooshanveer C.Nuckchady department of Internal Medicine Victoria HospitalCandosMauritius

Purpose:To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country,and to validate a new scoring system to predict bacterial ***:This was a retrospective,single-center study among patients who were admitted via the emergency department of a public *** patients who were started on antibiotics were included in the study,while patients aged0.85;however,these scoring systems failed to predict whether patients were truly *** INFECTIONS(short for impaired mental status,not conscious,fast heart rate,elevated creatinine,high temperature,on inotrope,low oxygen,high neutrophils and high sugar)model reached an AUROC of 0.88 to more accurately predict the infectious state of a ***:Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency *** INFECTIONS score may help recognize patients with bacterial infections,but it should be further validated in multiple countries prior to widely use.

关键词： Prognosis Mortality Bacterial infection INFECTIONS scoring system Sequential organ failure assessment Prediction

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

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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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Quantification of grain boundary effects on the geometrically necessary dislocation density evolution and strain hardening of polycrystalline Mg-4Al using in situ tensile testing in scanning electron microscope and HR-EBSD

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Journal of Magnesium and Alloys 2024年第5期12卷 1815-1829页

作者： Eunji Song Mohsen Taheri Andani Amit Misra department of Materials Science and Engineering University of Michigan department of Mechanical Engineering University of Michigan

In situ tensile testing in a scanning electron microscope(SEM) in conjunction with high-resolution electron backscatter diffraction(HR-EBSD) under load was used to characterize the evolution of geometrically necessary dislocation(GND) densities at individual grain boundaries as a function of applied strain in a polycrystalline Mg-4Al alloy. The increase in GND density was investigated at plastic strains of 0 %,0.6 %, 2.2 %, 3.3 % from the area including 76 grains and correlated with(i) geometric compatibility between slip systems across grain boundaries, and(ii) plastic incompatibility. We develop expressions for the grain boundary GND density evolution as a function of plastic strain and plastic incompatibility, from which uniaxial tensile stress-strain response of polycrystalline Mg-4Al are computed and compared with experimental measurement. The findings in this study contribute to understanding the mechanisms governing the strain hardening response of single-phase polycrystalline alloys and more reliable prediction of mechanical behaviors in diverse microstructures.

关键词： Mg Al alloys Grain boundaries Geometrically necessary dislocations Strain gradient plasticity HR-EBSD

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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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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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Imaging mass spectrometry: a molecular microscope for studying the role of lipids in Parkinson's disease

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Neural Regeneration Research 2024年第6期19卷 1179-1180页

作者： Vinata Vedam-Mai Jacob M.Samuel Boone M.Prentice department of Neurology University of Florida department of Chemistry University of Florida

Parkinson’s disease–A lipidopathy? The histopathological hallmark of Parkinson’s disease(PD) and dementia with Lewy bodies are inclusions enriched in α-synuclein(α-syn), known as Lewy bodies, which are not only composed of proteins, but also a core of lipid species. PD has been thus far principally thought of as a “proteinopathy” caused by the misfolding of α-syn. However,

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Phytochemical analysis, antioxidant, acetylcholinesterase, and α-amylase inhibitors from Hippeastrum hybridum extract

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Journal of Traditional Chinese Medicine 2024年第3期44卷 496-504页

作者： Naila Sher Mushtaq Ahmed Nadia Mushtaq department of Biotechnology University of Science and Technology department of Botany University of Science and Technology

OBJECTIVE:To investigate the effects of Hippeastrum hybridum（HH） as a free radical scavenger,and an inhibitor of the two enzymes i-e Alpha-amylase（α-amylase） and acetylcholinesterase（AChE）.METHODS:In this study,HH plant was preliminary analyzed for phytochemical screening and then tested for its antioxidant,anti-α-amylase,and anti-AChE efficiency via standard ***:Phytochemical analysis shows the existence of different compounds;while Coumarins and quinones were *** total phenolic,flavonoid,and tannins content were found to be（78.52±0.69） mg GAE/g,（2.01±0.04） mg RUE/g,and（58.12±0.23） mg TAE/g of plant extract respectively.28.02%±0.02% alkaloid and 2.02%±0.05% saponins were present in the HH *** HH extract showed the anti-oxidant property with IC50（50%inhibition） of（151.01±0.13）(HH),（79.01±0.04）(Ascorbic acid) for ferric reducing,（91.48±0.13）(HH),（48.02±0.11）(Ascorbic acid) against Ammonium molybdenum,（156.02±0.31）(HH),（52.38±0.21）(Ascorbic acid) against DPPH,136.01±0.21（HH）,52.02±0.31（Ascorbic acid） against H2O2,and 154.12±0.03（HH）,（40.05±0.15）(Ascorbic acid)μg/mL against ABTS *** analysis indicated that HH caused a competitive type of inhibition of α-amylase(Vmaxremained constant and Km increases from 10.65 to84.37%) while Glucophage caused the un-competitive type of inhibition i-e both Km and Vmaxdecreased from40.49 to 69.15%and 38.86 to 69.61%*** Ki,（inhibition constant）;KI,（dissociation constant）,Km,（Michaelis-Menten constant）,and IC50 were found to be62,364,68.1,and 38.08±0.22 for HH and 12,101.05,195,34.01±0.21 for ***,HH causes an anon-competitive type of inhibition of AChE i-e Km remains constant while Vmaxdecreases from 60.5%to74.1%.The calculated Ki,KI,Km,and IC50 were found to be 32,36.2,0.05,and 18.117±***:From the current results,it is concluded that HH extract contains bioactive compounds,and could be a good alternative to controlling oxidants,Alzheimer‘s and T

关键词： Hippeastrum hybridum acetylcholinesterase alpha-amylase antioxidant phytochemicals

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Laser beam effect on the entanglement of elastic collisions in quantum plasma

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Communications in Theoretical Physics 2024年第08期76卷 149-157页

作者： Ramin Roozehdar Mogaddam Nasser Sepehri Javan Hosein Mohammadzadeh department of Physics Ferdowsi University of Mashhad department of Physics University of Mohaghegh Ardabili

In the quantized field formalism, using Kramers–Henneberger unitary transformation as the semi-classical counterpart of Block–Nordsieck transformation, the dynamics of entanglement during the low energy scattering processes in bi-partite systems at the presence of a laser beam fields are studied. The stationary-state Schrodinger equation for the quantum scattering process is obtained for such systems. Then, using partial wave analysis, we introduce a new form of entanglement fidelity considering the effect of high-intensity laser beam fields. The effective potential of hot quantum plasma including plasmon and quantum screening effects is used to obtain the entanglement fidelity ratio as a function of the laser amplitude, and plasmon and Debye length parameters for the elastic electron-ion collisions. It is shown that the plasma free electrons oscillations under interaction with laser beam fields improve the correlations between charged particles and consequently lead to the increase in the system entanglement.

关键词： elastic collision entanglement fidelity laser plasmon quantum plasma

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Predicting grain size-dependent superplastic properties in friction stir processed ZK30 magnesium alloy with machine learning methods

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Journal of Magnesium and Alloys 2024年第5期12卷 1931-1943页

作者： Farid Bahari-Sambran Fernando Carre?o C.M.Cepeda-Jiménez Alberto Orozco-Caballero Physical Metallurgy department CENIM-CSIC department of Mechanical Engineering Chemistry and Industrial Design Polytechnic University of Madrid

The aim of this work is to predict, for the first time, the high temperature flow stress dependency with the grain size and the underlaid deformation mechanism using two machine learning models, random forest（RF） and artificial neural network（ANN）. With that purpose, a ZK30 magnesium alloy was friction stir processed（FSP） using three different severe conditions to obtain fine grain microstructures（with average grain sizes between 2 and 3 μm） prone to extensive superplastic response. The three friction stir processed samples clearly deformed by grain boundary sliding（GBS） deformation mechanism at high temperatures. The maximum elongations to failure, well over 400% at high strain rate of 10-2s-1, were reached at 400 ℃ in the material with coarsest grain size of 2.8 μm, and at 300 ℃ for the finest grain size of 2 μm. Nevertheless, the superplastic response decreased at 350 ℃ and 400 ℃ due to thermal instabilities and grain coarsening, which makes it difficult to assess the operative deformation mechanism at such temperatures. This work highlights that the machine learning models considered, especially the ANN model with higher accuracy in predicting flow stress values, allow determining adequately the superplastic creep behavior including other possible grain size scenarios.

关键词： Machine learning Artificial intelligence Magnesium alloys Superplasticity Friction stir processing Grain coarsening

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