Establishment and Evaluation of a Simplified Evaluation System of Acute Respiratory Distress Syndrome

Purpose

In recent years, a variety of acute respiratory distress syndrome (ARDS) evaluation systems have been developed worldwide; however, they are not so convenient for the doctors clinically, we decided to establish and evaluate a simplified evaluation system of ARDS (SESARDS).

Materials and Methods

Data from 140 ARDS patients (derivation data set) were collected to screen for prognostic factors affecting outcomes in ARDS patients. By logistic regression analysis, scores were allocated to corresponding intervals of the variables, respectively, by means of analysis of the frequency distribution to establish a preliminary scoring system. Based on this primary scoring system, a definitive evaluation scheme was created through consultation with a panel of experts. The scores for the validation data set (92 cases) were assigned and calculated by their predictive mortality with the SESARDS and acute physiology and chronic health evaluation II (APACHE II). The performance of SESARDS was compared with that of APACHE II by means of statistical analysis.

Results

The factors of age, pH, Glasgow coma scale (GCS), oxygenation index (OI), and the lobes of lung were associated with prognosis of ARDS respectively. The sensitivity and specificity of SESARDS for the validation data set were 96.43% and 58.33%, respectively. On the AUC, no significant difference between APACHE II and SESARDS was detected. There were no significant differences between the prediction and the actuality obtained by SESARDS for the validation data set the SESARDS scores were positively correlated with the actual mortality.

Conclusion

SESARDS was shown to be simple, accurate and effective in predicting ARDS progression.     

Increased regional homogeneity modulated by metacognitive training predicts therapeutic efficacy in patients with schizophrenia

European Archives of Psychiatry and Clinical Neuroscience - Previous studies have demonstrated the efficacy of metacognitive training (MCT) in schizophrenia. However, the underlying mechanisms...     

The effect of surfactants on hydrate particle agglomeration in liquid hydrocarbon continuous systems: a molecular dynamics simulation study

Anti-agglomerants (AAs), both natural and commercial, are currently being considered for gas hydrate risk management of petroleum pipelines in offshore operations. However, the molecular mechanisms of the interaction between the AAs and gas hydrate surfaces and the prevention of hydrate agglomeration remain critical and complex questions that need to be addressed to advance this technology. Here, we use molecular dynamics (MD) simulations to investigate the effect of model surfactant molecules (polynuclear aromatic carboxylic acids) on the agglomeration behaviour of gas hydrate particles and disruption of the capillary liquid bridge between hydrate particles. The results show that the anti-agglomeration pathway can be divided into two processes: the spontaneous adsorption effect of surfactant molecules onto the hydrate surface and the weakening effect of the intensity of the liquid bridge between attracted hydrate particles. The MD simulation results also indicate that the anti-agglomeration effectiveness of surfactants is determined by the intrinsic nature of their molecular functional groups. Additionally, we find that surfactant molecules can affect hydrate growth, which decreases hydrate particle size and correspondingly lower the risk of hydrate agglomeration. This study provides molecular-level insights into the anti-agglomeration mechanism of surfactant molecules, which can aid in the ultimate application of natural or commercial AAs with optimal anti-agglomeration properties.

Schematic of anti-agglomeration effect of surfactants promoting gas hydrate particle dispersion.     

A qualitative study of caring in hospice wards in Shanghai

Despite the large number of people with cancer who need hospice care, utilization rates at community hospice service in Shanghai are low. This study aimed to review the care provided in these hospice wards and examine the difficulties in delivering service. Fourteen hospice care providers were interviewed, and the data analyzed using qualitative content analysis. Three themes emerged from the interviews: (i) characteristics of hospice patients, mostly cancer patients at the end‐of‐life stage (within 3‐months of life expectancy) who were admitted without awareness of their condition; (ii) components of care, from physicians and nurses who focused mainly on physical problems as psycho‐spiritual care stagnated at a superficial level; and (iii) difficulties in care, including a lack of patients as well as inadequacies in service, along with suggestions for the future. Efforts at improvement should be made in both the health care system and society. To address the lack of patients, doctors in secondary/tertiary care hospitals need improved skills in discussing end‐of‐life care, while the general public needs better awareness and acceptance of hospice care. Solutions should respect the perspective of patients and their families, while hospice care providers must also enhance their skills of communication and psycho‐spiritual care.     

Linear quadratic regulator control of multi‐agent systems

This paper considers a collection of agents performing a shared task making use of relative information communicated over an information network. The designed suboptimal controllers are state feedback and static output feedback, which are guaranteed to provide a certain level of performance in terms of a linear quadratic regulator (LQR) cost. Because of the convexity of the LQR performance region, the suboptimal LQR control problem with state feedback is reduced to the solution of two inequalities, with the minimum and maximum eigenvalues of the Laplacian matrix as the coefficients. The advantage of the method is that the LQR control problem of network multi‐agent systems can be converted into the LQR control of a set of single‐agent systems, and the structure constraint on the feedback gain matrix can be eliminated. It can be shown that the size of the LQR control problem will not increase according to the number of the node in the fairly general framework. The method can be extended to the synthesis of the static output feedback, which is derived from the weighting matrices in LQR. Through some coordinate transformation and the augmentation of the output matrix, the LQR synthesis is provided on the basis of the output measurements of the adjacent agents. Numerical examples are presented to illustrate the proposed method. Copyright © 2013 John Wiley & Sons, Ltd.