During previous pandemic outbreaks, medical staff have reported high levels of psychological distress. The aim of the current study was to report a snapshot of the psychological impact of the ...coronavirus disease 2019 (COVID-19) pandemic and its correlated factors on medical staff in Guangdong, China.
On the 2nd and 3rd February 2020, soon after the start of the COVID-19 pandemic, we surveyed medical staff at four hospitals in Guangdong, China, to collect demographic characteristics, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-14), and Insomnia Severity Index (ISI) scores.
Complete responses were received from 1045 medical staff. Respondents were divided into high- and low-risk groups according to their working environment of contacting with potential or confirmed COVID-19 cases. The proportion of staff with anxiety (55.4% v. 43.0%, p < 0.001) or depression (43.6% v. 36.8%, p = 0.028) was significantly higher in the high-risk group than the low-risk group. The percentage of staff with severe anxiety was similar in the two groups. Doctors were more susceptible to moderate-to-severe depressive symptoms. The high-risk group had higher levels of clinical insomnia (13.5% v. 8.5%, p = 0.011) and were more likely to be in the upper quartile for stress symptoms (24.7% v. 19.3%, p = 0.037) than the low-risk group. Additionally, work experience negatively correlated with insomnia symptoms.
It is important for hospitals and authorities to protect both the physical and psychological health of medical staff during times of pandemic, even those with a low exposure risk.
The 2020 global sulphur cap has been implemented to reduce the sulphur emission of the maritime transportation industry. It is a huge challenge for the ship owners to select a proper strategy to ...comply with the regulation. This study analyzes the economic costs of measures to comply with the sulphur cap including switching to low sulphur fuel oil (LSFO) and scrubbers. Meanwhile, considering the influence of the speed optimization on the voyage cost, an economic cost model of the LSFO method is combined with speed differentiation inside and outside the Sulphur Emission Control Area (SECA). The route from Shanghai to Los Angeles is set as a case study. The optimal speeds inside and outside the SECA are calibrated. Then, the economic costs of both methods are calculated and compared. The results show that the speed differentiation strategy can reduce the economic cost of the LSFO method and thus reduce its cost disadvantage over scrubbers. In addition, a low discount rate would benefit the scrubber option based on sensitivity analysis.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction The speckle tracking ultrasound is an innovative technology enabling distinct assessment of diaphragmatic movement, yet the relative data are scarce. In this pilot study, we sought to ...evaluate the predictive value of the weaning outcome of automatic speckle tracking in assessing diaphragm excursion. Methods This is a prospective, multicenter, observational study. A total of 160 critically ill subjects underwent speckle-tracking ultrasonography of the right/left hemidiaphragm before the spontaneous breathing trial. Meanwhile, the diaphragm excursion and velocity values were measured manually by M-mode ultrasound. Patients were divided into weaning-failure and weaning-success groups. The correlation was assessed between automatic and manual measurement, and the diagnostic efficacy of automatic measured excursion and velocity for predicting weaning outcome was analyzed. Results A total of 88 patients completed the follow-up of the weaning outcome. The overall incidence of weaning failure was 43.18%. There was a significant correlation between the automatic measurement of mean excursion and velocity assessed by speckle tracking imaging and manual measurement (R 0.69 and 0.65, respectively). Receiver operating characteristic (ROC) curve analysis showed that the mean excursion and diaphragmatic velocity exhibited high diagnostic values for prolonged weaning area under the ROC curve (AUROC) 0.824 and 0.786, respectively. The diaphragmatic excursion showed moderate diagnostic value for predicting both weaning failure and in-hospital death/withdrawal of treatment (AUROC 0.659 and 0.653, respectively). Conclusion Automatic speckle tracking analysis of the diaphragm showed high consistency with conventional manual ultrasound measures. Diaphragmatic excursion and its excursion velocity helped predict mechanical ventilation weaning failure, prolonged weaning, as well as in-hospital adverse outcomes, which served as a reliable tool in guiding clinical weaning strategy. Key message Automatic speckle tracking analysis of the diaphragm showed high consistency with conventional manual ultrasound measures. Diaphragmatic excursion and its excursion velocity helped predict mechanical ventilation weaning failure, prolonged weaning, as well as in-hospital adverse outcomes. Keywords: Speckle tracking ultrasound, Diaphragmatic excursion, Weaning
China’s carbon peaking and carbon neutrality targets have created huge challenges for all the economic sectors in China, including the shipping industry. Various emission reduction measures, such as ...Waste Heat Recovery Systems (WHRSs), Drag Reduction Coatings (DRCs), and Slow Steaming (SS), are the main options for container ship companies to select in advance. This paper aims to find the optimal combination of measures for container ship companies to reach the carbon reduction targets, which are mainly set according to the carbon reduction requirements of the International Maritime Organization (IMO). A 0–1 integer programming model is proposed under the Maritime Emissions Trading Scheme (METS) to help container ship companies select the optimal combination of measures in the context of carbon peaking and carbon neutrality. Our results show that combination 6 (using a WHRS alone and a 5.0% reduction in the original speed) is the most suitable solution with the selected values of parameters. Sensitivity analyses of the parameters are performed, such as bunker price, the auction and purchase prices of carbon and incentive levels. From the sensitivity analysis, it is found that using a WHRS is the optimal combination of abatement measures within the fluctuation range of the parameters. At the same time, according to the results, container ship companies could choose the most appropriate and profitable strategy in the dual-carbon context. Therefore, container ship companies and policymakers have access to relevant carbon reduction suggestions to encourage the implementation of carbon reduction initiatives.
Following the updated global sulphur emission cap from 1 January 2020, shipowners are facing an increasing cost burden to comply with the new regulation in a tough shipping market. This research ...compares the lifespan costs of three main alternatives, all of which can satisfy the 2020 global sulphur emission regulation. A lifespan cost analysis model is built considering several cost items across the three alternatives, including the initial cost of investment, maintenance cost and fuel consumption cost. Two vessels with a capacity of 5000 and 10,000 TEUs are selected as case study vessels. The @risk software is utilized to conduct an uncertainty analysis with respect to the fuel price and the discount rate to test the three alternatives in different circumstances. The results indicate that the larger the vessel, the lower the discount rate, and the greater the price of Mixed Fuel Oil (a mixture of Very Low Sulphur Oil and Marine Gas Oil), the more attractive the scrubber option. Quantitatively, if the refining technology of low-sulphur fuel improves in the future and the price differential between Mixed Fuel Oil and Heavy Sulphur Fuel Oil decreases to $29 per ton for the 5000 TEU vessel or $27 per ton for the 10,000 TEU vessel, the fuel-switch alternative will be as competitive as the use of a scrubber in terms of the lifespan cost. Additionally, as the discount rate increases, the cost gap between the use of a scrubber and the other two alternatives gradually decreases.
Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and ...explored the relationship between risk for malnutrition at admission and in-hospital mortality. A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. The risk for malnutrition was assessed using the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission. Two hundred ninety-five patients were enrolled, including 66 severe patients and 41 critically ill patients. Twenty-five deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI, as well as higher CONUT scores, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality. Despite variant screening tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Xinkeshu tablets could be effective therapeutic drugs for CAD patients with depress/anxiety by increasing the level of NT-3 in plasma and decreasing the inflammation response.
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•A ...large proportion of CAD patients suffer from depression or anxiety symptoms which is associated with increased mortality.•This double-blinded, randomized placebo-controlled trial found that Xinkeshu tablets can reduce anxiety or depressive symptoms in CAD patients.•Xinkeshu tablets can improve anxiety/depressive symptoms in CAD patients by adjusting Trappin-2, NT-3, Transferrin and ALCAM.
A large proportion of patients with coronary artery disease (CAD) suffer from depression or anxiety symptoms and this is associated with increased mortality 1. This double-blinded, randomized, placebo-controlled, clinical trial (ChiCTR-IPR-17010940) aimed to explore whether Xinkeshu tablets can reduce anxiety or depressive symptoms in CAD patients and how this is related to the concentration of plasma cytokines. Sixty patients with CAD anda Hospital Anxiety and Depression Scale (HADS-a/HADS-d) score of ≥8 were treated with Xinkeshu tablets or placebo for 12 weeks following percutaneous revascularization. Depressive/anxiety symptoms and the levels of 440 peripheral blood cytokines were evaluated at baseline and after 12 weeks treatment. Results showed significantly lower (P < 0.05) HADS-a/HADS-d and PHQ-9 scores in CAD patients treated with Xinkeshu tablets than in those who received placebo. These improvements were associated with changes in certain peripheral blood cytokines; most notably trappin-2, adiponectin, interleukin 1β (IL-1β), thrombopoietin, activated leukocyte cell adhesion molecule (ALCAM), neurotrophin-3 (NT-3), and transferrin. A significant correlation between anxiety/depression symptoms and trappin-2, NT-3, transferrin, and ALCAM (p < 0.05) were observed in an independent cohort of patients with CAD. These findings were in-keeping with the anti-depressive effects of Xinkeshu tablets. This trial demonstrates that Xinkeshu tablets can improve anxiety and depression symtoms effectively address in patients with coronary heart disease possibly through increasing the blood ratio of anti-inflammatory:pro-inflammatory cytokines.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
There are two weaknesses in current researches into human casualty of ship collision. One is that the range of injuries or fatalities is restricted to the maximum number of casualties in a particular ...sample, which may not cover all the possible numbers of casualties in the future. International Maritime Organization (IMO) employed the injured or dead percentage of all the persons on board to represent casualties, but it only provided several discrete values to quantify human losses in different scenarios. The other is that the assumption that the distributions of the injuries or fatalities follow certain distribution, such as negative binomial and Poisson distributions is left to be statistically tested. Firstly, this study considers casualty rate, including injury and fatality rates, as random variables; the interval of the variables are from 0 to 1. Then, the distributions of the variables are investigated using historical data. From historical data, we can find that there are many zeros. Zero-inflated mode
To observe if blood return, also defined as the blood infusion test (BIT) could predict fluid responsiveness in critically ill patients with acute circulatory failure and renal replacement therapy ...(RRT).
This was a single-center, prospective, diagnostic accuracy study. Before BIT, the passive leg raise test (PLRT) was performed to record the change of cardiac output (ΔCO) by pulse contour analysis, and ΔCO > = 10% was defined as the fluid responder. Meanwhile, the change in velocity time integral (ΔVTI) was recorded by ultrasound. Later, the ΔCO and ΔVTI during BIT were recorded 5-10 min after PLRT. The receiver-operating characteristic curves of ΔCO and ΔVTI of BIT were performed in predicting the fluid responder defined by PLRT.
A total of 43 patients with acute circulatory failure undergoing RRT were enrolled in the present study, and 25 patients (58.1%) were recognized as responders during PLRT. According to the receiver-operating characteristic curves, the cutoff value of ΔCO was 10% and ΔVTI was 9% during BIT with the area under curve of 0.96 and 0.94, respectively.
BIT in RRT could identify fluid responsiveness in critically ill patients with shock.
ChiCTR-DDD-17010534. Registered on 30/01/2017 (retrospective registration).
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Given the in-depth advancement of the “Belt and Road” initiative, cooperation among countries along the initiative is increasing. The strategic maritime transport passage is closely related to the ...interests of relevant countries. The games between countries along important transport passages in terms of the pursuit of geopolitical rights and interests occur frequently. This paper establishes an evolutionary game model of the strategic maritime transport passages taking the Strait of Hormuz as an example and explores the game of the countries on both sides of the strait. By analysing their behaviour and possible strategies, the evolutionary stable strategy for each country is obtained. Recommendations are made to aid with the relevant rights and interests of related countries.
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