The Effect of introducing a nurse guided enhanced recovery after surgery program on patients undergoing hepatectomy

Background: enhanced recovery after surgery (ERAS) could shorten hospital stay and decrease postoperative complications for patients undergoing colorectal surgery. Whether  ERAS have  the  same   effect   in   patients undergoing hepatectomy is not clear, researches led by nurse are especially   rare.   The   study   aimed   at investigating the safety, feasibility and efficiency of nurse  guided  ERAS program on patients undergoing hepatectomyMethod: patients undergoing liver  resection treated  with nurse guided ERAS program were taken for ERAS group. ERAS program included: perioperative  respiratory  function training, perioperative diet guidance, early postoperative activity and  postoperative  pain  management. Primary outcome measures we postoperative length of stay and postoperative complications. Secondary outcome measures were the first time to flatus and defecation, NRS on first and second postoperative day (POD), mortality and readmission rate.Result: The study included totally 100 patients, the patients in each group were 50.The length of stay of patients in ERAS group was shorter than control group (5 days vs 7 days, P=0.001). The overall complications rate and general complications rate of patients in ERAS group were obviously lower than control group (12% vs 30%, P=0.027; 8% vs 24%, P=0.029). The first time to flatus and defecation of ERAS group were both earlier than control group (3 days vs 4 days, P=0.000; 5 days vs 6 days, P=0.010). The NRS score on POD 1 and POD 2 of the ERAS groups were both lower than control group (6 vs 4, P=0.006; 5 vs 3, P=0.000). The surgery-related complications rate of two groups had no significant difference. There were no perioperative mortality or readmission of two groups in the study (0, P=1.000).Conclusion: The application of nurse guided ERAS program safe, effective and feasible for patients undergoing liver resection. It shortened postoperative length of stay  and decreased postoperative complication. At the same time, it reduced postoperative pain and improved patient comfort. 

Experimental demonstration of broadband Lorentz non-reciprocity in an integrable photonic architecture based on Mach-Zehnder modulators

We demonstrate the first active optical isolator and circulator implemented in a linear and reciprocal material platform using commercial Mach-Zehnder modulators. In a proof-of-principle experiment based on single-mode polarization-maintaining fibers, we achieve more than 12.5 dB isolation over an unprecedented 8.7 THz bandwidth at telecommunication wavelengths, with only 9.1 dB total insertion loss. Our architecture provides a practical answer to the challenge of non-reciprocal light routing in photonic integrated circuits.Comment: include Appendix, 9 figures and 2 table

Pyruvate Kinase Inhibits Proliferation during Postnatal Cerebellar Neurogenesis and Suppresses Medulloblastoma Formation

Aerobic glycolysis supports proliferation through unresolved mechanisms. We have previously shown that aerobic glycolysis is required for the regulated proliferation of cerebellar granule neuron progenitors (CGNP) and for the growth of CGNP-derived medulloblastoma. Blocking the initiation of glycolysis via deletion of hexokinase-2 (Hk2) disrupts CGNP proliferation and restricts medulloblastoma growth. Here, we assessed whether disrupting pyruvate kinase-M (Pkm), an enzyme that acts in the terminal steps of glycolysis, would alter CGNP metabolism, proliferation, and tumorigenesis. We observed a dichotomous pattern of PKM expression, in which postmitotic neurons throughout the brain expressed the constitutively active PKM1 isoform, while neural progenitors and medulloblastomas exclusively expressed the less active PKM2. Isoform-specific Pkm2 deletion in CGNPs blocked all Pkm expression. Pkm2-deleted CGNPs showed reduced lactate production and increased SHH-driven proliferation.13C-flux analysis showed that Pkm2 deletion reduced the flow of glucose carbons into lactate and glutamate without markedly increasing glucose-to-ribose flux. Pkm2 deletion accelerated tumor formation in medulloblastoma- prone ND2:SmoA1 mice, indicating the disrupting PKM releases CGNPs from a tumor-suppressive effect. These findings show that distal and proximal disruptions of glycolysis have opposite effects on proliferation, and that efforts to block the oncogenic effect of aerobic glycolysis must target reactions upstream of PKM

A CMOS-compatible silicon photonic platform for high-speed integrated opto-electronics

We have developed a CMOS-compatible Silicon-on-Insulator photonic platform featuring active components such as p- i-n and photoconductive (MIM) Ge-on-Si detectors, p-i-n ring and Mach-Zehnder modulators, and traveling-wave modulators based on a p-n junction driven by an RF transmission line. We have characterized the yield and uniformity of the performance through automated cross-wafer testing, demonstrating that our process is reliable and scalable. The entire platform is capable of more than 40 GB/s data rate. Fabricated at the IME/A-STAR foundry in Singapore, it is available to the worldwide community through OpSIS, a successful multi-project wafer service based at the University of Delaware. After exposing the design, fabrication and performance of the most advanced platform components, we present our newest results obtained after the first public run. These include low loss passives (Y-junctions: 0.28 dB; waveguide crossings: 0.18 dB and cross-talk -41±2 dB; non-uniform grating couplers: 3.2±0.2 dB). All these components were tested across full 8” wafers and exhibited remarkable uniformity. The active devices were improved from the previous design kit to exhibit 3dB bandwidths ranging from 30 GHz (modulators) to 58 GHz (detectors). We also present new packaging services available to OpSIS users: vertical fiber coupling and edge coupling

Fault Recovery Strategy for Power–Communication Coupled Distribution Network Considering Uncertainty

In the face of multiple failures caused by extreme disasters, the power and communication sides of the distribution network are interdependent in the fault recovery process. To improve the post-disaster recovery efficiency of the distribution network, this paper proposes a coordinated optimization strategy for distribution network reconfiguration and repair, which integrates the power and communication aspects. First, the recovery process is divided into islanding–reconfiguration and dynamic emergency repair. The coupling relationship between power and communication is considered; that is, power failure may cause communication nodes to lose power, and communication failure may affect the effective operation of remote control devices. Based on this, the fault recovery process is optimized with the objective of maximizing load transfer and direct recovery while introducing a stochastic model predictive control method to handle the uncertainty of distributed power generation by rolling optimization of typical scenarios. Finally, the effectiveness of the proposed strategy is verified using an improved IEEE33-node distribution network system. The simulation results show that the proposed method can recover power to the maximum extent and reduce loss while ensuring the safe and stable operation of the distribution system

Examining Program Quality Disparities Between Urban And Rural Kindergartens In China: Evidence From Zhejiang

In recent years, the Chinese government has initiated a national plan to universalize quality kindergartens for all age-eligible Chinese children. Kindergarten is the main form of early childhood education and care (ECEC) service across China. However, the government faces two thorny issues on the journey toward realizing educational equity for some of the nations most vulnerable children. The first issue is the critical shortage of kindergarten programs. The second issue is a widening gap in quality between rural and urban kindergarten programs. Therefore, this study examines the quality of 91 kindergarten programs across different locations and funding sources in Zhejiang Province based on a stratified random selection method to gain insights into the aspects and magnitude of quality disparities in programs serving children from the richest and most powerful urban residents to the most disadvantaged village families. Program quality was rated utilizing eight subscales of the Chinese Early Childhood Programs Rating Scale, modified from Harms, Clifford, and Cryers (2005) Early Childhood Environment Rating Scale. Finally, recommendations for future studies and policy formation are provided to enhance and perhaps hasten the process of universalizing quality kindergartens in the increasingly market-based context of modern China

Modeling and Evaluation of SiC Inverters for EV Applications

In this paper, the efficiency benefits of adopting Silicon–Carbide devices for electric vehicle applications are studied. A hybrid time and frequency domain-based simulation tool is developed for the Silicon–Carbide (SiC) traction inverter modeling. The tool provides steady-state results with comparable accuracy to standard time domain methods and achieves a factor of thousand reductions in time when simulating a large number of operating points. Especially, the impact of temperature-dependent device losses has been considered to ensure the simulation precision. Next, a vehicle-level modeling is developed to evaluate the impact of the inverter efficiency on the endurance mileage increase of vehicles. It is found that, by applying Silicon–Carbide devices, the energy consumption of the inverter can be greatly reduced by 3/4 under WLTC (World light light-duty vehicle test cycle) profile. It can be transformed into a mileage endurance increase of 3–5%. The impact of the drive cycle profile and the vehicle’s drag coefficient on the endurance mileage are evaluated as well. In addition, an economic/cost model is developed for selecting the “optimal” chip paralleling number for Silicon–Carbide power modules. Interestingly, the results indicate that this number should be slightly overdesigned to achieve the most cost saving from the system point of view

A facile method to synthesize boron-doped Ni/Fe alloy nano-chains as electrocatalyst for water oxidation

We report a novel magnetic field assisted chemical reduction method for the synthesis of boron-doped Ni/Fe nano-chains as promising catalysts for the oxygen evolution reaction (OER). The boron-doped Ni/Fe nano-chains were synthesised in a one step process at room temperature using NaBH as a reducing agent. The addition of boron reduced the magnetic moment of the intermediate synthesis products and produced nano-chains with a high specific surface area of 73.4\ua0m\ua0g. The boron-doped Ni/Fe nano-chains exhibited catalytic performance superior to state-of-the-art BaSrCoFeO perovskite and RuO noble metal oxide catalysts. The mass normalized activity of the boron-doped Ni/Fe nano-chains measured at an overpotential of 0.35\ua0V was 64.0\ua0A\ua0g, with a Tafel slope of only 40\ua0mV\ua0dec. The excellent performance of the boron-doped Ni/Fe nano-chains can be attributed to the uniform elemental distribution and highly amorphous structure of the B-doped nano-chains. These results provide new insights into the effect of doping transition-metal based OER catalysts with non-metallic elements. The study demonstrates a facile approach to prepare transition metal nano-chains using magnetic field assisted chemical reduction method as cheap and highly active catalysts for electrochemical water oxidation