Evaluating the validity of the nursing statements algorithmically generated based on the International Classifications of Nursing Practice for respiratory nursing care using large language models.

OBJECTIVE: This study aims to facilitate the creation of quality standardized nursing statements in South Korea's hospitals using algorithmic generation based on the International Classifications of Nursing Practice (ICNP) and evaluation through Large Language Models. MATERIALS AND METHODS: We algorithmically generated 15 972 statements related to acute respiratory care using 117 concepts and concept composition models of ICNP. Human reviewers, Generative Pre-trained Transformers 4.0 (GPT-4.0), and Bio_Clinical Bidirectional Encoder Representations from Transformers (BERT) evaluated the generated statements for validity. The evaluation by GPT-4.0 and Bio_ClinicalBERT was conducted with and without contextual information and training. RESULTS: Of the generated statements, 2207 were deemed valid by expert reviewers. GPT-4.0 showed a zero-shot  AUC of 0.857, which aggravated with contextual information. Bio_ClinicalBERT, after training, significantly improved, reaching an AUC of 0.998. CONCLUSION: Bio_ClinicalBERT effectively validates auto-generated nursing statements, offering a promising solution to enhance and streamline healthcare documentation processes.

Performance Comparison between Densified and Undensified Silica Fume in Ultra-High Performance Fiber-Reinforced Concrete.

Silica fume (SF) is a key ingredient in the production of ultra-high performance fiber-reinforced concrete (UHPFRC). The use of undensified SF may have an advantage in the dispersion efficiency inside cement-based materials, but it also carries a practical burden such as high material costs and fine dust generation in the workplace. This study reports that a high strength of 200 MPa can be achieved by using densified SF in UHPFRC with Portland limestone cement. Additionally, it was experimentally confirmed that there was no difference between densified and undensified SFs in terms of workability, compressive and flexural tensile strengths, and hydration reaction of the concrete, regardless of heat treatment, because of a unique mix proportion as well as mixing method for dispersing agglomerated SF particles. It was experimentally validated that the densified SF can be used for both precast and field casting UHPFRCs with economic and practical benefits and without negative effects on the material performance of the UHPFRC.

Influence of Effective Water-to-Cement Ratios on Internal Damage and Salt Scaling of Concrete with Superabsorbent Polymer.

Superabsorbent polymer (SAP) is attracting attention as a water-entraining admixture that reduces shrinkage or heals cracks in concrete. Cross-linked sodium polyacrylate SAPs, which are the most widely produced SAPs in the global market, are applicable as concrete admixtures. However, there have been contradictory results on the freeze-thaw resistance of concrete with SAPs. This study aims to clarify these results considering the water absorption behavior of SAPs in hardened concrete when effective water-to-cement ratios are different. Firstly, the absorbencies of one kind of cross-linked sodium polyacrylate SAP (SAP_SP) in pore solution and fresh mortar were measured by a tea bag test and flow test, respectively. Pore size distribution, capillary water absorption, and deformation during freeze-thaw cycles were analyzed for mortar samples with varying SAP_SP dosages. In the main tests, concrete samples with three different SAP_SPs/cement ratios (0.1%, 0.2%, and 0.3%) and a reference sample were prepared, and internal damage and salt scaling were measured under freeze-thaw cycles. Because SAP_SP absorbs water in fresh mixtures, additional water was added to the mixture considering the water absorbency of the SAP_SP. It was found that the used SAP_SPs prematurely release their stored water so the effective water-to-cement ratio was increased when a larger amount of SAP_SP was used. The higher effective water-to-cement ratio caused more internal damage and salt scaling due to the weaker cementitious matrix. In addition, mortar samples with a high SAP_SP content show a larger absorption of capillary water than the reference sample. The result can be interpreted by an observation that SAP_SP in air voids absorbs water and expands to relatively large capillary pores or neighbor air voids during the capillary water absorption process.

Microstructural Investigation of Heat-Treated Ultra-High Performance Concrete for Optimum Production.

For optimum production of ultra-high performance concrete (UHPC), the material and microstructural properties of UHPC cured under various heat treatment (HT) conditions are studied. The effects of HT temperature and duration on the hydration reaction, microstructure, and mechanical properties of UHPC are investigated. Increasing HT temperature accelerates both cement hydration and pozzolanic reaction, but the latter is more significantly affected. This accelerated pozzolanic reaction in UHPC clearly enhances compressive strength. However, strength after the HT becomes stable as most of the hydration finishes during the HT period. Particularly, it was concluded that the mechanical benefit of the increased temperature and duration on the 28 day-strength is not noticeable when the HT temperature is above 60 °C (with a 48 h duration) or the HT duration is longer than 12 h (with 90 °C temperature). On the other hand, even with a minimal HT condition such as 1 day at 60 °C or 12 h at 90 °C, outstanding compressive strength of 179 MPa and flexural tensile strength of 49 MPa are achieved at 28 days. Microstructural investigation conducted herein suggests that portlandite content can be a good indicator for the mechanical performance of UHPC regardless of its HT curing conditions. These findings can contribute to reducing manufacturing energy consumption, cost, and environmental impact in the production of UHPC and be helpful for practitioners to better understand the effect of HT on UHPC and optimize its production.

Acceleration of Intended Pozzolanic Reaction under Initial Thermal Treatment for Developing Cementless Fly Ash Based Mortar.

Without using strong alkaline solution or ordinary Portland cement, a new structural binder consisting of fly ash and hydrated lime was hardened through an intensified pozzolanic reaction. The main experimental variables are the addition of silica fume and initial thermal treatment (60 °C for 3 days). A series of experiments consisting of mechanical testing (compressive and flexural strength, modulus of elasticity), X-ray diffraction, and measurements of the heat of hydration, pore structure, and shrinkage were conducted. These tests show that this new fly ash-based mortar has a compressive strength of 15 MPa at 91 days without any silica fume addition or initial thermal treatment. The strength increased to over 50 MPa based on the acceleration of the intensified pozzolanic reaction from the silica fume addition and initial thermal treatment. This is explained by a significant synergistic effect induced by the silica fume. It intensifies the pozzolanic reaction under thermal treatment and provides a space filling effect. This improved material performance can open a new pathway to utilize the industrial by-product of fly ash in cementless construction materials.

Novel composite score to predict atrial Fibrillation in acute stroke patients: AF predicting score in acute stroke.

BACKGROUND AND PURPOSE: Identification of high risk population for atrial fibrillation among acute stroke patients is a center of attention. The objective of the present study was to construct a model that can predict the presence of atrial fibrillation in ischemic stroke patients and to validate the model. METHODS: From a prospectively collected hospital-based stroke registry participated by two hospital, we selected data of patients who were admitted within 24 h after the onset of symptoms. Using a dataset of 1355 acute ischemic stroke patients, a model to predict the presence of atrial fibrillation was constructed and the probability of the presence of atrial fibrillation (AF-probability) was calculated. The patients were classified into low-risk, moderate-risk, and high-risk groups according to AF-probability. The performance of the model to predict atrial fibrillation among acute stroke patients was investigated and validated. RESULTS: Seven factors were selected as constituents of the model including age, left atrial size, free fatty acid level, triglyceride level, susceptibility vessel sign, hemorrhagic transformation, and cortical involvement. The performance of the model was excellent, with a C-statistic of 0.908 (95% confidence interval 0.887-0.930). According to risk group, true positivity for atrial fibrillation was 4.3%, 36.5%, 91.2% in the low-risk, moderate-risk, and high-risk groups, respectively. The internal and external validation test showed stable consistency of the model. CONCLUSION: The model constructed in this study could stratify stroke patients according to their risk of AF and may be helpful for selecting candidates who need extensive cardiac monitoring.

A unified statistical framework for material decomposition using multienergy photon counting x-ray detectors.

PURPOSE: Material decomposition using multienergy photon counting x-ray detectors (PCXD) has been an active research area over the past few years. Even with some success, the problem of optimal energy selection and three material decomposition including malignant tissue is still on going research topic, and more systematic studies are required. This paper aims to address this in a unified statistical framework in a mammographic environment. METHODS: A unified statistical framework for energy level optimization and decomposition of three materials is proposed. In particular, an energy level optimization algorithm is derived using the theory of the minimum variance unbiased estimator, and an iterative algorithm is proposed for material composition as well as system parameter estimation under the unified statistical estimation framework. To verify the performance of the proposed algorithm, the authors performed simulation studies as well as real experiments using physical breast phantom and ex vivo breast specimen. Quantitative comparisons using various performance measures were conducted, and qualitative performance evaluations for ex vivo breast specimen were also performed by comparing the ground-truth malignant tissue areas identified by radiologists. RESULTS: Both simulation and real experiments confirmed that the optimized energy bins by the proposed method allow better material decomposition quality. Moreover, for the specimen thickness estimation errors up to 2 mm, the proposed method provides good reconstruction results in both simulation and real ex vivo breast phantom experiments compared to existing methods. CONCLUSIONS: The proposed statistical framework of PCXD has been successfully applied for the energy optimization and decomposition of three material in a mammographic environment. Experimental results using the physical breast phantom and ex vivo specimen support the practicality of the proposed algorithm.