Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Evaluation of the Impact of Refined Quality Control Management Model on the Qualified Rate of Disinfection and Sterilization of Surgical Instruments in the Sterilization Supply Center

Objective:To evaluate the application value of a refined quality control management model for a sterilization supply center.Methods:A retrospective analysis was conducted on the work situation of the sterilization supply center from January 2021 to January 2023.The work situation before January 31,2022,was classified as the control group;a routine quality control management model was implemented,and the work situation after January 31,2022,was classified as the observation group.The quality of medical device management and department satisfaction between the two groups were compared.Results:The timely recovery and supply rate,classification and cleaning pass rate,disinfection pass rate,packaging pass rate,sterilization pass rate,and department satisfaction score in the observation group were all higher than those of the control group(P<0.05).Conclusion:Implementing a refined quality control management model in the sterilization supply center can improve the quality management level of medical devices and department satisfaction and is worthy of promotion.

Research on the Application and Effectiveness of the DRG Model on Perioperative Medical Management of Cholecystectomy

Objective:This study aimed to explore the application and effectiveness of the DRG model in the perioperative management of cholecystectomy.By comparing the DRG model with traditional management methods,this study focused on evaluating the potential impact of the DRG model in improving surgical efficiency and reducing complication rates and medical costs.Methods:The random envelope method was used to divide patients scheduled for cholecystectomy from January 2021 to October 2023 into two groups:one group underwent surgery under the DRG model(experimental group),and the other group underwent the traditional management model(control group).Data including basic information,surgery-related data,length of stay,complication records,and medical expenses were collected.Data analysis was carried out using a t-test and chi-square(χ2)test.Results:Results showed that the DRG model shortened the average length of stay,decreased the incidence of complications,reduced medical expenses,and increased patient satisfaction.These results demonstrate the effectiveness of the DRG model in the perioperative management of cholecystectomy,especially in improving surgical efficiency,reducing medical costs,and improving patient satisfaction.Conclusion:The DRG model in the perioperative management of cholecystectomy can significantly improve medical service quality and efficiency and enhance patient satisfaction as compared to traditional treatment methods.

Analysis of the“Trinity”Model of Corporate Compliance Management

In today’s fast-changing business environment,enterprises are facing unprecedented challenges.In today’s fast-changing business environment,enterprises are facing unprecedented challenges.Compliance management has become a key element to ensure the sustainable development of enterprises,not only because it assists enterprises to comply with laws and regulations,but also because it is the cornerstone of corporate reputation and culture.A compliance management model called“Trinity”has emerged.Based on this,this paper analyzes in detail the“Trinity”model of compliance management from the value of its application in enterprises,to provide new ideas and directions for the compliance management work of enterprises,and promote enterprises to achieve a more robust and stable business environment in the complex and changing market environment.In order to provide new ideas and directions for enterprise compliance management,and to promote enterprises to realize more stable and sustainable development in the complex and changing market environment.

Whole-Process Project Cost Management Based on Building Information Modeling (BIM)

The whole-process project cost management based on building information modeling(BIM)is a new management method,aiming to realize the comprehensive optimization and improvement of project cost management through the application of BIM technology.This paper summarizes and analyzes the whole-process project cost management based on BIM,aiming to explore its application and development prospects in the construction industry.Firstly,this paper introduces the role and advantages of BIM technology in engineering cost management,including information integration,data sharing,and collaborative work.Secondly,the paper analyzes the key technologies and methods of the whole-process project cost management based on BIM,including model construction,data management,and cost control.In addition,the paper also discusses the challenges and limitations of the whole-process BIM project cost management,such as the inconsistency of technical standards,personnel training,and consciousness change.Finally,the paper summarizes the advantages and development prospects of the whole-process project cost management based on BIM and puts forward the direction and suggestions for future research.Through the research of this paper,it can provide a reference for construction cost management and promote innovation and development in the construction industry.

Application of Hazard Vulnerability Analysis Based on Kaiser Model in Neonatal Breast Milk Management

Objective:To analyze the existing risks in breast milk management at the neonatal department and provide corresponding countermeasures.Methods:22 risk events were identified in 7 risk links in the process of bottle-feeding of breast milk.Hazard Vulnerability Analysis based on the Kaiser model was applied to investigate and evaluate the risk events.Results:High-risk events include breast milk quality inspection,hand hygiene during collection,disinfection of collectors,cold chain management,hand hygiene during the reception,breast milk closed-loop management,and post-collection disposal.Root cause analysis of high-risk events was conducted and breast milk management strategies outside the hospital and within the neonatal department were proposed.Conclusion:Hazard Vulnerability Analysis based on the Kaiser model can identify and assess neonatal breast milk management risks effectively,which helps improve the management of neonatal breast milk.It is conducive to the safe development and promotion of bottle feeding of breast milk for neonates,ensuring the quality of medical services and the safety of children.

Research on the Optimization of Enterprise Financial Management under the Financial Sharing Model

With the advancement of globalization and information technology,the financial sharing mode has gradually emerged as a crucial means for enterprises to optimize their financial management.Particularly within the context of economic globalization,informatization,and digital transformation,enterprises find themselves navigating a rapidly evolving market environment by intensifying competition.To enhance efficiency and competitiveness,many enterprises have embraced the financial sharing model to streamline financial management processes,curtail costs,and bolster the execution of corporate strategies.This article aims to dissect the definition and essence of the financial sharing model and its significance in the realm of enterprise financial management.Drawing upon this analysis and aligning with the needs of enterprise financial management,the article proposes ideas for optimizing management practices,aspiring to foster reform and innovation in enterprise financial management while enhancing its level of financial management and ability to respond to financial risks.This contribution seeks to provide valuable insights for practitioners in the field.

Application and Promotion of Whole-Process Capacity Management Model for CHF Patients Led by Specialist Nurses in “Heart Failure Center Alliance Unit”

Objective: To implement the whole-process capacity management model led by specialist nurses, improve the capacity management behavior of medical staff, and build a standardized, standardized and operable CHF capacity management system. Methods: According to the evidence pyramid principle and search strategy, 2 evidence-based nursing backbone completed literature search in both Chinese and English, and finally included 7 literatures. Results: Around the three key links of capacity assessment, monitoring and management, stakeholders were invited to evaluate each evidence according to the FAME principle, that is, the feasibility, suitability, effectiveness and clinical significance of evidence. Finally, 11 best evidences were obtained and 5 clinical review indicators of the cost project were transformed. This study formulated the competence management plan for CHF patients based on the current situation, established competence load evaluation criteria for CHF patients, and determined the target “dry weight” value for CHF patients. Conclusion: The whole-course volume management model of CHF patients guided by specialist nurses should be established and applied and promoted in the “heart failure Center Alliance unit”, so as to improve the capacity management ability of medical staff for CHF patients, enhance the self-management ability of CHF patients, improve the capacity management behavior and health outcomes, and effectively reduce the hospitalization rate and mortality rate of CHF patients in the region.

An Integrated Building Information Modeling (BIM) and Circular Economy (CE) Model for the Management of Construction and Deconstruction Waste Based on Construction Methods

As the climate change signs become more noticeable, the concern to prioritize sustainability within the AEC industry intensifies. This particularly pertained to issues related to the demand of resources, the excessive consumption of raw materials, and the associated generated waste. Presently, the construction industry is ranked among the industries that are accountable for the global generation of solid waste and energy consumption, leading to detrimental environmental effects. Nonetheless, over the years, construction methods, technological innovations, and building practices have made considerable progress, influenced by a growing emphasis on sustainability, especially in energy conservation and in adopting the Industrialized Production layer of Construction 4.0 (i.e., modular prefabrication, 3D concrete printing, and BIM). The concept of Circular Economy (CE) has been identified as a potential solution to achieve sustainability in building construction through the design, construction, and end-of-life deconstruction processes that enhance the management of waste based on the framework that is related to reducing, reusing, and recycling. Moreover, information and data related to geolocation complement advanced digital technologies by providing a collaborative platform that supports the application of CE as a practical approach to sustainability. Thus, this study will provide a straightforward methodology for developing a model that integrates BIM and sustainable design with Circular Economy’s concept to enhance the sustainability of construction projects to minimize their waste based on various construction methods (i.e., conventional, modular, and 3D concrete printing). The proposed model interrelates tools and data for the evaluation and planning strategies for the construction and deconstruction waste (CDW) management at the design stage, including estimating the quantities of the wasted materials, quantifying the production rates of selected equipment for the waste handling (loading and hauling) at the various stages of a project as well their associated cost. The proposed model will help users to calculate the quantity of construction and deconstruction waste (CDW) during the design of buildings based on their different construction methods at the early stage by using the concept of Design for Deconstruction (DfD);sustainable construction methods;and deconstruction process for waste management, which will lead to the suitable construction method.

Impact of a Nurse-Led Chronic Disease Management Intervention Model on Quality of Care and Satisfaction of Maintenance Hemodialysis Patients

Objective:To explore the impact of a nurse-led chronic disease management model on the quality of care and satisfaction of maintenance hemodialysis patients.Methods:72 patients who received maintenance hemodialysis(MHD)from June 2021 to March 2022 were selected to undergo the nurse-led chronic disease management model.The hemodialysis indexes,nutritional status,and the occurrence of adverse events were assessed after 24 weeks of the intervention,and patients’satisfaction was investigated and analyzed.Results:Comparing pre-intervention and after 24 weeks of intervention,urea reduction rate and urea clearance were improved but not statistically different(P>0.05),butβ2-microglobulin was significantly reduced compared with pre-intervention(P<0.05);after 24 weeks of intervention,the effect of decreasing blood calcium,parathyroid hormone,and potassium levels was not obvious(P>0.05),and the level of blood phosphorus decreased significantly compared with pre-intervention(P<0.01),albumin and hemoglobin levels were increased and better than before intervention(P<0.05);after 24 weeks of intervention,the incidence of intradialytic hypotension and hypertension was lower than before intervention(P<0.05),and the total incidence of complications was significantly lower than before intervention(P<0.01);there was no significant difference in the Self-Depression Scale scores after 24 weeks of intervention(P>0.05),and Self-Anxiety Scale scores were significantly lower and better than before intervention(P<0.01).Patient satisfaction was greatly improved,with a statistically significant difference(P<0.05).Conclusion:The chronic disease management intervention model led by specialized nurses is conducive to improving the psychological state and nutritional status of dialysis patients,enhancing the adequacy of dialysis for patients,reducing the incidence of related complications,and ultimately achieving the purpose of improving the quality of life of patients,which has significant clinical value.

The Effect of Case Management Model on the Application of Pancreatic Cancer Surgery Patients and the Recovery of Gastrointestinal Function

Objective:To evaluate the effect of the case management model on patients operated for pancreatic cancer.Methods:90 pancreatic cancer surgery patients admitted to the hospital between January 2022 and June 2023 were selected and grouped by randomized numerical table.For 45 cases in the observation group,case management mode was adopted,and for 45 cases in the intervention group,conventional nursing care was chosen to compare the indexes of gastrointestinal function recovery.Results:The recovery time of all gastrointestinal functions of the observation group was shorter than that of the intervention group;after nursing,the psychological state score of the observation group was lower than that of the intervention group,the self-efficacy score was higher than that of the intervention group and the rate of complications was lower than that of the intervention group(P<0.05).Conclusion:The case management model can promote the recovery of gastrointestinal function in patients with pancreatic cancer surgery and its nursing feasibility is high.

采用STAMP-24Model的多组织事故分析

安全生产事故往往由多组织交互、多因素耦合造成,事故原因涉及多个组织。为预防和遏制多组织生产安全事故的发生,基于系统理论事故建模与过程模型(Systems-Theory Accident Modeling and Process,STAMP)、24Model,构建一种用于多组织事故分析的方法,并以青岛石油爆炸事故为例进行事故原因分析。结果显示:STAMP-24Model可以分组织,分层次且有效、全面、详细地分析涉及多个组织的事故原因,探究多组织之间的交互关系;对事故进行动态演化分析,可得到各组织不安全动作耦合关系与形成的事故失效链及管控失效路径,进而为预防多组织事故提供思路和参考。

基于改进24Model-ISM-SNA建筑工人不安全行为关联路径研究

建筑施工现场环境复杂,为有效控制不安全行为发生,基于行为安全“2-4”模型对360份具有代表性的建筑安全事故调查报告进行分析,提取出22个不安全行为的主要影响因素。利用灰色关联分析方法(GRA)改进的集成ISM-SNA模型,将不安全行为风险因素划分为表层、过渡层与深层,然后对风险因素进行可视化分析、中心度分析及凝聚子群分析,揭示了各致因因素间的关联关系和传导路径。结果表明,建筑工人不安全行为影响因素可划分成7级3阶的多级递阶结构,安全意识、现场监管、外部环境是建筑工人不安全行为的关键影响因素,同时现场监管和隐患排查到位能有效降低不安全行为的发生。

基于24Model-D-ISM的地铁站火灾疏散影响因素研究

为预防地铁站火灾事故,深入了解地铁站火灾人员疏散影响因素间的内在联系与层次结构,基于第6版“2-4”模型(24Model)分析63起地铁站火灾疏散事故,充分考虑各个因素之间的交互作用,提取19个影响地铁站人员疏散的关键因素,建立地铁站火灾人员疏散影响因素指标体系;采用算子客观赋权法(C-OWA)改进决策试验与评价实验法(DEMATEL),确定地铁站火灾人员疏散的重要影响因素;在此基础上,采用解释结构模型(ISM)分析各个因素间的层次结构及相互作用路径,构建地铁站火灾人员疏散影响因素的多级递阶结构模型。研究结果表明:疏散引导、恐慌从众行为、人员拥挤为地铁站火灾人员疏散的关键影响因素;地铁站火灾人员疏散受表层因素、中间层因素、深层因素共同作用的影响,其中,疏散教育与培训、设施维护与检查、疏散预案等因素是根源影响因素,重视根源影响因素的改善有利于从本质上预防和控制事故的发生。

Green Roof Performance for Stormwater Management in Equatorial Urban Areas Using Storm Water Management Model (SWMM)

Many Low Impact Developments (LIDs) have recently been developed as a sustainable integrated strategy for managing the quantity and quality of stormwater and surrounding amenities. Previous research showed that green roof is one of the most promising LIDs for slowing down rainwater, controlling rainwater volume, and enhancing rainwater quality by filtering and leaching contaminants from the substrate. However, there is no guideline for green roof design in Malaysia. Hence, Investigating the viability of using green roofs to manage stormwater and address flash flood hazards is urgently necessary. This study used the Storm Water Management Model (SWMM) to evaluate the effectiveness of green roof in managing stormwater and improving rainwater quality. The selected study area is the multistory car park (MSCP) rooftop at Swinburne University of Technology Sarawak Campus. Nine green roof models with different configurations were created. Results revealed that the optimum design of a green roof is 100 mm of berm height, 150 mm of soil thickness, and 50 mm of drainage mat thickness. With the ability to reduce runoff generation by 26.73%, reduce TSS by 89.75%, TP by 93.07%, TN by 93.16%, and improved BOD by 81.33%. However, pH values dropped as low as 5.933 and became more acidic due to the substrates in green roof. These findings demonstrated that green roofs improve water quality, able to temporarily store excess rainfall and it is very promising and sustainable tool in managing stormwater.

Modelling the response of larch growth to age,density,and elevation and the implications for multifunctional management in northwest China

Plantations of Rupprecht's larch(Larix principis-rupprechtii)have been widely established in the drylands of northwest and north China under traditional fastgrowing plantation management strategies.These strategies and the long-term logging ban have led to over-populated stands with lower structural and functional stability,less economic benefit and higher water consumption.To guide the sustainable management of larch plantations,field surveys and historical data compilation were undertaken in the Liupan Mountains of northwest China.The main influencing factors(stand structure and site condition)and their effects on mean tree height,mean DBH and timber volumes were determined based on up-boundary line analysis.Tree growth models coupling the effects of tree age,stand density,and elevation were established.Both height and DBH markedly increased initially and then slowly with tree age,decreased with stand density,and showed unimodal change with elevation.The coupled growth models accounted for72-78%of the variations in tree height,DBH and timber growth.Recommendations for future plantation management are:(1)prolong the rotation to at least 60 years to produce large-diameter,high-quality timber and maintain greater carbon stocks;(2)zone the target functions of stands by elevation;and,(3)reduce stand density for balanced supply of multiple ecosystem services.The growth models developed can predict growth response of larch plantations to density alteration under given ages and elevations,and assist the transformation from traditional management for maximum timber production to site-specific and multifunctional management with longer rotations and moderate tree density.

Intelligent Student Mental Health Assessment Model on Learning Management System

A learning management system(LMS)is a software or web based application,commonly utilized for planning,designing,and assessing a particular learning procedure.Generally,the LMS offers a method of creating and delivering content to the instructor,monitoring students’involvement,and validating their outcomes.Since mental health issues become common among studies in higher education globally,it is needed to properly determine it to improve mental stabi-lity.This article develops a new seven spot lady bird feature selection with opti-mal sparse autoencoder(SSLBFS-OSAE)model to assess students’mental health on LMS.The major aim of the SSLBFS-OSAE model is to determine the proper health status of the students with respect to depression,anxiety,and stress(DAS).The SSLBFS-OSAE model involves a new SSLBFS model to elect a useful set of features.In addition,OSAE model is applied for the classification of mental health conditions and the performance can be improved by the use of cuckoo search optimization(CSO)based parameter tuning process.The design of CSO algorithm for optimally tuning the SAE parameters results in enhanced classifica-tion outcomes.For examining the improved classifier results of the SSLBFS-OSAE model,a comprehensive results analysis is done and the obtained values highlighted the supremacy of the SSLBFS model over its recent methods interms of different measures.

A robust optimization model for demand response management with source-grid-load collaboration to consume wind-power

To accommodate wind power as safely as possible and deal with the uncertainties of the output power of winddriven generators,a min-max-min two-stage robust optimization model is presented,considering the unit commitment,source-network load collaboration,and control of the load demand response.After the constraint functions are linearized,the original problem is decomposed into the main problem and subproblem as a matrix using the strong dual method.The minimum-maximum of the original problem was continuously maximized using the iterative method,and the optimal solution was finally obtained.The constraint conditions expressed by the matrix may reduce the calculation time,and the upper and lower boundaries of the original problem may rapidly converge.The results of the example show that the injected nodes of the wind farms in the power grid should be selected appropriately;otherwise,it is easy to cause excessive accommodation of wind power at some nodes,leading to a surge in reserve costs and the load demand response is continuously optimized to reduce the inverse peak regulation characteristics of wind power.Thus,the most economical optimization scheme for the worst scenario of the output power of the generators is obtained,which proves the economy and reliability of the two-stage robust optimization method.

耦合优化蚁群算法与P-Median model的选址模型设计

为节省城建部门对于公共体育设施的投入成本以及提高城市人民生活质量,以运动场所优化选址为例,提出一种新型设施选址模型。该模型主要基于P-Median model(最小化阻抗模型)根据需求点数量从全部候选设施选址中选择设施空间位置,让用户达到离自己最近设施距离成本总和最小的目的,对选址的基本原则和实际情况提出要求,构造目标函数用于优化后蚁群算法求解进行选址工作。优化蚁群算法实现基于Python语言模块,通过改进蚁群原始信息素,提升原有算法的收敛速度,求出目标函数最优解,可以很好地模拟对于运动场所的选址。用二者耦合进行优势互补所设计的选址模型来搜寻研究区蚁群信息素浓度残留最大的栅格像元,从而确定未被已有设施点服务半径覆盖的最佳设施点建立位置。实验结果表明,该新型选址模型相较于最小化阻抗模型与最大化覆盖模型,新增优化设施点使整体服务半径覆盖率分别高出10.42%和6.95%,适合求解较为精确且小规模空间下的选址问题。

Anisotropic time-dependent behaviors of shale under direct shearing and associated empirical creep models

Understanding the anisotropic creep behaviors of shale under direct shearing is a challenging issue.In this context,we conducted shear-creep and steady-creep tests on shale with five bedding orientations (i.e.0°,30°,45°,60°,and 90°),under multiple levels of direct shearing for the first time.The results show that the anisotropic creep of shale exhibits a significant stress-dependent behavior.Under a low shear stress,the creep compliance of shale increases linearly with the logarithm of time at all bedding orientations,and the increase depends on the bedding orientation and creep time.Under high shear stress conditions,the creep compliance of shale is minimal when the bedding orientation is 0°,and the steady-creep rate of shale increases significantly with increasing bedding orientations of 30°,45°,60°,and 90°.The stress-strain values corresponding to the inception of the accelerated creep stage show an increasing and then decreasing trend with the bedding orientation.A semilogarithmic model that could reflect the stress dependence of the steady-creep rate while considering the hardening and damage process is proposed.The model minimizes the deviation of the calculated steady-state creep rate from the observed value and reveals the behavior of the bedding orientation's influence on the steady-creep rate.The applicability of the five classical empirical creep models is quantitatively evaluated.It shows that the logarithmic model can well explain the experimental creep strain and creep rate,and it can accurately predict long-term shear creep deformation.Based on an improved logarithmic model,the variations in creep parameters with shear stress and bedding orientations are discussed.With abovementioned findings,a mathematical method for constructing an anisotropic shear creep model of shale is proposed,which can characterize the nonlinear dependence of the anisotropic shear creep behavior of shale on the bedding orientation.