Continuity of Care in Primary Health Care Affecting Control of Diabetes

Background: Continuity of care is a distinguishing feature of primary care. Better continuity of care program showed a significant effect in controlling diabetes and it is complications. This study explores the effect of continuity of care on control of diabetes mellites in primary health care centres. Objectives: 1) To assess the effect of Continuity of care on controlling haemoglobin (Hb A1C) and fasting blood Sugar (FBS);2) To compare the control of Diabetes by using (Hb A1C and FBS) indices on same patient before and after application of chronic illness clinic;3) To identify the relation between age and gender affecting continuity of care in diabetic patient. Methods: It is a Prospective cohort study design. Included both gender and diabetic patient age above 24 years old. The data extracted from health care specialty center (HCSC) clinics in National guard hospital at Riyadh, through HCSC data base on three phases: 1) Phase 1: the data extracted of diabetic patients from October to November 2022 including MRN, diabetic patient, age, Hb A1C, Fasting blood glucose. 2) Phase 2: the same MRN extracted from phase 1 was extracted again retrospectively for six months from April to September 2022, to compare the indices before implanting the chronic illness clinic including Hb A1C, Fasting blood glucose. 3) Phase 3: prospectively from December 2022 to September 2023. Results: Among diabetic patients aged 60 years old and above showed better control of HbA1C and FBS comparing to these patients below age of 60 years old, with significant improvement of HbA1C after implanting chronic illness clinic. Conclusion: The significant improvement in the control of diabetic patients followed in primary health care centers reinforce the evidence of the importance of continuity of care.

GLOBAL CONVERGENCE OF A CAUTIOUS PROJECTION BFGS ALGORITHM FOR NONCONVEX PROBLEMS WITHOUT GRADIENT LIPSCHITZ CONTINUITY

A cautious projection BFGS method is proposed for solving nonconvex unconstrained optimization problems.The global convergence of this method as well as a stronger general convergence result can be proven without a gradient Lipschitz continuity assumption,which is more in line with the actual problems than the existing modified BFGS methods and the traditional BFGS method.Under some additional conditions,the method presented has a superlinear convergence rate,which can be regarded as an extension and supplement of BFGS-type methods with the projection technique.Finally,the effectiveness and application prospects of the proposed method are verified by numerical experiments.

Analysis of the Nursing Effect of Continuity of Care on Elderly Patients with Coronary Heart Disease Unstable Angina and its Impact on Quality of Life

Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method.The nursing effect and quality of life of the observation group(continuity nursing)and the control group(routine nursing)were compared.Results:The total effective rate of nursing care was 96.00%observation group and 80.00%for the control group,and the differences were significant(χ2=6.061,P<0.05).Patients in the observation group had fewer episodes(1.42±0.21)times/week and a shorter duration(5.46±0.39)min,which were better than the control group(t=3.465,2.973;P<0.05).The depression self-rating depression scale(SDS)score(42.16±6.64)and anxiety self-rating scale(SAS)score(32.26±7.35)in the observation group were lower and the quality of life was higher as compared to that of the control group(P<0.05).Conclusion:Continuous nursing care improved the nursing effect of elderly CHD with UAP patients,promoted the alleviation of UAP symptoms,improved patient mentality,and improved their quality of life.Hence,continuous nursing care possesses significant clinical application value.

Application Effect of WeChat Platform Continuity of Care Model Based on KAP Theory on Self-Management of Stroke Patients with Hypertension

Objective: To explore the impact of the WeChat platform continuity of care model based on the KAP (knowledge, attitudes, and practices) theory on the self-management of stroke patients with hypertension after discharge from the hospital. Methods: 62 stroke patients with hypertension discharged from the rehabilitation department of a tertiary A hospital in Nanning City, Guangxi Zhuang Autonomous Region, from October 2022 to April 2023 were sampled by convenience sampling method. Patients discharged from Rehabilitation I were included in the control group, and conventional nursing care was used;while patients discharged from Rehabilitation II were included in the observation group, and WeChat platform continuity of nursing care model based on the KAP theory was implemented. The intervention effect of the two groups was compared. Results: After 4 and 12 weeks of intervention, the diastolic and systolic blood pressure of the patients in the observation group were lower than those in the control group (P < 0.05);after 12 weeks of intervention, the rate of medication adherence and the score of adherence to hypertension treatment in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion: The application of the WeChat platform continuity of care model based on KAP theory to stroke patients with hypertension can improve blood pressure, medication adherence rate, hypertension treatment adherence, and overall enhance the self-management level of these patients.

Application and management of continuous glucose monitoring in diabetic kidney disease

Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.

Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

BACKGROUND The emergency department plays a crucial role in providing acute care to patients.Nursing interventions in this setting are essential for improving the continuity of care,enhancing patients’self-care abilities,and reducing psychological symp-toms.AIM To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department.METHODS A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023.The patients were divided into two groups:The control group(conventional nursing intervention)and the observation group(conventional nursing intervention+emergency department nursing intervention).The two groups were compared regarding continuity of care,self-care ability,psychological symptoms,and satisfaction with care.RESULTS The emergency department nursing interventions significantly improved the continuity of care,enhanced patients’self-care abilities,and reduced psycho-logical symptoms such as anxiety and depression.CONCLUSION Nursing interventions in the emergency department positively impact continuity of care,self-care,and psychological symptoms.However,it is important to acknowledge the limitations of this study,including the small number of studies,variable methodological quality,and the heterogeneity of the study population.Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department.Additionally,efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

Situational continuity-based air combat autonomous maneuvering decision-making

In order to improve the performance of UAV's autonomous maneuvering decision-making,this paper proposes a decision-making method based on situational continuity.The algorithm in this paper designs a situation evaluation function with strong guidance,then trains the Long Short-Term Memory(LSTM)under the framework of Deep Q Network(DQN)for air combat maneuvering decision-making.Considering the continuity between adjacent situations,the method takes multiple consecutive situations as one input of the neural network.To reflect the difference between adjacent situations,the method takes the difference of situation evaluation value as the reward of reinforcement learning.In different scenarios,the algorithm proposed in this paper is compared with the algorithm based on the Fully Neural Network(FNN)and the algorithm based on statistical principles respectively.The results show that,compared with the FNN algorithm,the algorithm proposed in this paper is more accurate and forwardlooking.Compared with the algorithm based on the statistical principles,the decision-making of the algorithm proposed in this paper is more efficient and its real-time performance is better.

Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with Upper Gastrointestinal Bleeding Due to Ulcers

Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.

Continuity of Commitment

As a popular saying goes,do not be afraid to celebrate a promise when kept.In doing so,you are embracing the potential for a better world.In keeping with its unshakable promise made over three decades ago and following the footsteps of his predecessors,China’s new Foreign Minister Qin Gang is beginning his term with a seven-day visit to five African nations-Ethiopia,Gabon,Angola,Benin,and Egypt-from 9 to 16 January.The visit also brought him to the African Union(AU)Headquarters and the League of Arab States Headquarters.

NCCMF:Non-Collaborative Continuous Monitoring Framework for Container-Based Cloud Runtime Status

The security performance of cloud services is a key factor influencing users’selection of Cloud Service Providers(CSPs).Continuous monitoring of the security status of cloud services is critical.However,existing research lacks a practical framework for such ongoing monitoring.To address this gap,this paper proposes the first NonCollaborative Container-Based Cloud Service Operation State Continuous Monitoring Framework(NCCMF),based on relevant standards.NCCMF operates without the CSP’s collaboration by:1)establishing a scalable supervisory index system through the identification of security responsibilities for each role,and 2)designing a Continuous Metrics Supervision Protocol(CMA)to automate the negotiation of supervisory metrics.The framework also outlines the supervision process for cloud services across different deployment models.Experimental results demonstrate that NCCMF effectively monitors the operational state of two real-world IoT(Internet of Things)cloud services,with an average supervision error of less than 15%.

Continual Reinforcement Learning for Intelligent Agricultural Management under Climate Changes

Climate change poses significant challenges to agricultural management,particularly in adapting to extreme weather conditions that impact agricultural production.Existing works with traditional Reinforcement Learning(RL)methods often falter under such extreme conditions.To address this challenge,our study introduces a novel approach by integrating Continual Learning(CL)with RL to form Continual Reinforcement Learning(CRL),enhancing the adaptability of agricultural management strategies.Leveraging the Gym-DSSAT simulation environment,our research enables RL agents to learn optimal fertilization strategies based on variable weather conditions.By incorporating CL algorithms,such as Elastic Weight Consolidation(EWC),with established RL techniques like Deep Q-Networks(DQN),we developed a framework in which agents can learn and retain knowledge across diverse weather scenarios.The CRL approach was tested under climate variability to assess the robustness and adaptability of the induced policies,particularly under extreme weather events like severe droughts.Our results showed that continually learned policies exhibited superior adaptability and performance compared to optimal policies learned through the conventional RL methods,especially in challenging conditions of reduced rainfall and increased temperatures.This pioneering work,which combines CL with RL to generate adaptive policies for agricultural management,is expected to make significant advancements in precision agriculture in the era of climate change.

Strengthening effect of prefabrication(10-12)tensile twinning on AZ80+0.4%Ce magnesium alloy and inhibition mechanism of discontinuous precipitation

This paper provided an effective method to further improve the mechanical properties of the AZ80+0.4%Ce magnesium alloy wheel spoke.The effect of high strength and ductility was obtained with a yield strength of 295.36 MPa,an elongation of 10%,by the combination of pre-deformation(7%deformation)and two-stage aging treatment(120℃/9 h+175℃/24 h).The evolution of the microstructure and properties of the alloy was explored under the coupling conditions of different pre-deformation degrees and multi-stage aging.The results show that,pre-deformation introduced a large number of(1012)tensile twinning and dislocations,which greatly promoted the probability of continuous precipitates(CPs)appearing.On the contrary,the discontinuous precipitates(DPs)were limited by the vertical and horizontal twin structure.As a result,the pre-nucleation method of two-stage aging increased the proportion of CPs by 34%-38%.Owing to the DPs was effectively suppressed,the alloy's yield strength has been greatly improved.Besides,under multi-stage aging,the twin boundaries induce protruding nucleation to form static recrystallization by hindering the migration of dislocations,and the matrix swallows the twins,then the texture gradually tilts from the two poles to the basal plane.As an important supplement,the grain refinement and oblique texture promoted the improvement of the yield strength of the component.

Enhanced measurement precision with continuous interrogation during dynamical decoupling

Dynamical decoupling(DD)is normally ineffective when applied to DC measurement.In its straightforward implementation,DD nulls out DC signal as well while suppressing noise.This work proposes a phase relay method that is capable of continuously interrogating the DC signal over many DD cycles.We illustrate its efficacy when applied to the measurement of a weak DC magnetic field with an atomic spinor Bose-Einstein condensate.Sensitivities approaching standard quantum limit or Heisenberg limit are potentially realizable for a coherent spin state or a squeezed spin state of 10000 atoms,respectively,while ambient laboratory level noise is suppressed by DD.Our work offers a practical approach to mitigate the limitations of DD to DC measurement and would find other applications for resorting coherence in quantum sensing and quantum information processing research.

MULTIFRACTAL ANALYSIS OF CONVERGENCE EXPONENTS FOR PRODUCTS OF CONSECUTIVE PARTIAL QUOTIENTS IN CONTINUED FRACTIONS

For each real number x∈(0,1),let[a_(1)(x),a_(2)(x),…,a_n(x),…]denote its continued fraction expansion.We study the convergence exponent defined byτ(x)=inf{s≥0:∞∑n=1(a_(n)(x)a_(n+1)(x))^(-s)<∞},which reflects the growth rate of the product of two consecutive partial quotients.As a main result,the Hausdorff dimensions of the level sets ofτ(x)are determined.

Improvement and security analysis of multi-ring discrete modulation continuous variable quantum secret sharing scheme

In order to avoid the complexity of Gaussian modulation and the problem that the traditional point-to-point communication DM-CVQKD protocol cannot meet the demand for multi-user key sharing at the same time, we propose a multi-ring discrete modulation continuous variable quantum key sharing scheme(MR-DM-CVQSS). In this paper, we primarily compare single-ring and multi-ring M-symbol amplitude and phase-shift keying modulations. We analyze their asymptotic key rates against collective attacks and consider the security key rates under finite-size effects. Leveraging the characteristics of discrete modulation, we improve the quantum secret sharing scheme. Non-dealer participants only require simple phase shifters to complete quantum secret sharing. We also provide the general design of the MR-DM-CVQSS protocol.We conduct a comprehensive analysis of the improved protocol's performance, confirming that the enhancement through multi-ring M-PSK allows for longer-distance quantum key distribution. Additionally, it reduces the deployment complexity of the system, thereby increasing the practical value.

Irregular initial solidification by mold thermal monitoring in the continuous casting of steels:A review

Occasional irregular initial solidification phenomena,including stickers,deep oscillation marks,depressions,and surface cracks of strand shells in continuous casting molds,are important limitations for developing the high-efficiency continuous casting of steels.The application of mold thermal monitoring(MTM) systems,which use thermocouples to detect and respond to temperature variations in molds,has become an effective method to address irregular initial solidification phenomena.Such systems are widely applied in numerous steel companies for sticker breakout prediction.However,monitoring the surface defects of strands remains immature.Hence,indepth research is necessary to utilize the potential advantages and comprehensive monitoring of MTM systems.This paper summarizes what is included in the irregular initial solidification phenomena and systematically reviews the current state of research on these phenomena by the MTM systems.Furthermore,the influences of mold slag behavior on monitoring these phenomena are analyzed.Finally,the remaining problems of the formation mechanisms and investigations of irregular initial solidification phenomena are discussed,and future research directions are proposed.

Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge

BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

THE ABSENCE OF SINGULAR CONTINUOUS SPECTRUM FOR PERTURBED JACOBI OPERATORS

This paper is mainly about the spectral properties of a class of Jacobi operators(H_(c,b)u)(n)=c_(n)u(n+1)+c_(n-1)u(n-1)+b_(n)u(n),.where∣c_(n)−1∣=O(n^(−α))and b_(n)=O(n^(−1)).We will show that,forα≥1,the singular continuous spectrum of the operator is empty.

Path-Dependent Progressive Failure Analysis for 3D-Printed Continuous Carbon Fibre Reinforced Composites

In order to predict the damage behaviours of 3D-printed continuous carbon fibre(CCF)reinforced composites,when additional short carbon fibre(SCF)composite components are employed for continuous printing or special functionality,a novel path-dependent progressive failure(PDPF)numerical approach is developed.First,a progressive failure model using Hashin failure criteria with continuum damage mechanics to account for the damage initiation and evaluation of 3D-printed CCF reinforced polyamide(PA)composites is developed,based on actual fibre placement trajectories with physical measurements of 3D-printed CCF/PA constituents.Meanwhile,an elastic-plastic model is employed to predict the plastic damage behaviours of SCF/PA parts.Then,the accuracy of the PDPF model was validated so as to study 3D-printed CCF/PA composites with either negative Poisson's ratio or high stiffness.The results demonstrate that the proposed PDPF model can achieve higher prediction accuracies in mechanical properties of these 3D-printed CCF/PA composites.Mechanism analyses show that the stress distribution is generally aggregated in the CCF areas along the fibre placement paths,and the shear damage and matrix tensile/compressive damage are the key damage modes.This study provides a new approach with valuable information for characterising complex 3D-printed continuous fibre-matrix composites with variable mechanical properties and multiple constituents.

Microstructure and mechanical properties of continuous drive friction welded Ti_(2)AlNb alloy under different rotational rates

Ti_(2)AlNb-based alloy was joined in a continuous drive friction welding machine under different rotational rates(500,1000 and 1500 r/min).The microstructure and mechanical properties of the joints were investigated.It is shown that the weld zone(WZ) is fully composed of recrystallized B2 phase,and the grain size decreases with increasing rotational rate.The thermo-mechanically affected zone(TMAZ) suffers severe deformation during welding,due to which most of original precipitation phase is dissolved and streamlines are present.In the heat affected zone(HAZ),only the fine O phase is dissolved.The as-welded joint produced using 1000 r/min has the best mechanical properties,whose strength and elongation are both close to those of the base metal,while the as-welded joint obtained using 500 r/min exhibits the worst mechanical properties.Post-weld annealing treatment annihilates the deformation microstructure and fine O phase precipitates in the joints,consequently improving the mechanical properties significantly.Decomposed α_(2) phase is a weakness for the mechanical performance of the joint since microcracks are apt to form in it in the tensile test.