社区骨关节炎患者的疾病认知与行为特点及就诊行为的影响因素:一项混合方法学研究

背景骨关节炎作为社区常见慢性病,其影响因素众多且相互作用,当前患者的就医认知和行为不足,造成骨关节炎的诊治和管理困难。目的了解社区骨关节炎患者的就医认知和行为特点,为改善该类患者的社区就医诊治提供策略。方法本研究为混合方法学研究。2019年5—6月,采用目的抽样法从上海市杨浦区一家区域医疗中心的综合医院选取骨科医生和全科医生各5例,同时在区域内的其中6家社区卫生服务中心方便抽取12例全科医生、12例前来就诊的骨关节炎患者,进行多方访谈,了解访谈对象的疾病认知、疾病管理现况及就医行为影响因素。2019年6月至2020年12月,从以上6家社区卫生服务中心中随机选取3家,对前来就诊的425例骨关节炎患者进行问卷调查。结合访谈归纳的主题,除去部分具有较大主观性难以采用问卷量化的指标,设计定量问卷。调查问卷内容包括一般资料、患病现况、就医认知和行为、自我管理情况及慢性病APP利用。采用二元Logistic回归分析骨关节炎患者就医行为的影响因素。结果定性访谈共提炼出3个主题,分别为对骨关节炎认知不足、缺乏对骨关节炎的管理、影响就医行为的因素。定量研究共计回收有效问卷397份(93.4%)。397例调查对象中,152例(38.3%)了解骨关节炎相关知识;152例了解骨关节炎相关知识者中,知识来源为媒体、病友的分别有79例(52.0%)、50例(32.9%);397例调查对象中,200例(50.4%)表示了解骨关节炎治疗措施,其中分别有91例(45.5%)、105例(52.5%)知晓运动和物理治疗及止痛药措施。不同性别、体质指数(BMI)、关节疼痛程度、疼痛影响睡眠情况、既往就医经历骨关节炎患者就医情况比较,差异有统计学意义(P<0.05)。二元Logistic回归结果显示,性别、BMI、疼痛程度、疼痛影响睡眠情况、既往就医经历是就医行为的影响因素(P<0.05)。结论社区骨关节炎患者就医认知不足、自我管理意识薄弱,就医行为受多种因素影响。未来应注重提高患者就医认知,并培养患者自我管理能力;提高全科医生诊疗技能,改善医患双方消极态度,促进患者积极就医。

大洋彼岸的涛声:发展混合方法研究对发展中国全科医学研究的重要价值

混合方法学源于实用主义哲学,以问题为起点,以解决问题为导向,与全科医学学科理论可以很好地契合,近年在欧美全科医学领域的影响力正日渐增加。中国全科医学的发展对科研具有迫切需求,但中国全科医学研究目前仍有待发展。全科医学从业者常面临学科研究变量复杂、缺乏本国证据、缺乏从事定性研究意愿、缺乏研究人员与资源,且资源分布不平衡等问题。混合方法学可以在研究理论上有效结合定性和定量研究,从发现新变量、提升信效度和寻找创新点等3个方面帮助中国全科医学研究者提升研究质量。本文通过对1篇近期发表的全科医学Q1区论文的拆解,探讨了在中国从事类似的混合方法研究的现实可能性,并在此基础上,提出了发展中国全科医学领域混合方法研究的3项建议。

社区医护人员高尿酸血症健康管理知信行现状分析

目的调查社区医护人员的高尿酸血症健康管理知信行现状及影响因素,为改善高尿酸血症的社区健康管理提出改进策略。方法采用定量研究和定性研究相结合的方法。2022年8月,采取便利抽样法对广州市社区卫生服务中心的193名医护人员进行高尿酸血症健康干预知信行问卷调查,了解基层医护人员高尿酸血症健康管理知识掌握情况及健康管理行为。采用目的抽样法对14名社区医务人员进行半结构式访谈,了解高尿酸血症社区健康管理的开展现状。结果定量研究结果显示社区医护人员高尿酸血症健康管理知信行得分为(73.60±10.06)分。高尿酸血症管理知识、信念及行为之间存在显著的正相关关系(P<0.01)。年龄、学历、职业和是否参加过高尿酸血症管理培训是健康管理知信行得分的影响因素(P<0.05)。定性研究发现社区高尿酸血症健康管理存在重治轻防的现象,健康管理团队内部未实现有质量的分工合作,社区医护人员提供健康管理服务的主动性不足。结论社区医护人员对高尿酸血症管理知识的掌握处于中等水平,对高尿酸血症健康干预的态度较积极,但行为得分不理想。未来需加强对社区医护人员高尿酸血症健康管理方面的培训和实践指导,优化社区健康管理团队的职能部署,丰富健康管理服务内涵,提高社区高尿酸血症健康管理水平。

基于概念图教学法的初中生物归纳和概括能力提升策略

该研究旨在探索如何通过运用概念图教学法来提升初中生物学生的归纳和概括能力。研究采用了混合方法学,结合了定量和定性数据分析,以评估概念图教学法在实际教学过程中的效果。研究表明,概念图教学法显著提高了学生在生物科学领域的归纳和概括能力。通过这种方法,学生能更好地理解和整合复杂的生物学概念,提高他们的批判性思维和创新能力。此外,研究还发现概念图教学法能有效提升学生的学习动机和参与度,促进了更深层次的学习。

基于临床护理能力培养的实习护生带教模式构建与实践

目的 探讨基于临床护理能力培养的实习护生带教模式对护生临床护理能力的影响。方法 采用质性量性综合性研究法,以质性扎根理论研究为核心,提炼建立基于临床护理能力培养的实习护生带教模式的关键要素;辅以量性研究,收集2012~2017年级来我院实习护生的认知、临床护理基本知识及技能测评结果和教学满意度,并与2011年级比较以推断该模式的实践效果。结果 提炼出该模式的8个关键要素,构建了该模式关键要素关联图;2012~2017年级实习护生的认知、临床护理基本知识及技能测评等优良率均>95%,平均优良率96.12%;实习护生对带教工作满意度均>95%,平均满意度96.58%;并分别与2011年级护生的优良率、满意度进行比较,差异有统计学意义(P<0.05)。结论 基于临床护理能力培养的实习护生带教模式能有力地指引临床护理教学实践,有助于培养护生的临床护理能力,值得在教学医院进一步推广。

Dynamic analysis and experimental study of vibro-acoustic system with uncertainties at middle frequencies

To take into account the influence of uncetainties on the dynamic response of the vibro-acousitc structure, a hybrid modeling technique combining the finite element method（FE）and the statistic energy analysis（SEA） is proposed to analyze vibro-acoustics responses with uncertainties at middle frequencies. The mid-frequency dynamic response of the framework-plate structure with uncertainties is studied based on the hybrid FE-SEA method and the Monte Carlo（MC）simulation is performed so as to provide a benchmark comparison with the hybrid method. The energy response of the framework-plate structure matches well with the MC simulation results, which validates the effectiveness of the hybrid FE-SEA method considering both the complexity of the vibro-acoustic structure and the uncertainties in mid-frequency vibro-acousitc analysis. Based on the hybrid method, a vibroacoustic model of a construction machinery cab with random properties is established, and the excitations of the model are measured by experiments. The responses of the sound pressure level of the cab and the vibration power spectrum density of the front windscreen are calculated and compared with those of the experiment. At middle frequencies, the results have a good consistency with the tests and the prediction error is less than 3. 5dB.

美国新毕业家庭医生寻找产科相关工作的体验

背景足够的产科家庭医生对于确保患者获取必需的产科服务至关重要。然而,既往研究表明执业范围包含产科的家庭医生数量正在逐年减少,如今从事新生儿接生工作的家庭医生不到10%。目的旨在探究希望将产科纳入其执业范围的新毕业家庭医生如何发现和选择工作,并进一步了解当前就业形势对家庭医生的执业范围,特别是产科、新生儿接生方面的影响。方法于2017年进行问卷调查和定性访谈的混合方法研究。对美国家庭医生进行电子问卷调查并在目的性子抽样后对这些医生进行深度半结构化电话访谈。问卷调查总结了家庭医生未从事产科工作的原因,为进一步明确选择从事产科工作的家庭医生的具体情况,采用基于群体的沉浸式方法来转译定性访谈的结果。本研究向2098例毕业于2014—2016年并希望从事新生儿接生工作的美国家庭医学专业实习医生发送调查问卷,回复1016份,回复率48.43%,其中56例接受了电话访谈。结果问卷调查结果显示,未能找到工作范围包含产科的工作是希望从事产科工作的家庭医学毕业生未从事该工作的主要原因。定性访谈结果显示,家庭医生通常通过人脉关系或人才招聘的途径找到产科相关工作,并根据地理位置偏好、家庭义务及生活方式要求等个人考虑因素做出选择。同时,求职过程和择业决策也受到工作结构、执业特点及缺乏产科相工作经验等因素的限制。结论虽然个人意向决定大部分医学生的工作选择,但其选择仍受到多种不可控因素限制,特别是家庭医学工作提供产科相关工作的能力。美国毕业医学生从医院实习生到执业医师的转变同时影响着毕业生的求职选择和医疗机构患者寻求医疗服务的质量。因此,了解就业情况对家庭医生就业范围的影响方式,有助于进一步明确如何协助家庭医生在其希望从事的范围内工作并对其进行相应协助,从而确保每一个家庭可以获得更好的医疗服务。

Using Mixed Methods to Investigate the Relationship Between Student Motivation and Academic Achievement From Socio-Cultural Perspective

Language learning is a complex process for many reasons. First, it is closely related to linguistics. Second, language is social as it occurs within certain social contexts. And finally, it is individual. Personal characteristics such as experience, gender and age, attitude and aptitude, motivation, beliefs, self-confidence, and anxiety greatly influence language learning. Among these variables, motivation is considered to be one of the most important factors affecting the success of second or foreign language learning. However, the relationship between motivation and educational achievement is not quite clear. In the current literature, motivation is regarded as socially constructed, therefore as dynamic rather than static. Little research has been conducted on the motivation of Vietnamese students studying English as a compulsory curriculum component rather than as a major from a socio-cultural perspective. Understanding the relationship between student motivation and academic achievement as well as the socio-cultural factors that affect students＇ motivation will be an important contribution to motivation theory. Therefore, the situation requires longitudinal and in-depth research into student motivation, the factors affecting it during the learning process, and the relationship between student motivation and academic achievement. A mixed method approach has been chosen to meet the needs of the study. It is believed that insights in these areas will help address the issue of motivation at the Police University.

Theories and Applications of Mixed Quantum-Classical Non-adiabatic Dynamics

Electronically non-adiabatic processes are essential parts of photochemical process, collisions of excited species, electron transfer processes, and quantum information processing. Various non-adiabatic dynamics methods and their numerical implementation have been developed in the last decades. This review summarizes the most significant development of mixed quantum-classical methods and their applications which mainly include the Liouville equa- tion, Ehrenfest mean-field, trajectory surface hopping, and multiple spawning methods. The recently developed quantum trajectory mean-field method that accounts for the decoherence corrections in a parameter-free fashion is discussed in more detail.

A simple physical mixing method for MnO2/MnO nanocomposites with superior Zn^2+storage performance

MnO2/MnO cathode material with superior Zn^2+storage performance is prepared through a simple physical mixing method.The MnO2/MnO nanocomposite with a mixed mass ratio of 12:1 exhibits the highest specific capacity(364.2 mA·h/g at 0.2C),good cycle performance(170.4 mA·h/g after 100 cycles)and excellent rate performance(205.7 mA·h/g at 2C).Analysis of cyclic voltammetry(CV)data at various scan rates shows that both diffusioncontrolled insertion behavior and surface capacitive behavior contribute to the Zn2+storage performance of MnO2/MnO cathodes.And the capacitive behavior contributes more at high discharge rates,due to the short paths of ion diffusion and the rapid transfer of electrons.

Design Hybrid Methods for Encoding Prior Knowledge in Feedforward Network with Application in Chemical Engineering

Three-layer feedforward networks have been widely used in modeling chemical engineering processes and prior-knowledge-based methods have been introduced to improve their performances.In this paper,we propose the methodology of designing better prior-knowledge-based hybrid methods by combining the existing ones. Then according to this methodology,two hybrid methods,interpolation-optimization (IO) method and interpolation penalty-function (IPF) method,are designed as examples.Finally,both methods are applied to modeling two cases in chemical engineering to investigate their effectiveness.Simulation results show that the performances of the hybrid methods are better than those of their parents.

Motion Capture for Puppet Control Using Integrated Sensor System

The paper aims to execute puppet without restrictions by controling puppet using robot. We controling puppet in the same way as the present puppet, but we perform this by robot. It offers more advantages and lessen the weak points. It needs various actions and expressions because of the nature of a puppet. The biggest problem which executes this is the ways to create a system. This thesis proposes motion capture of developed method with solution of this problem. So, we create various contents needed by puppet. In this part, developed method means a mixed method on the basis of optical system and magnetic system used mainly for the present method of motion capture. We lessen the weak points of each method and propoe solution of create motion for pupct by offering more advantages. So we solve difficulties of executing puppet and probable probkans when we execute puppet by using robot. The solution of this thesis is proven by applying control of puppet.

Intrusion Detection Algorithm Based on Density,Cluster Centers,and Nearest Neighbors

Intrusion detection aims to detect intrusion behavior and serves as a complement to firewalls.It can detect attack types of malicious network communications and computer usage that cannot be detected by idiomatic firewalls.Many intrusion detection methods are processed through machine learning.Previous literature has shown that the performance of an intrusion detection method based on hybrid learning or integration approach is superior to that of single learning technology.However,almost no studies focus on how additional representative and concise features can be extracted to process effective intrusion detection among massive and complicated data.In this paper,a new hybrid learning method is proposed on the basis of features such as density,cluster centers,and nearest neighbors(DCNN).In this algorithm,data is represented by the local density of each sample point and the sum of distances from each sample point to cluster centers and to its nearest neighbor.k-NN classifier is adopted to classify the new feature vectors.Our experiment shows that DCNN,which combines K-means,clustering-based density,and k-NN classifier,is effective in intrusion detection.

Through Pacific/Pasifika Lens to Understand Student＇s Experiences to Promote Success Within New Zealand Tertiary Environment

Traditionally, education environments are Eurocentric. They have reinforced ＂pedagogy of the oppressed＂ where Western knowledge is reflected in the university curriculum and ways of learning and teaching. Factors influencing success in learning remain an area of strong interest particularly in regard to non-traditional students in learning and teaching settings. This study explores the strategies undertaken by first, second, and third generation Paciflc/Pasifika students to overcome challenges whilst studying and utilizing services provided by staff in the Pasifika Learning Village at the Auckland University of Technology in New Zealand. The study adopted a mixed method approach that was adapted by integrating a Pasfika method of talanoa to understand their experiences so that their voices and stories on how they made it through a tertiary environment are heard and valued. Through Pacific/Pasifika lens, a cultural analysis of Pacific/Pasifika students＇ knowledge, values, and beliefs highlighted that supplementary cultural spaces, Pacific/Pasifika staff support, and valuing and acknowledging the social space relationships are imperative factors empowering them to succeed in a New Zealand tertiary setting. This paper argues that cultural pedagogies integrated into mainstream revealed successes that warrant recognition as they have demonstrated that traditional models within contemporary settings empower and enhance Pacific/Pasifika students＇ success.

Introduction and evaluation of a novel hybrid brattice for improved dust control in underground mining faces: A computational study

A proper control and management of dust dispersion is essential to ensure safe and productive underground working environment. Brattice installation to direct the flow from main shaft to the mining face was found to be the most effective method to disperse dust particle away from the mining face. However,it limits the movement and disturbs the flexibility of the mining fleets and operators at the tunnel. This study proposes a hybrid brattice system- a combination of a physical brattice together with suitable and flexible directed and located air curtains- to mitigate dust dispersion from the mining face and reduce dust concentration to a safe level for the working operators. A validated three-dimensional computational fluid dynamic model utilizing Eulerian–Lagrangian approach is employed to track the dispersion of dust particle. Several possible hybrid brattice scenarios are evaluated with the objective to improve dust management in underground mine. The results suggest that implementation of hybrid brattice is beneficial for the mining operation: up to three times lower dust concentration is achieved as compared to that of the physical brattice without air curtain.

Hybrid Differential Evolution for Estimation of Kinetic Parameters for Biochemical Systems

Determination of the optimal model parameters for biochemical systems is a time consuming iterative process. In this study, a novel hybrid differential evolution （DE） algorithm based on the differential evolution technique and a local search strategy is developed for solving kinetic parameter estimation problems. By combining the merits of DE with Gauss-Newton method, the proposed hybrid approach employs a DE algorithm for identifying promising regions of the solution space followed by use of Gauss-Newton method to determine the optimum in the identified regions. Some well-known benchmark estimation problems are utilized to test the efficiency and the robustness of the proposed algorithm compared to other methods in literature. The comparison indicates that the present hybrid algorithm outperforms other estimation techniques in terms of the global searching ability and the con- vergence speed. Additionally, the estimation of kinetic model parameters for a feed batch fermentor is carried out to test the applicability of the proposed algorithm. The result suggests that the method can be used to estimate suitable values of model oarameters for a comolex mathematical model.

A hybrid method for extraction of protein-protein interactions from literature

In this work, a hybrid method is proposed to eliminate the limitations of traditional protein-protein interactions （PPIs） extraction methods, such as pattern learning and machine learning. Each sentence from the biomedical literature containing a protein pair describes a PPI which is predicted by first learning syntax patterns typical of PPIs from training corpus and then using their presence as features, along with bag-of-word features in a maximum entropy model. Tested on the BioCreAtIve corpus, the PPIs extraction method, which achieved a precision rate of 64%, recall rate of 60%, improved the performance in terms of F1 value by 11% compared with the component pure pattern- based and bag-of-word methods. The results on this test set were also compared with other three extraction methods and found to improve the performance remarkably.

Selectivity of Parvalbumin B Protein Binding to Ca^(2+) and Mg^(2+) at an Ab Initio QM/MM Level Using the Reference-Potential Method

Ion selectivity in protein binding sites is of great significance to biological functions.Although additive force fields have been successfully applied to various protein-related studies,it is difficult to well capture the subtle metal-protein interaction for the prediction of ion selectivity,due to the remarkable polarization and charge transfer effect between the metals and the surrounding residues.Quantum mechanics-based methods are well-suited for dealing with these systems,but they are too costly to apply in a direct manner.In this work,the reference-potential method(RPM)was used to measure the selectivity for calcium and magnesium cations in the binding pocket of parvalbumin B protein by calculating the free energy change associated with this substitution reaction at an ab initio quantum mechanics/molecular mechanics(QM/MM)level.The alchemical transformations were performed at the molecular mechanics level,and the relative binding free energy was then corrected to the QM/MM level via thermodynamic perturbation.In this way,the free energy change at the QM/MM level for the substitution reaction was obtained without running the QM/MM simulations,thus remarkably enhancing the efficiency.In the reweighting process,we found that the selection of the QM region greatly affects the accuracy of the QM/MM method.In particular,the charge transfer effect on the free energy change of a reaction cannot be neglected.

Highlights in Museum Education

The aim of this paper is to research museum audience and its expectations, experiences, and influence on museum＇s practices at the Sinebrychoff Art Museum in Finland. The common idea is that museum pedagogy as a word creates easily an image of dusty, silent, and serious moment when the audience is forced to follow a lecture or a guided tour The author＇s research questions are： （I） Museum as an institution--what are the limits and possibilities to create highlights for audience work？ （2） How to look and talk about art for different audiences--also for non-visitors？ And （3） How can museum combine the knowledge of results and new technology to create more interesting approach for its audiences？ Participants of the author＇s research are teachers, students, senior citizens, and colleagues from other museums. Besides the literature the author uses mixed methods by combining visitor questionnaires （made during last ten years） and qualitative research made by narrative methods. Interviews have been made by H4 recorder. The qualitative analysis is going to be made by Atlas.ti. The results will finally be analyzed in 2014. Until now, it has become clear that museum experience mostly starts from the web pages. What can we offer, how to give value to our museum audience？

Teaching and Assessing Critical Thinking in Second Language Writing: An Infusion Approach

Recent calls for promoting students＇ critical thinking （CT） abilities leave second language （L2） teachers wondering how to integrate CT into their existing agenda. Framed by Paul and Elder＇s （2001） CT model, the study explores how CT could be effectively taught in L2 writing as a way to improve students＇ CT skills and L2 writing performance. In this study, an infusion approach was developed and implemented in actual classroom teaching. Mixed methods were employed to investigate： （1） the effectiveness of the infusion approach on improving students＇ CT and L2 writing scores; （2） the relationship between students＇ CT and L2 writing scores; and （3） the effects of the infusion approach on students＇ learning of CT and L2 writing. The results of the statistical analyses indicate that the infusion approach has effectively improved students＇ CT and L2 writing scores and that there was a significant positive relationship （r=0.893, p〈0.01） between students＇ CT and L2 writing scores. The results of the post-study interview illustrate that the infusion approach has beneficial effects on students＇ learning of CT and L2 writing by bridging the abstract CT theories and interactive writing activities and by integrating the instruction and practice of CT into those of L2 writing.