Clean-energy utilization technology in the transformation of existing urban residences in China

Clean-energy substitution technology for existing residential buildings in cities is an inevitable choice for sustainable development and low-carbon ecological city construction.In this paper,the current status of energy-saving renovation and renewable-energy applications for existing residential buildings in various cities in China was summarized by using statistical methods.The geographical distribution of clean-energy power generation in primary energy production in China was explored in depth.According to different climatic divisions for existing urban residences,clean-energy production and consumption were analyzed and predicted based on the STIRPAT model.The results show that the energy consumption of urban residential buildings in 2016 increased by 43.6%compared with 2009,and the percentage of clean energy also increased from 7.9%to 13.4%.Different climatic regions have different advantages regarding clean energy:nuclear power generation leads in the region that experiences hot summers and warm winters,whereas wind and solar power generation lead in the cold and severely cold regions.The present results provide basic data support for the planning and implementation of clean-energy upgrading and transformation systems in existing urban residences in China.

Geochemical and Isotopic Techniques Constraints on the Origin,Evolution,and Residence Time of Low-enthalpy Geothermal Water in Western Wugongshan,SE China

Geothermal resources are increasingly gaining attention as a competitive,clean energy source to address the energy crisis and mitigate climate change.The Wugongshan area,situated in the southeast coast geothermal belt of China,is a typical geothermal anomaly and contains abundant medium-and low-temperature geothermal resources.This study employed hydrogeochemical and isotopic techniques to explore the cyclic evolution of geothermal water in the western Wugongshan region,encompassing the recharge origin,water-rock interaction mechanisms,and residence time.The results show that the geothermal water in the western region of Wugongshan is weakly alkaline,with low enthalpy and mineralization levels.The hydrochemistry of geothermal waters is dominated by Na-HCO_(3)and Na-SO_(4),while the hydrochemistry types of cold springs are all Na-HCO_(3).The hydrochemistry types of surface waters and rain waters are NaHCO_(3)or Ca-HCO_(3).The δD and δ^(18)O values reveal that the geothermal waters are recharged by atmospheric precipitation at an altitude between 550.0 and 1218.6 m.Molar ratios of maj or solutes and isotopic compositions of^(87)Sr/^(86)Sr underscore the significant role of silicate weathering,dissolution,and cation exchange in controlling geothermal water chemistry.Additionally,geothermal waters experienced varying degrees of mixing with cold water during their ascent.Theδ^(13)C values suggest that the primary sources of carbon in the geothermal waters were biogenic and organic.Theδ^(34)S value suggests that the sulfates in geothermal water originate from sulfide minerals in the surrounding rock.Age dating using 3H and^(14)C isotopes suggests that geothermal waters have a residence time exceeding 1 kaBP and undergo a long-distance cycling process.

Particle residence time distribution and axial dispersion coefficient in a pressurized circulating fluidized bed by using multiphase particle-in-cell simulation

The particle residence time distribution(RTD)and axial dispersion coefficient are key parameters for the design and operation of a pressurized circulating fluidized bed(PCFB).In this study,the effects of pressure(0.1-0.6 MPa),fluidizing gas velocity(2-7 m·s^(-1)),and solid circulation rate(10-90 kg·m^(-2)·s^(-1))on particle RTD and axial dispersion coefficient in a PCFB are numerically investigated based on the multiphase particle-in-cell(MP-PIC)method.The details of the gas-solid flow behaviors of PCFB are revealed.Based on the gas-solid flow pattern,the particles tend to move more orderly under elevated pressures.With an increase in either fluidizing gas velocity or solid circulation rate,the mean residence time of particles decreases while the axial dispersion coefficient increases.With an increase in pressure,the core-annulus flow is strengthened,which leads to a wider shape of the particle RTD curve and a larger mean particle residence time.The back-mixing of particles increases with increasing pressure,resulting in an increase in the axial dispersion coefficient.

Plain language in the healthcare of Japan:a systematic review of“plain Japanese”

Objective:Despite the decrease in the number of foreign visitors and residents in Japan due to the coronavirus disease 2019,a resurgence is remarkable from 2022.However,Japan's medical support system for foreign patients,especially residents,is inadequate,with language barriers potentially causing health disparities.Comprehensive interpretation and translation services are challenging,but“plain Japanese”may be a viable alternative for foreign patients with basic Japanese language skills.This study explores the application and obstacles of plain Japanese in the medical sector.Methods:A literature review was performed across these databases:Web of Science,PubMed,Google Scholar,Scopus,CINAHL Plus,Springer Link and Ichushi-Web(Japanese medical literature).The search covered themes related to healthcare,care for foreign patients,and scholarly articles,and was conducted in July 2023.Results:The study incorporated five papers.Each paper emphasized the language barriers foreign residents in Japan face when accessing healthcare,highlighting the critical role and necessity of plain Japanese in medical environments.Most of the reports focused on the challenges of delivering medical care to foreign patients and the training of healthcare professionals in using plain Japanese for communication.Conclusion:The knowledge and application of plain Japanese among healthcare professionals are inadequate,and literature also remains scarce.With the increasing number of foreign residents in Japan,the establishment of a healthcare system that effectively uses plain Japanese is essential.However,plain Japanese may not be the optimal linguistic assistance in certain situations,thus it is imperative to encourage more research and reports on healthcare services using plain Japanese.

Assessment of Online Transgender Healthcare Teaching Modules for Internal Medicine Residents and Fellows

Background: Transgender healthcare is not a formal learning requirement in Internal Medicine residency or fellowship. The National LGBTQ Task Force appealed to urgently train clinicians on the effective care of transgender patients. Few studies address the successful implementation of transgender healthcare teaching and education in graduate medical education. Purpose: The purpose was to design an online asynchronous curriculum to address the need for improved transgender healthcare education in graduate medical education and assess change in knowledge and comfort in transgender healthcare for residents and fellow learners. Methods: A 6-module curriculum was developed using established guidelines and ACGME competencies as a framework for content. To assess curriculum effectiveness, participants received anonymous pre- and post-curriculum surveys which included a multiple-choice knowledge assessment, Likert scale comfort questions focusing on healthcare skills, and open-ended feedback questions. Results: Twenty-six internal medicine residents and fellows participated in the curriculum (2022-2023). There was a 69% post-survey response rate. Participants improved their gender-affirming knowledge after completing the curriculum (p Conclusion: This online curriculum was successful in increasing knowledge and comfort in transgender care for IM residents and fellows. It provides a promising framework to address this gap in curricular content.

Empowerment Mechanisms and Empirical Evidence of Payment Technology in Capacity Expansion and Quality Improvement of Residents’Consumption

The time-varying difference-in-difference model is used to identify the impact of payment technology on residents’consumption,and the moderation effect analysis method is used to identify its mechanism.It is found that payment technology promotes consumption capacity expansion and quality improvement(CEQI)through three pathways of alleviating liquidity constraints,reducing transaction costs and weakening the payment of pain.The parallel and serial mechanisms of the three are further explored.The effect of payment technology on the CEQI of residents’consumption shows obvious heterogeneity due to differences in urban and rural household registration and financial literacy.Based on the empirical research results and the national conditions of China,targeted policy recommendations are proposed from the demand side,the supply side and the technological side.

Associations between residence and cognitive function among Chinese older adults: the mediating role of leisure activity

Background:Cognitive function is a current research hotspot,residence may be related to differences in cognitive function,and the mediating role of leisure activities are limited in Chinese research.This study used leisure activities as a mediating variable to investigate the mediating role of leisure activity between place of residence(city-town-rural)and cognitive function among Chinese older,this is where the innovation of the article comes in.Methods:Using cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey,Pearson correlation analyses were employed to examine the relationships among various indicators.Mediation analyses were conducted using the SPSS PROCESS macro program,version 3.5,written by Hayes,to explore the mediating effects of leisure activity between place of residence and cognitive function in older adults.Results:A total of 10955 older adults were included in this study,with a mean age of(84.23±11.57)years.Among them,2739(24.8%)lived in the city,3627(33.1%)in town,and 4615(42.1%)in rural areas;their leisure activity score was(5.34±3.77),and their cognitive function score was(24.69±6.65).Place of residence,leisure activities,and cognitive function were significantly correlated(P<0.01).Using city as a reference,place of residence is negatively associated with cognitive function,and place of residence not only had a direct effect on cognitive function in older adults:town-cognitive function(effect=–0.399;95%confidence interval(CI)=(–0.685,–0.113));rural-cognitive function(effect=–0.42;95%CI=(–0.698,–0.141)).There were also indirect effects on cognitive function through the pathway of leisure activity:town-leisure activity-cognitive function(effect=–0.17;95%CI=(–0.246,–0.1)),rural-leisure activity-cognitive function(effect=–0.199;95%CI=(–0.272,–0.13)).Conclusion:Leisure activities play a partially mediating role between the impact of place of residence and cognitive function in Chinese older adults,and it is vital to pay attention to the impact of place of residence on the cognitive function of older adults in various aspects,and to increase the participation rate of older adults in leisure activities,which is beneficial to the prevention of cognitive decline and the protection of older adult’s physical and mental health.

“大带小”教学模式在肌电图临床教学中的探索及效果评价

目的探索“大带小”教学(near peer learning,NPL)模式在神经科住院医师一阶段规范化培养(下文简称“规培”)“肌电图”学习模块中的实施效果。方法北京协和医院神经科于2020年11月至2024年3月期间在北京市一阶段规培生神经系统辅助检查教学中探索实施NPL教学模式。具体教学方法:每年1次,主要以第三年规培生作为“主讲”,第一、二年规培生作为“学员”进行肌电图学习,客观评价方式为随机抽取试卷进行入口和出口理论测试,对比规培生培训前后成绩变化;主观评价方式为规培生通过问卷对课后学习感受进行多维度评分,以了解该模式对其专业知识、自信程度等方面的作用。结果研究期间共开展4次NPL教学,累计83人次规培生参加了该教学项目。其中,临床医学博士后24人次,专业型研究生52人次,基地规培生7人次。结果显示,规培生出口平均成绩显著高于入口成绩[(74.33±2.43)分比(70.11±2.49)分,P=0.005]。亚组分析显示,作为“学员”的规培生[(73.84±20.53)分比(70.29±21.46)分,P=0.020]、专业型研究生[(74.04±22.51)分比(68.97±21.40)分,P=0.009]、第一年规培生[(70.19±4.02)分比(63.59±3.59)分,P=0.040]、第一次参加该课程的规培生[(65.23±3.24)分比(60.97±3.21)分,P=0.030]其出口成绩较入口成绩提高显著。问卷调查结果显示,96.69%的“学员”规培生对课程内容、形式及效果表示满意或很满意,100%的规培生感觉“能力有实质性提高”。结论NPL模式有助于神经科住院医师一阶段规培学员夯实神经系统辅助检查相关基础知识,提高解决临床实际问题的能力,值得在其他教学项目和教学基地中推广应用。

基于德尔菲法的全科住院医师临床思维能力评价体系构建研究

背景全科医学的临床思维基于全科医学专业的自身特点,有其独特性,要求全科医师具备“以患者为中心”的临床诊断和治疗技能。为了更好地反映出全科临床住院医师的临床思维能力,需要建立一套完善的、可以反映出其全方面能力的有效评价标准,目前尚无适用于衡量全科住院医师临床思维能力的评价体系。目的通过德尔菲法(Delphi法)构建全科住院医师以岗位胜任力为导向的临床思维能力评价体系。方法2021年12月—2022年2月,本课题组基于文献研究初步构建了全科住院医师临床思维能力指标体系框架,运用Delphi法,与12位专家进行了两轮深入沟通,就指标的重要性给出客观评估,筛选出合适的指标,并运用层次分析法确定每个指标的权重。结果通过两轮专家咨询,本课题组建立了一个综合性的评估体系,其中包括5个一级指标(临床知识学习和扩展、资料收集和利用、诊断分析和利用、治疗决策能力、沟通和合作能力)以及30个二级指标。两轮咨询问卷有效回收率达到100.0%,专家权威系数为0.85,一级和二级指标的专家协调系数分别达到了0.299和0.189(P<0.01),一级指标的权重分别为0.198、0.198、0.227、0.227、0.150。结论本研究使用Delphi法建立一个全面评价住院医师临床思维能力的评估体系。经过对结果数据分析可知该评估体系具有较高的权威性和科学性,为今后培养高质量全科住院医师,提升全科医学教学质量提供了参考。

2024年浙江省≥50岁城乡居民流感疫苗接种意愿及影响因素分析

目的分析2024年浙江省≥50岁城乡居民流感疫苗接种意愿及影响因素。方法本研究为横断面研究。于2024年3月至5月在浙江省90个县(市、区)中选取35个县(市、区)、175个社区/村,采用多阶段拦截调查的方法在当地医院、社区卫生服务中心/社区卫生院中前去就诊的居民进行问卷调查,内容包括基本情况、流感防治知识、慢性病患病情况、流感疫苗接种情况以及接种意愿等。根据调查对象户口所在地,依据国家统计局制定的《统计用区划代码和城乡划分代码编制规则》对城乡居民进行划分。采用χ^(2)检验、方差分析、多元logistic回归模型分析居民流感疫苗接种意愿及影响因素。结果共调查10500例,其中,农村居民4885例(46.52%),城镇居民5615例(53.48%);农村居民、城镇居民愿意接种流感疫苗者分别有3430例(70.21%)和3718例(66.22%);多元logistic回归模型分析结果显示,对于≥50岁农村居民,年龄较小(50~59岁组:OR=1.747,95%CI:1.290~2.366;60~69岁组:OR=1.838,95%CI:1.401~2.411)、有流感疫苗接种史(OR=6.721,95%CI:5.152~8.767)、医生推荐(OR=3.788,95%CI:3.078~4.662)、流感防治知识得分高(OR=1.090,95%CI:1.054~1.128)是接种流感疫苗意愿的促进因素;对于≥50城镇居民,60~69岁年龄组(OR=1.264,95%CI:1.023~1.563)、有流感疫苗接种史(OR=5.392,95%CI:4.309~6.748)、医生推荐(OR=5.307,95%CI:4.420~6.371)、流感防治知识得分高(OR=1.051,95%CI:1.021~1.082)是接种流感疫苗意愿的促进因素。结论浙江省≥50岁城乡居民流感疫苗接种意愿较高,但还有待进一步提高。年龄、流感疫苗接种史、医生是否推荐以及流感防治知识得分是影响流感疫苗接种意愿的因素。

中医住培过程考核体系构建

我国已全面启动新的住院医师规范化培训制度,并取得了一定成效,然而目前还存在培训模式偏西化、理论学习轻基础、考核模式轻过程和管理模式未分层等不足。考核是住院医师规范化培训管理的重要组成部分,其结果是衡量基地与住院医师规范化培训学员培养质量的客观指标,其中的过程考核是重中之重。浙江中医药大学附属第三医院作为首批国家中医住院医师规范化培训基地,按照上级主管部门相关文件要求建立了过程考核体系,制定了规范的考核管理制度,采取规范日常考核、严肃出科考核、增设季度考核、设置专项考核、组织年度考核、落实绩效考核等相关举措,多管齐下,保证培训质量。

多学科综合治疗模式在肾内科住院医师规范化培训教学中的应用研究

目的:探讨多学科综合治疗(MDT)模式在肾内科住院医师规范化培训中的应用效果。方法:选取2021—2022年在新乡医学院第一附属医院肾内科进行规范化培训的208名住院医师、12名带教老师和268名住院患者作为研究对象,根据教学模式不同分为MDT实验组和传统对照组。针对住院医师进行问卷调查及出科考核,针对带教老师及患者进行问卷调查,分析MDT模式的应用效果。结果:MDT实验组住院医师在理论考试、临床实践能力、临床思维能力、医患沟通能力、文献查阅能力和协作能力方面成绩均优于传统对照组,差异均有统计学意义(χ^(2)=13.645、10.169、6.226、26.426、12.794、9.669,P<0.05)。在科研工作方面,MDT实验组带教老师在投入时间、投入精力和科研产出均多于传统对照组,差异均有统计学意义(χ^(2)=7.118、7.118、6.902,P<0.05)。MDT实验组患者临床诊疗效果、医患沟通方式和医患沟通效果满意度均高于传统对照组,差异均有统计学意义(χ^(2)=6.342、16.244、16.395,P<0.05),且MDT实验组患者对多学科会诊满意度几乎均为优秀。结论:MDT模式既能保证教学质量,又能兼顾医教研协同发展,还可提高患者满意度。

消费基础设施建设对居民消费同群效应的影响研究

本文基于相对收入消费理论,利用家庭微观数据,实证分析了居民消费基础设施对消费同群效应的影响。结果表明:第一,居民消费观念受生活环境因素影响,消费基础设施完善可显著提高居民消费的同群效应;第二,作用机制分析发现,消费基础设施建设可通过促进居民消费结构升级和丰富居民社会网络来提高居民消费的同群效应;第三,消费基础设施建设对不同类型家庭消费的影响具有显著异质性,城镇家庭、中等收入家庭消费的同群效应受影响更大。因此,建议完善现代化消费基础设施体系,促进消费基础设施升级,并健全消费基础设施建设激励制度。

年龄结构、人口出生率与居民消费

研究基于我国1998—2021年的省级面板数据,考察年龄结构、人口出生率对居民消费的影响,并通过构建三变量交互项的双向固定效应模型进一步探究人口出生率的调节效应。结果表明:(1)少儿抚养比对居民消费有显著的促进作用,而老年抚养比有显著的抑制作用;(2)人口出生率对年龄结构与居民消费关系有显著的调节效应,它会通过改变居民消费结构、弱化收入对消费的正向效应和降低居民预防性储蓄这三个渠道起到调节作用;(3)人口出生率对年龄结构与居民消费关系的调节作用存在区域异质性和政策异质性。研究可为我国促进人口长期均衡发展,缓解人口老龄化,充分释放居民消费潜力,制定相关政策提供参考依据。

内分泌专业住院医师规范化培训现状分析和建议

内分泌专业作为医学的一个重要分支,其内容涉及人体内分泌腺及其分泌的激素与机体代谢、生长发育、生殖衰老、疾病等生理、病理过程。内分泌专业的医师不仅需要深厚的医学知识,还需对病理生理过程有深刻理解,以便能够准确诊断和治疗各种内分泌疾病。为切实提升内分泌科专科医师的整体素质和医疗服务水平,充分保障患者的根本权益,培养具有扎实的内分泌与代谢病专科理论知识和操作技能,同时积累一定的临床诊断和治疗工作经验的医师显得迫切且重要。住院医师规范化培训是提升医师临床技能和专业知识的重要途径。然而,目前住院医师规范化培训在内分泌专业领域仍存在一些问题,例如培训内容可能与临床实际需求存在脱节、培训时间可能不足以让住院医师充分掌握所需技能以及培训质量参差不齐等。本文通过对内分泌专业住院医师规范化培训现状进行分析以及给出相应的建议,以提升内分泌专业住院医师的临床能力,确保医疗质量和安全,为推动内分泌专业的发展和提升整体医疗服务水平提供参考。

新疆和田地区社区居民心理健康服务需求现状及影响因素

目的:了解和田地区社区居民心理健康服务需求状况并探讨其影响因素,为开展心理健康服务工作提供科学依据。方法:抽取和田地区4个不同县市8个社区1600名社区居民为调查对象,使用自编的社区居民心理健康服务需求问卷进行调查。了解社区居民在服务态度、服务内容、服务方式、服务途径、服务人员、服务机构方面的需求,运用多元线性回归分析的方法分析心理健康服务需求的影响因素。结果:和田地区社区居民对心理健康服务需求的总均值为2.90。86.1%社区居民希望社区心理健康服务中心提供心理健康服务,83.8%社区居民希望社区心理健康服务人员提供心理健康服务。居住在农村的居民对心理健康服务需求的得分最高(F=37.954,P<0.001);受教育程度为初中及以下和高中的居民对心理健康服务需求的得分较高(F=13.260,P<0.001);月收入在2000元以下和2000~3999元的居民对心理健康服务需求的得分较高(F=13.748,P<0.001);已婚居民比未婚居民对心理健康服务需求的得分高(F=3.236,P<0.05)。多元线性回归分析显示:居住地(镇中心区)、居住地(镇乡结合区)、居住地(主城区)、婚姻状况(已婚)、月收入水平是影响居民对心理健康服务需求的主要因素。B值及其95%CI分别为-0.170(-0.236~-0.103)、-0.429(-0.519~-0.340)、-0.336(-0.409~0.263)、0.115(0.037~0.192)、-0.051(-0.083~-0.019)。结论:和田地区社区居民心理健康服务需求较高,居民选择社区心理健康服务中心及人员提供心理健康服务的比例较大。低学历、低收入、农村、已婚居民对心理健康服务的需求较大。居住地、婚姻状况、月收入水平是居民心理健康服务需求的主要影响因素。

虚拟仿真模式教学对提高麻醉住培医生临床思维能力的思考

临床思维能力是医学生专业发展中非常重要的一部分,它关系到医生对病人病情的准确诊断和有效治疗。医学虚拟仿真教学是一种新兴的医学教学方法,是一种利用计算机技术模拟真实医疗环境和医疗过程的教学方法。因通过创建虚拟的患者、医疗设备和操作环境,让学生能够在没有实际患者的情况下进行学习和实践而备受关注。本文就虚拟仿真模式教学对提高麻醉学本科生临床思维能力进行探讨,明确虚拟仿真教学模式在医学教育中的独特优势,旨在更好地推动虚拟仿真教学模式在麻醉住培医学生教育中的应用,帮助学生在进入临床学习期间能通过实践提高自身临床思维及临场反应能力。最终能应用于临床实践中,达到提高患者安全性和医疗质量的目的。

影响住培教师实施形成性评价的因素分析

目的探讨影响住院医师规范化培训临床教师形成性评价(formative assessment,FA)实施的因素。方法回顾性选取2023年3—6月南京大学医学院附属鼓楼医院参加住院医师规范化培训的234名带教老师的问卷调查结果,分析住培带教老师对形成性评价的理解程度、形成性评价实施情况和影响临床教师形成性评价实施的因素。结果234名接受调查的带教老师中,非常熟悉形成性评价占10.68%(25/234),熟悉形成性评价占44.02%(103/234),了解形成性评价的占33.33%(78/234);其中23.50%(55/234)常规实施形成性评价;31.62%(74/234)偶有实施形成性评价。影响临床教学中形成性评价实施的多种因素中自我效能是影响住培带教老师形成性评价实施的主要个人因素(89/234,38.03%);内部支持性教学政策是影响住培带教老师形成性评价实施的主要外部因素(105/234,44.87%)。结论自我效能和内部支持性教育政策是影响住培带教老师形成性评价实施的最主要的个人因素和外部因素。

收入不平衡、共享发展与居民幸福感

改革开放以来,我国经济发展取得了举世瞩目的成就,但收入不平衡和共享发展程度较低的问题仍然较为突出,这在一定程度上不利于居民幸福感的提升.采用中国家庭追踪调查数据,实证检验了收入不平衡、共享发展与居民幸福感之间的关系.研究发现,收入不平衡与居民幸福感之间存在非线性的倒U型关系,并且共享发展发挥了重要的调节效应,使得共享发展程度较高的群体对收入不平衡更加包容,而且更易发挥收入不平衡对居民幸福感的提升作用.精准扶贫、乡村振兴和社会保障支出等政策也有助于提升居民幸福感对收入不平衡的包容度.因此,政府相关部门应积极实施有效举措降低收入不平衡、多措并举提升共享发展水平并着力落实扶贫类和保障类政策,进一步提升居民家庭的幸福感,加快实现共同富裕的伟大目标.

港澳居民来粤公立医院就医服务的SWOT分析及对策探讨

在粤港澳大湾区一体化发展背景下,港澳居民来粤就医需求持续增长。广东公立医院作为广东医疗服务供给的主力军,本文旨在探讨该群体发展港澳居民来粤就医的现状,并基于医院视角提出发展对策,以助力大湾区一体化发展事业。本文采用SWOT方法,系统评估广东公立医院在发展港澳居民来粤就医服务方面的优势、劣势、机会与威胁,并构建SWOT矩阵以制定发展对策。分析显示广东公立医院具有交通便利、文化亲近、医疗资源丰富、服务效率高且费用较低等优势;面临医保跨境可携政策覆盖不足、专项诊疗服务不成熟、服务标准不统一、跨境医疗探索不足等劣势;同时,国家战略支持和市场需求旺盛提供了发展机会,而市场竞争激烈和三地医疗规则衔接缓慢构成了外部威胁。针对分析结果,本文提出了加强宣传与产业合作创新、业务分步发展、争取政策覆盖、强化业务统筹、加快与港澳办医合作以及推进医院国际化评审等对策建议,为广东的公立医院群体发展面向港澳居民的医疗服务业务提供了决策参考。