Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

A case study of performance-based pavement maintenance and rehabilitation needs assessment in Pennsylvania

This paper presents the theory,method,and application of performance-based pavement needs assessment at a state level,using the Pennsylvania Interstate System as an example.First,a general framework is presented for the pavement asset management and a general optimization model is established for the pavement maintenance and rehabilitation needs assessment.Also,the bundling of pavement segments for the project implementation is discussed.Using the examples of Statewide Transportation Improvement Plan and Long Range Transportation Plan for Pennsylvania Interstate System,the application of performance-based pavement needs assessment is demonstrated.It is shown that unconstrained analysis can help decision-makers investigate the real maintenance and rehabilitation needs;financially-constrained analysis can help decision-makers select projects for implementation and examine the corresponding future pavement conditions.Trade-off analysis can help decision-makers investigate the outcomes of different investment levels on pavement maintenance and rehabilitation and make the final decision on the investment level.The proposed case study provides a good example of performance-based pavement needs assessment for developing countries.

Multi-objective optimization in highway pavement maintenance and rehabilitation project selection and scheduling:A state-of-the-art review

The motivation for cost-effective management of highway pavements is evidenced not only by the massive expenditures associated with these activities at a national level but also by the consequences of poor pavement condition on road users.This paper presents a state-of-the-art review of multi-objective optimization(MOO)problems that have been formulated and solution techniques that have been used in selecting and scheduling highway pavement rehabilitation and maintenance activities.First,the paper presents a taxonomy and hierarchy for these activities,the role of funding sources,and levels of jurisdiction.The paper then describes how three different decision mechanisms have been used in past research and practice for project selection and scheduling(historical practices,expert opinion,and explicit mathematical optimization)and identifies the pros and cons of each mechanism.The paper then focuses on the optimization mechanism and presents the types of optimization problems,formulations,and objectives that have been used in the literature.Next,the paper examines various solution algorithms and discusses issues related to their implementation.Finally,the paper identifies some barriers to implementing multi-objective optimization in selecting and scheduling highway pavement rehabilitation and maintenance activities,and makes recommendations to overcome some of these barriers.

荷兰人工育滩工程Sand Motor的经验与启示

海岸侵蚀已成为砂质海岸重要灾害之一,世界各国都致力于海滩防护。荷兰由于地势低洼,在护滩工程中进行大量尝试,于2011年在代尔夫兰海岸开展创新性人工育滩工程即Sand Motor,单个工程补沙总量达2.15×107 m3。持续监测结果显示,工程建成后的沙滩形态与模拟结果基本吻合,沙量损失速度低于预期。阶段性评价结果表明,Sand Motor通过波浪、海流等向海滩缓慢输沙,稳定海岸沙滩和海岸沙丘,具有防护效果显著、成本较低、使用寿命长、增加海岸利用等优点,值得我国借鉴。

Sustainable Maintenance of Rural Roads in Slovakia

Systematic approach to the maintenance of rural road network is a very important issue from the viewpoint of public costs. Most countries developed custom PMS （pavement management systems） based on deterministic or probabilistic approach. The main goal is to ensure safety and continuity of road traffic on road network with low intensity and lower technical requirements. Article presents PMS used for Slovakia rural road network based on road construction diagnostics, traffic volume, climate factors and evaluation of maintenance works economics effectives by using of software tools like HDM-4 developed by World Bank. Local road administrators of rural road networks often lack the software equipment, most PMS, however effective, are often cumbersome, demanding in regard to energy, know-how and software equipment. The majority of local road administrators of rural road networks thus resort to non-effective reactive maintenance strategies. This article describes an easy to use method, based on predetermined maintenance repair and rehabilitation standards. A simple method, based on road user cost, is introduced that administrator can use to prepare a list of road section eligible for repair according to their repair priority.

Retro-Analysis of Rehabilitation of Existing Bridge over the River Cubiculo on Federal Highway BR-101, Brazil

This work describes the retro-analysis of design of rehabilitation of existing bridge over the river Cubiculo on BR-101 in Santa Catarina, Brazil, aiming to evaluate the intervention processes. In this way, it was verified that the project adopted for strengthening of the structure was not adequate to support the evolution of the maximum load over time and the overload due to widening, and it was also verified that the changes in the load factor do not comply with the update of the Brazilian Technical Standards ABNT： NBR-7188 [1]. The retro-analysis of the bridge rehabilitation project has demonstrated fundamental importance to avoid possible design failings, accidents, and reworks. Affirming that it is essential to comply with Standards and Technical Manuals on the elaboration of the rehabilitation project of structures and in choosing the type of intervention to the existing structure.

A systematic review of steel bridge deck pavement in China

As an important part of steel bridge deck,the engineering quality and service condition of steel bridge deck pavement(SBDP)directly affects the capacity and operational efficiency of the bridge.This paper reviews the history of the development of SBDP in China over the past 20 years from the exploration stage,rapid development stage and prosperity stage.The development and application of SBDP at different stages are discussed in terms of materials,structure,design,performance evaluation,maintenance and rehabilitation,respectively.The advantages and disadvantages of different pavement materials and structures,and the application of different research methods are summarized.The review shows that the improvement of pavement materials and structures and the development of new materials should be further studied on the multi-scale to enhance the durability of pavement materials,so as to extend the service life of pavements.The design method of SBDP related to the synergistic effect of vehicle,pavement and bridge should be established,and the design concept and method standard of rigid base pavement structure should be improved and formulate a complete design standard.In addition,multi-disease intelligent identification system and equipment should be studied to track the entire course of disease development in real time.And it is necessary to develop appropriate algorithms to select and classify the complex data of disease and maintenance history.

MBE与TBE模式在《运动医务监督》课程中的应用效果研究

目的 探讨保留式双语教学(maintenance bilingual education,MBE)和过渡式双语教学(transitional bilingual education,TBE)模式在运动康复专业《运动医务监督》课程教学中的应用效果,为普通高校双语教学模式的选择提供合理化建议。方法 于2022年8月—2023年1月,选择锦州医科大学运动康复专业2021级两个自然班各26名、27名学生为研究对象,分为试验组和对照组。试验组采用MBE模式,对照组采用TBE模式。通过问卷调查的方式对两组学习效果、学习满意度、对专业知识的学习等方面进行评估。结果 经实验教学研究及分析,将试验组和对照组期末考试成绩进行分段,显示达到良好以上者试验组的比例为66.7%,对照组的比例为53.8%,试验组的良好率高于对照组;试验组有1名同学达到优秀,对照组没有;及格区间内,试验组为1名(3.7%),对照组为3名(11.5%)。2组均没有不及格学生。试验组和对照组的期末成绩:试验组为(81.83±5.09)分,对照组为(78.75±4.73)分,试验组高于对照组,差异有统计学意义(P <0.05)。结论 对于普通高校而言,从考核成绩、学生满意度等方面来看,MBE模式的教学效果均优于TBE模式。目前主要存在的问题是中英文对照教材的缺失,授课形式方面需要教师在多媒体课件、预习资料、课堂表达英语占用比例等方面加以改进。

Preface for the special issue on ＂Maintenance and Rehabilitation of Pavements＂

The International Society for Maintenance and Rehabilitation of Transport Infrastructures （iSMARTi）, the National University of Singapore and the Pavement Engineering Society （Singapore） jointly organized the 8th International Conference on Maintenance and Rehabilitation of Pavements （MAIREPAV- 8） in Singapore on 27-291uly 2016. The conference covered all aspects of maintenance and rehabilitation of road and airport pavements. Over 200 participants from 32 countries participated in this conference, which featured more than 120 technical presentations and two forums.

MHD患者的康复运动意愿、态度及运动意愿的影响因素分析

目的分析维持性血液透析(MHD)患者的康复运动意愿、态度及运动意愿的影响因素.方法选取2019年7月—2020年7月本院收治的169例MHD患者为研究对象.采用自制康复运动意愿问卷调查MHD患者的康复运动意愿,MHD自评量表调查运动态度,分析运动意愿的影响因素.结果169例MHD患者中,40.83%的患者对康复运动了解,44.38%的患者进行主动锻炼,57.39%的患者愿意参加康复运动,但希望参加专业机构开展的康复运动占比仅为34.91%.169例MHD患者中,MHD自评量表康复运动优势调查结果显示,认为康复运动存在至少一项优势占比为96.45%,改善生活质量、缓解末梢循环、保持积极心态是康复运动的3个显著优势;MHD自评量表康复运动的阻碍因素调查结果显示,认为康复运动存在至少一项阻碍占比为89.94%,担心不安全、身体虚弱、没有专业人员指导是康复运动的3个显著阻碍.两组的合并心血管疾病、高血压、贫血情况比较,组间差异有统计学意义(P<0.05).经Logistic回归分析,合并心血管疾病、高血压、贫血均是MHD患者康复运动意愿的影响因素.结论MHD患者的康复运动意愿不容乐观,健康宣教时应强调康复运动对患者身心健康和生活质量的积极影响,以及康复运动的个体化、专业指导、安全性,运动意愿的影响因素包括合并心血管疾病、高血压、贫血.

Survival Analysis Using Cox Proportional Hazards Regression for Pile Bridge Piles Under Wet Service Conditions

This paper studies the deterioration of bridge substructures utilizing the Long-Term Bridge Performance(LTBP)Program InfoBridge^(TM)and develops a survival model using Cox proportional hazards regression.The survival anal­ysis is based on the National Bridge Inventory(NBI)dataset.The study calculates the survival rate of reinforced and prestressed concrete piles on bridges under marine conditions over a 29-year span(from 1992 to 2020).The state of Maryland is the primary focus of this study,with data from three neighboring regions,the District of Columbia,Vir­ginia,and Delaware to expand the sample size.The data obtained from the National Bridge Inventory are condensed and filtered to acquire the most relevant information for model development.The Cox proportional hazards regres­sion is applied to the condensed NBI data with six parameters:Age,ADT,ADTT,number of spans,span length,and structural length.Two survival models are generated for the bridge substructures:Reinforced and prestressed concrete piles in Maryland and reinforced and prestressed concrete piles in wet service conditions in the District of Columbia,Maryland,Delaware,and Virginia.Results from the Cox proportional hazards regression are used to construct Markov chains to demonstrate the sequence of the deterioration of bridge substructures.The Markov chains can be used as a tool to assist in the prediction and decision-making for repair,rehabilitation,and replacement of bridge piles.Based on the numerical model,the Pile Assessment Matrix Program(PAM)is developed to facilitate the assessment and main­tenance of current bridge structures.The program integrates the NBI database with the inspection and research reports from various states’department of transportation,to serve as a tool for condition state simulation based on mainte­nance or rehabilitation strategies.

医护-社工联动康复模式对美沙酮维持治疗患者心理状况的影响

目的 探究医护-社工联动康复模式对美沙酮维持治疗患者心理状况的影响。方法 纳入94例美沙酮维持治疗服务的患者,随机分为观察组(48例)和对照组(46例)。对观察组运用医护-社工联动康复模式进行个体化干预,对照组则运用常规美沙酮治疗服务模式进行干预。分别在干预前、干预3个月及6个月三个时间点对两组受试者的焦虑状态、抑郁状态及生活质量进行评估。结果 观察组受试者在接受医护-社工联动康复模式干预6个月后在抑郁状态和焦虑状态方面均较干预前显著改善,并且无论是BDI评分和BAI评分均显著低于对照组(P <0.05)。同时,观察组受试者中“有抑郁”的人数占比和“有焦虑”的人数占比均显著低于对照组(P <0.05)。干预6个月后,观察组受试者的生活质量评分(183.77±8.90)显著高于对照组(174.76±11.14)(P <0.01)。结论 医护-社工联动康复模式在改善美沙酮维持治疗患者的心理状态方面具有一定的优越性,值得被推广应用。

新型冠状病毒感染疫情中医肺养生康复思路探讨

新型冠状病毒感染(corona virus disease 2019,COVID-19)(简称新冠感染)疫情中医肺养生康复以“辨质养生”“辨症/证康复”等中医理论基础为支撑,凭借中医养生康复“形神兼顾,标本同治”“三因制宜,辨证论治”“疗养结合,调节康复”优势,以“五脏相关,以肺为要”“肺体金魄,形神共养”“天人合一,杂合以治”为整体原则,采用鼻部保养、肠道调护、中药、针灸、按摩、气功等基本方法,缩短患者康复时间、有序回归社会,结合当前新冠恢复期特点建立多方法多途径科学全面的新冠感染中医肺养生康复方案以充分发挥中医药全程深度介入新冠疫情工作的重大作用。

中青年维持性血液透析患者社会回归情况调查及进入透析前后社会功能退化程度的影响因素分析

目的调查中青年维持性血液透析(maintenance hemodialysis,MHD)患者社会回归现状,并探讨其进入透析前后社会功能退化程度的影响因素。方法对2023年6月于山西医科大学第二医院接受MHD的中青年患者,采用横断面及回顾性调查方法收集资料,采集生活质量简表(the kidney disease quality of life questionnaire,short-form version 1.3,KDQOL-SFtm 1.3)、社会功能缺陷筛选量表(social disability screening schedule,SDSS),以透析前后SDSS评分差值的中位数为界将患者分为社会功能退化不明显组和退化明显组。采用单因素分析、二元Logistic回归分析探讨中青年MHD患者社会功能退化的影响因素。结果本研究共纳入MHD患者112例,其中社会回归3级42例(37.50%)、4级70例(62.50%);社会回归4级患者生活质量评分高于3级患者(t=-2.554,P=0.012),而仅在肾病影响(t=2.185,P=0.031)、工作状态(t=3.203,P=0.002)、社交质量(t=2.117,P=0.037)、情感职能(t=2.700,P=0.008)、社会功能(t=2.349,P=0.021)方面有统计学差异。短透析龄(OR=3.031,95%CI:1.192~7.706,P=0.020)、有疲乏症状(OR=7.574,95%CI:1.829~31.367,P=0.005)、合并焦虑和(或)抑郁(OR=3.765,95%CI:1.120~12.658,P=0.032)、较高的社会影响量表得分(OR=1.303,95%CI:1.104~1.537,P=0.002)是中青年MHD患者社会功能退化的独立危险因素。结论中青年MHD患者社会回归及生活质量水平较高;透析龄短、伴有疲乏、有焦虑和/或抑郁状态、病耻感得分高的MHD患者社会功能减退更明显。应高度重视中青年MHD患者的心理和情绪问题。

Analysis of cost effective pavement treatment and budget optimization for arterial roads in the city of Chattanooga

Many transportation agencies lack sufficient funds to maintain and repair roads, which results into increased pavement maintenance cost. Pavement Management System （PMS） has demonstrated to be an essential tool for proper management of infrastructure and proper utilization of available funds. The University of Tennessee at Chattanooga utilized Micropaver software as PMS tool to conduct a pavement management analysis of principal arterials in the City of Chattanooga. The study used the City of Chattanooga pavement database to create the current and future pavement conditions. Maintenance and repair （M＆R） planning analysis was also performed in order to determine the most cost-effective treatment and suggest the optimum utilization of funds for the city. An analysis of five budget scenarios was conducted for a five-year plan using the critical pavement condition index （PCI） method （ASTM D6433）. Results show that the backlog elimination budget would be the best scenario because it increases the pavement condition and eliminates the backlog of major maintenance and repairs over the five-year period. The unlimited budget seems though ideal, it does not improve pavement condition. Maintaining current condition and limited budget scenarios would increase both the backlog and the total cost of maintenance and repairs over the analysis period.

基于HAPA模型的护理干预在维持性血液透析患者运动康复中的应用

目的以健康行动过程取向(HAPA)模型理论为依据,研究其在维持性血液透析患者运动康复中的实施效果。方法将符合标准的维持性血液透析(MHD)患者根据其透析时间分为干预组和对照组,每组均30例。对照组接受传统的透析护理,在干预组中,除了进行对照组相同的透析护理外,还采用基于HAPA模型的运动干预。对比两组干预前后的身体功能、运动自我效能以及透析患者锻炼益处/障碍得分。结果干预3个月后,干预组躯体功能、运动自我效能及透析患者锻炼益处/障碍与对照组相比,均显著改善(P均<0.05)。结论基于HAPA模型的运动护理干预能有效改善MHD患者躯体功能、运动自我效能及透析患者锻炼益处/障碍得分,并建立运动健康信念。

红光治疗仪的质量安全管理探析

本文针对红光治疗仪在使用过程中存在的质量安全风险进行分析,掌握仪器的各项性能参数情况,并提出采用专业的检测设备定期对红光治疗仪的各项参数进行检测的方案,同时结合临床使用情况加强日常质量安全管理和维护,从而提高红光治疗仪临床使用的安全性和有效性。

基于思考-行动-维持理论的肺康复运动健康教育方案在慢性阻塞性肺疾病患者中的应用

目的探讨基于思考-行动-维持(CAM)理论的肺康复运动健康教育方案在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法选取90例COPD患者为研究对象,随机分为对照组45例和干预组45例。本研究共脱落5例患者,干预组最终纳入42例,对照组最终纳入43例。对照组给予常规运动健康教育,干预组给予基于CAM理论的肺康复运动健康教育。比较2组患者出院准备度量表(RHDS)、运动行为调节量表(BREQ-3)、疾病获益感量表(BFS)、运动依从性量表评分以及运动耐力[6 min步行试验(6MWT)]。结果出院时,干预组的RHDS得分高于对照组,差异有统计学意义(P<0.05)。出院时和出院1、3个月末,干预组的BREQ-3和BFS得分高于对照组,差异有统计学意义(P<0.05)。出院1、3个月末,干预组的运动依从性量表得分和6MWT距离高于或长于对照组,差异有统计学意义(P<0.05)。结论基于CAM理论的肺康复运动健康教育方案能够提高COPD患者的出院准备度、运动动机水平,增强其疾病获益感,提升运动依从性,进而改善患者的运动耐力。

观察5E理念下渐进性康复干预对糖尿病肾病血液透析患者自我管理及睡眠质量的影响

目的:分析5E理念下渐进性康复干预在糖尿病肾病(DN)血液透析患者中的应用效果。方法:选取2023年1—12月福建省泉州第一医院收治的维持性血液透析(MHD)的DN患者110例作为研究对象,按照随机数字表法分为对照组和观察组,每组55例。对照组给予常规治疗护理干预,观察组给予5E理念下渐进性康复干预。比较2组患者干预前与12周后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平的差异,采用血液透析患者自我管理量表评估2组患者的自我管理能力,采用阿森斯失眠量表(AIS)比较2组患者干预前后睡眠障碍的发生情况。结果:干预后,观察组12周后血液透析患者自我管理量表评分高于对照组,空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白水平(HbA1c)显著低于对照组,差异均有统计学意义(均P<0.05)。结论:5E理念下渐进性康复干预可提升DN血液透析患者自我管理能力与血糖控制效果,减少睡眠障碍的发生,值得临床推广应用。

煤矿运输中轨道修复与维护的技术分析与优化策略

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