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.

Maturity status classification of papaya fruits based on machine learning and transfer learning approach

Papaya(Carica papaya)is a tropical fruit having commercial importance because of its high nutritive and medicinal value.The packaging of papaya fruit as per its maturity status is an essential task in the fruit industry.The manual grading of papaya fruit based on human visual perception is time-consuming and destructive.The objective of this paper is to suggest a novel non-destructive maturity status classification of papaya fruits.The paper suggested two approaches based on machine learning and transfer learning for classification of papaya maturity status.Also,a comparative analysis is carried out with different methods of machine learning and transfer learning.The experimentation is carried out with 300 papaya fruit sample images which includes 100 of each three maturity stages.The machine learning approach includes three sets of features and three classifiers with their different kernel functions.The features and classifiers used in machine learning approaches are local binary pattern(LBP),histogram of oriented gradients(HOG),Gray Level Cooccurrence Matrix(GLCM)and k-nearest neighbour(KNN),support vector machine(SVM),Naı¨ve Bayes respectively.The transfer learning approach includes seven pretrained models such as ResNet101,ResNet50,ResNet18,VGG19,VGG16,GoogleNet and AlexNet.The weighted KNN with HOG feature outperforms other machine learningbased classification model with 100%of accuracy and 0.0995 s training time.Again,among the transfer learning approach based classification model VGG19 performs better with 100%accuracy and 1 min 52 s training time with consideration of early stop training.The proposed classification method for maturity classification of papaya fruits,i.e.VGG19 based on transfer learning approach achieved 100%accuracy which is 6%more than the existing method.