On Psychological Continuity and Dementia

This letter responds to the article “On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case,” by Henri Wijsbek and Thomas Nys, in the September-October 2022 issue of the Hastings Center Report.     

Factors associated with the perception of parents and children regarding obesity-related terminology used by healthcare professionals in a sample of Korean children and adolescents with obesity

ObjectiveThis study aimed to compare how children with overweight or obesity and their parents perceive the obesity-related terms used by healthcare professionals and investigate the factors associated with these perceptions.MethodsChildren and adolescents aged 8–16 years with overweight or obesity (n = 192) and their parents participated in the cross-sectional study by responding to a 5-point Likert-scale questionnaire on 10 obesity-related terms, including “chubby,” “weight problem,” “weight,” “overweight,” “BMI,” “obese,” “heavy,” “fleshy,” “fat,” and “severely obese.”ResultsFor both children and parents, “chubby” was the most desirable term (mean ± standard deviation: 3.50 ± 1.12 and 2.95 ± 0.83, respectively), and “severely obese” was the least acceptable term (2.83 ± 1.17 and 2.02 ± 1.02, respectively). Although the parents preferred all the terms less than the children did (p < 0.001), “weight problem” was considered most motivating for a child to lose weight (3.93 ± 0.94). Among children, older age and a larger self-perceived body size were associated with a more positive response towards obesity-related terms, whereas having internalized or externalized problems were negatively associated with these terms. Parents with a history of cardiovascular disease considered “severely obese” (β = ?0.419, [95% CI: ?0.739, ?0.099]) and “fat” (β = ?0.457, [95% CI: ?0.750, ?0.164]) less desirable.ConclusionsChildren and adolescents had a higher preference for obesity-related terms than their parents and preferred that healthcare professionals use euphemistic terms such as “chubby,” or neutral terms such as “weight problem.” Children with larger self-perceived body sizes or older age had a higher preference for obesity-related words. The terms used by healthcare professionals to describe excess weight must be motivating and respectful for all family members participating in the treatment.     

基于ADOPT问题解决模式下的个体化护理对口腔正畸患者自我 护理能力的影响

目的 探讨ADOPT问题解决模式下的个体化护理对口腔正畸患者自我护理能力的影响。方法 选 取2021年1月-12月我院正畸科收诊的80例正畸患者作为观察对象，采用自拟抽签法随机分为对照组与观察 组，各40例。对照组采用常规护理，观察组采用ADOPT问题解决模式下的个体化护理，比较两组干预前后 自我管理能力、生活质量以及社会心理适应能力。结果 两组干预后1个月生活质量以及自我管理能力评分 高于干预前，且观察组高于对照组，差异有统计学意义（P＜0.05）。观察组接受水平、持续担忧、积极 面对评分高于对照组，差异有统计学意义（P＜0.05）。结论 ADOPT问题解决模式下的个体化护理有助于 提升口腔正畸患者自我管理能力及社会心理适应能力，进而提高患者生活质量。     

Exact penalty functions for optimal control problems I: Main theorem and free‐endpoint problems

In this two‐part study, we develop a general approach to the design and analysis of exact penalty functions for various optimal control problems, including problems with terminal and state constraints, problems involving differential inclusions, and optimal control problems for linear evolution equations. This approach allows one to simplify an optimal control problem by removing some (or all) constraints of this problem with the use of an exact penalty function, thus allowing one to reduce optimal control problems to equivalent variational problems and apply numerical methods for solving, eg, problems without state constraints, to problems including such constraints, etc. In the first part of our study, we strengthen some existing results on exact penalty functions for optimisation problems in infinite dimensional spaces and utilise them to study exact penalty functions for free‐endpoint optimal control problems, which reduce these problems to equivalent variational ones. We also prove several auxiliary results on integral functionals and Nemytskii operators that are helpful for verifying the assumptions under which the proposed penalty functions are exact.     

病例引导的PBL教学模式在烧伤外科临床见习中的应用探讨

以问题为导向的(Problem based learning,PBL)教学法在国内外高等医学教育中应用广泛并进行了不断改良。我们通过建立典型病例的资料库,逐步将病例引导的PBL教学模式应用于烧伤外科的临床见习教学中,强调以学生为中心,充分调动学生的主观能动性,着眼于学生形成正确的临床思维方法和最终分析解决问题的能力,以此来提高烧伤外科见习教学的质量。     

呼吸内科PBL教学法在全科医师规培中的应用

目的探索基于呼吸治疗团队教学的以问题为基础的教学法(problem based learning,PBL)在全科住院医师规范化培训中的应用。方法呼吸系统以老年人慢性疾病为主,是全科医学生教育的重要环节。开展PBL教学法的教学探索,以期达到对全科医师的专科疾病培训,使其理解并掌握相关疾病知识,能适应未来医学发展和社会需要,为患者提供更好的社区医疗服务。结果PBL教学法的精髓是发挥问题对学习过程的指导作用,调动学生学习的积极性和主动性,整体提升学生的综合素质和能力。结论在全科医学规范化培训教学中运用PBL教学,带教老师以任务为主线、以学员为主体进行引导,可极大的提高学生的学习兴趣、主动性以及自学能力,从而培养学员的分析问题、解决问题的能力。可以更好的帮助学员形成以患者为中心的临床诊断思路、提高解决临床问题的综合能力及团队合作能力。     

A Multi-Scale DNN Algorithm for Nonlinear Elliptic Equations with Multiple Scales

Algorithms based on deep neural networks (DNNs) have attracted increasing attention from the scientific computing community. DNN based algorithms are easy to implement, natural for nonlinear problems, and have shown great potential to overcome the curse of dimensionality. In this work, we utilize the multi-scale DNN-based algorithm (MscaleDNN) proposed by Liu, Cai and Xu (2020) to solve multi-scale elliptic problems with possible nonlinearity, for example, the p-Laplacian problem. We improve the MscaleDNN algorithm by a smooth and localized activation function. Several numerical examples of multi-scale elliptic problems with separable or non-separable scales in low-dimensional and high-dimensional Euclidean spaces are used to demonstrate the effectiveness and accuracy of the MscaleDNN numerical scheme.     

Effective Two-Level Domain Decomposition Preconditioners for Elastic Crack Problems Modeled by Extended Finite Element Method

In this paper, we propose some effective one- and two-level domain decomposition preconditioners for elastic crack problems modeled by extended finite element method. To construct the preconditioners, the physical domain is decomposed into the "crack tip" subdomain, which contains all the degrees of freedom (dofs) of the branch enrichment functions, and the "regular" subdomains, which contain the standard dofs and the dofs of the Heaviside enrichment function. In the one-level additive Schwarz and restricted additive Schwarz preconditioners, the "crack tip" subproblem is solved directly and the "regular" subproblems are solved by some inexact solvers, such as ILU. In the two-level domain decomposition preconditioners, traditional interpolations between the coarse and the fine meshes destroy the good convergence property. Therefore, we propose an unconventional approach in which the coarse mesh is exactly the same as the fine mesh along the crack line, and adopt the technique of a non-matching grid interpolation between the fine and the coarse meshes. Numerical experiments demonstrate the effectiveness of the two-level domain decomposition preconditioners applied to elastic crack problems.