高校在职教职工体检空腹血糖统计分析与健康干预策略研究

目的：探讨定期查体及针对检测结果进行健康干预对高校教职工空腹血糖（FPG）的影响。方法：回顾性分析山东大学在职教职工2013年~2019年4次健康查体的空腹血糖（FPG）检测结果及健康干预方式,分析4次查体高血糖患病情况;不同职业人员健康干预效果;不同年龄组、不同性别高血糖患病情况;高血糖患病率与身体质量指数及家族史的关系;部分血糖持续增高患者原因。结果：后两次体检高血糖患病率明显降低,空腹血糖受损患病状况改善明显,FPG值≥7.0 mmol/L者患病状况无改善。教师、机关及管理人员2019年高血糖患病率及FPG均值与2013年相比有明显降低,但后勤工人高血糖患病率无降低,FPG水平居高不下。45~55岁年龄组男女患病率相当,其他年龄组男性高血糖患病率及FPG水平均明显高于女性。高血糖患病率与身体质量指数及家族遗传因素关系密切。随机抽取2013年及2019年查体两次FPG均≥8.0 mmol/L的患者12例,调查血糖未达标原因,主要为不了解糖尿病并发症的危害,对疾病不重视;对健康处方中的建议一知半解,不能正确执行;工作性质特殊,无法执行医嘱;对胰岛素有偏见,口服药物效果不理想的情况下,不愿意及时采取胰岛素治疗。结论：定期查体及针对检测结果进行健康干预可有效降低高校教职工高血糖发病率,需要针对后勤工人、更年期女性、身体质量指数超标及有相关疾病家族史等重点人群实施更加有效的干预措施。     

Coal fly ash is a major carbon flux in the Chang Jiang (Yangtze River) basin

Fly ash—the residuum of coal burning—contains a considerable amount of fossilized particulate organic carbon (FOC_ash) that remains after high-temperature combustion. Fly ash leaks into natural environments and participates in the contemporary carbon cycle, but its reactivity and flux remained poorly understood. We characterized FOC_ash in the Chang Jiang (Yangtze River) basin, China, and quantified the riverine FOC_ash fluxes. Using Raman spectral analysis, ramped pyrolysis oxidation, and chemical oxidation, we found that FOC_ash is highly recalcitrant and unreactive, whereas shale-derived FOC (FOC_rock) was much more labile and easily oxidized. By combining mass balance calculations and other estimates of fly ash input to rivers, we estimated that the flux of FOC_ash carried by the Chang Jiang was 0.21 to 0.42 Mt C⋅y⁻¹ in 2007 to 2008—an amount equivalent to 37 to 72% of the total riverine FOC export. We attributed such high flux to the combination of increasing coal combustion that enhances FOC_ash production and the massive construction of dams in the basin that reduces the flux of FOC_rock eroded from upstream mountainous areas. Using global ash data, a first-order estimate suggests that FOC_ash makes up to 16% of the present-day global riverine FOC flux to the oceans. This reflects a substantial impact of anthropogenic activities on the fluxes and burial of fossil organic carbon that has been made less reactive than the rocks from which it was derived.

Fossil particulate organic carbon (FOC) is a geologically stable form of carbon that was produced by the ancient biosphere and then buried and stored in the lithosphere; it is a key player in the geological carbon cycle (1–7). Uplift and erosion liberate FOC from bedrock, delivering it to the surficial carbon cycle. Some is oxidized in sediment routing systems, but a portion escapes and can be transported by rivers to the oceans (5, 8–10). Oxidation of FOC represents a long-term atmospheric carbon source and O₂ sink, whereas the reburial of FOC in sedimentary basins has no long-term net effect on atmospheric CO₂ and O₂ (1, 9, 11). Exhumation and erosion of bedrock provide a natural source of FOC (2, 8), which we refer to as FOC_rock. Human activities have introduced another form of FOC from the mining and combustion of coal. Burning coal emits CO₂ to the atmosphere but also leaves behind solid waste that contains substantial amounts of organic carbon (OC) that survives high-temperature combustion (12–14). This fossil-fuel-sourced carbon represents a poorly understood anthropogenic flux in the global carbon cycle; it also provides a major source of black carbon, which is a severe pollutant and climate-forcing agent (12–15).Previous studies sought to quantify black carbon in different terrestrial and marine environments and to distinguish fossil fuel versus forest fire sources (14–18). In this study, we focused on fly ash—the material left from incomplete coal combustion. As a major fossil fuel, coal supplies around 30% of global primary energy consumption (19, 20). Despite efforts to capture and utilize fly ash, a fraction enters soils and rivers; the resulting fossil OC from fly ash (FOC_ash) has become a measurable part of the contemporary carbon cycle (14). FOC_ash is also referred to as “unburned carbon” in fly ash (21–25); it provides a useful measure of combustion efficiency and the quality of fly ash as a building material (e.g., in concrete) (23–26). Industrial standards of FOC_ash content in fly ash have been established for material quality assurance (23, 24, 26, 27). However, the characteristics and fluxes of FOC_ash released to the environment, and how these compare to FOC_rock from bedrock erosion, remain less well understood.To fill this knowledge gap, we examined the Chang Jiang (Yangtze River) basin in China—a system that allowed us to evaluate the influence of FOC_ash on the carbon cycle at continental scales. In the 2000s, China became the largest coal-consuming country in the world, with an annual coal consumption of over 2,500 Mt, equating to ∼50% of worldwide consumption (19, 20, 28). Coal contributed over 60% of China’s national primary energy consumption through the 2000s. A significant portion of this coal (approximately one-third) was consumed in the Chang Jiang (CJ) basin, where China’s most populated and economically developed areas are located (29). Significant amounts of fly ash and FOC_ash continue to be produced and consumed in the CJ basin. To determine the human-induced FOC_ash flux, we investigated the FOC_ash cycle in the CJ basin. We characterized OC in a series of samples including fly ash, bedrock sedimentary shale, and river sediment through multiple geochemical analyses. We then estimated the CJ-exported FOC_ash flux and evaluated how human activities modulated FOC transfer at basin scales. We found that in the CJ basin, coal combustion and dam construction have conspired to boost the FOC_ash flux and reduce the FOC_rock flux carried by the CJ; as a result, these two fluxes converged over an interval of 60 y.     

新型冠状病毒肺炎疫情下一线医务人员风险感知特点及影响因素

目的 研究新型冠状病毒肺炎（COVID-19）疫情下一线医务人员风险感知特点及影响因素,为其在高风险、高强度抗疫医疗工作中正确感知风险、提升压力应对能力、维护心理健康提供有效参考。方法 采用抗击COVID-19疫情一线医务人员疫情风险感知问卷对181名抗疫一线医务人员进行风险感知问卷调查,采用非参数检验对人口学因素及风险感知维度进行差异比较,用logistic回归分析人口学因素对抗疫一线医务人员风险感知水平的预测作用。结果 COVID-19疫情下一线医务人员风险感知问卷总得分为（36.39±8.59）分,得分率为60.65%,得分率排前3位的维度为身体功能风险、组织风险及人身安全风险。湖北地区医务人员风险感知问卷总得分高于非湖北地区（Z=－2.180,P<0.05）;医技人员（医师和技师）风险感知问卷总得分高于护士（Z=－3.039,P<0.01）。医务人员所在地对总体风险感知具有预测作用（P<0.05）。结论 在COVID-19疫情下,抗疫一线医务人员风险感知处于中等程度,湖北地区医务人员风险感知程度高于非湖北地区,医技人员风险感知程度高于护士,医务人员所在地区对风险感知具有预测作用。     

新型冠状病毒肺炎流行期间医护人员心理健康与应对方式相关性研究

目的 调查新型冠状病毒肺炎(COVID-19)流行期间六安市区三家三级医院医护人员心理健康的现状,分析医护人员心理健康水平与应对方式的关系。方法 于2020年2月7日～2月15日,使用问卷星形式,采用焦虑自评量表、抑郁自评量表及简易应对方式问卷调查COVID-19流行期间六安市区三家三级医院360名医护人员心理状况,分析医护人员焦虑、抑郁水平及其与应对水平的相关性。结果 COVID-19流行期间六安市区三家三级医院医护人员焦虑粗分(32.82±7.80)分,抑郁粗分(37.90±8.30)分,均高于中国常模,差异有统计学意义(P<0.05)。焦虑阳性者(总粗分≥40分)68例(18.9%),抑郁阳性者(总粗分≥41 分)138例(38.4%);医护人员应对方式总分9～60分,平均为(36.61±8.55)分。积极应对6～36分,平均为(24.49±6.14)分。消极应对1～24分,平均为(12.12±4.19)分;偏相关分析显示,医护人员焦虑得分与积极应对呈负相关(r=-0.315,P<0.05),与消极应对呈正相关(r=0.147,P<0.05)。抑郁得分与积极应对呈负相关(r=-0.374,P<0.05),与消极应对呈正相关(r=0.207,P<0.05)。结论 COVID-19流行期间医护人员存在不同程度的焦虑和抑郁,疫情期间医护人员的心理健康与积极应对方式呈正相关,与消极应对方式呈负相关。     

Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT—An integrated community hepatitis C service

Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community‐based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one‐to‐one semi‐structured interviews. Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital‐based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation. Our findings indicate the positive impact of an integrated and personalized community‐based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non–DAT‐based community services and increasing awareness of new treatments amongst this cohort.     

A Study on the Utilization of Coal Fly Ash Derived Grog in Clay Ceramics

Grog is an additive material that plays important roles in ceramic making. It improves the fabrication process of green bodies as well as the physical properties of fired bodies. Few low-cost materials and wastes have found their application as grog in recent years, thus encouraging the replacement of commercial grogs with cost-saving materials. Coal fly ash, a combustion waste produced by coal-fired power plant, has the potential to be converted into grog owing to its small particle sizes and high content of silica and alumina. In this study, grog was derived from coal fly ash and mixed with kaolin clay to produce ceramics. Effects of the grog addition on the resultant ceramics were investigated. It was found that, to a certain extent, the grog addition reduced the firing shrinkage and increased the total porosity of the ceramics. The dimensional stability of the ceramics at a firing temperature of 1200 °C was also not noticeably affected by the grog. However, the grog addition in general had negative effects on the biaxial flexural strength and refractoriness of the ceramics.     

Study of Mechanical Properties and Durability of Alkali-Activated Coal Gangue-Slag Concrete

Herein, a new geopolymer is recognized as a potential alternative cementing material of ordinary Portland cement (OPC), which is used for reducing carbon emissions and efficiently recycling the waste. Therefore this paper mainly studied the alkali-activated coal gangue-slag concrete (ACSC) was prepared by using the coal gangue-slag and Na₂SiO₃ and NaOH complex activator. The ratio of coal gangue (calcined and uncalcined) coarse aggregate replacing the gravel was 0%, 30%, 50%, 70%, and 100%. The water and salt freeze-thaw resistance, compressive strength, chloride permeation, microstructure, performance mechanism, inner freeze-thaw damage distribution, and mechanics models of ACSC were investigated. Results show that ACSC displayed excellent early age compressive strength, and the compact degree and uniformity of structure were better compared with the ordinary Portland cement (OPC) when the coal gangue replacement rate was less than 50%. The ACSC demonstrated the best chloride penetration resistance under 30% uncalcined coal gangue content, which was less than 27.75% lower than that of using OPC. At the same number cycles, especially in the salt freezing, the calcined coal gangue had lowered advantages of improving resistance freeze-thaw damage resistance. Water and salt accumulative freeze-thaw damage mechanics models of ACSC were established by using the relative dynamic elasticity modulus. The exponential function model was superior to the power function model with better precision and relativity, and the models accurately reflected the freeze-thaw damage effect.     

Estimation of Coal’s Sorption Parameters Using Artificial Neural Networks

This article presents research results into the application of an artificial neural network (ANN) to determine coal’s sorption parameters, such as the maximal sorption capacity and effective diffusion coefficient. Determining these parameters is currently time-consuming, and requires specialized and expensive equipment. The work was conducted with the use of feed-forward back-propagation networks (FNNs); it was aimed at estimating the values of the aforementioned parameters from information obtained through technical and densitometric analyses, as well as knowledge of the petrographic composition of the examined coal samples. Analyses showed significant compatibility between the values of the analyzed sorption parameters obtained with regressive neural models and the values of parameters determined with the gravimetric method using a sorption analyzer (prediction error for the best match was 6.1% and 0.2% for the effective diffusion coefficient and maximal sorption capacity, respectively). The established determination coefficients (0.982, 0.999) and the values of standard deviation ratios (below 0.1 in each case) confirmed very high prediction capacities of the adopted neural models. The research showed the great potential of the proposed method to describe the sorption properties of coal as a material that is a natural sorbent for methane and carbon dioxide.     

呼吸与危重症医学科护理人员对雾化吸入治疗应用的调查与分析

目的了解呼吸与危重症医学科的护理人员对雾化吸入态度、技能与知识的应用状况,并分析影响因素。方法采用横断面调查的方法,使用问卷发放(自制问卷),对江苏省内18家医院呼吸与危重症医学科护士的雾化吸入态度、技能和知识掌握情况进行调查。结果共发放795份量表,回收774份,回收率97.3%,涵盖10家三级医院,8家二级医院,调查显示了呼吸与危重症医学科护理人员对雾化吸入态度技能与知识的掌握情况,雾化吸入的知识与态度、技能呈正相关。结论应加强呼吸与危重症医学科护理人员对雾化吸入相关知识的培训,端正其对雾化吸入的态度,从而提高雾化吸入的护理质量,为规范临床护理操作提供依据。