胃食管反流病(gastroesophageal reflux disease,GERD)是一种发病机制复杂、临床表现多样且容易复发的消化道常见病.GERD 的发病与年龄、性别、生活方式密切相关,随着经济的增长,饮食及生活方式的改变,GERD 的发病率呈上升趋势[1],最近的一项Meta 分析显示GERD 全球患病率为13.98％ [2],中国社区人群 GERD 患病率为7.69％ [3].与健康人相比,GERD 患者具有更高的心理障碍风险[4].GERD与焦虑、抑郁等心理障碍存在着密切联系,合并焦虑、抑郁的GERD 患者具有更低的生活质量.本文就GERD 患者相关的焦虑、抑郁及其干预进行综述.

青少年非自杀性自伤(NSSI)是全球重大公共卫生事件之一,对其进行有效干预具有重要意义.本文对青少年常见NSSI特定和非特定性的心理干预进行综述,以期提高医护人员对NSSI的重视,为后续研究选择合适的干预方式提供借鉴.

The energy management of hybrid energy storage system (HESS) and the nonlinear control strategy of the interface circuit are studied in this paper. In order to realize the reasonable distribution of load power between the battery and the supercapacitor, the energy management strategies (EMS) are used to decompose the load power required for electric vehicles under different driving cycle conditions, aiming at choosing an optimal power allocation strategy. Based on the local modeling, the global mathematical model of two bidirectional DC/DC converters under the HESS with active control topology is established, and the nonlinear control strategies are studied for the interface circuit and then the target controller is designed to realize the EMS. The current inner loop controller based on synergetic control theory is to track the battery current and supercapacitor current. The voltage outer loop controller takes power conservation as the criterion and adds the DC bus voltage PI controller to construct the Lyapunov function, where the connection between the DC bus voltage stability and the supercapacitor reference current is established. The supercapacitor replaces the battery to overcome the fluctuation of the DC bus voltage caused by the sudden change of the load power, maintaining the stability of the entire control system, and at the same time the case that the power allocated by the supercapacitor is consistent with the EMS is ensured. Two typical vehicle driving cycle conditions, IM240 and ECE-15, are selected to test the effectiveness of the current controller and the voltage controller. The experimental platform of a small-capacity HESS is built to conduct experimental verification. The simulation and experimental results show that the nonlinear controllers are feasible and have strong robustness and good adaptability under different driving conditions.

目的 了解湖北省6所医院精神科护士挑战性-障碍性压力与职业获益感现状并分析二者之间的关系.方法 2021年1-3月,采用便利抽样法,选取湖北省某6所医院的415名精神科护士为调查对象,应用一般资料调查表、挑战性-障碍性压力源问卷和护士职业获益感量表进行线上调查,并对数据进行分析.结果 湖北省6所医院精神科护士挑战性压力条目均分为(3.081±0.857)分,障碍性压力条目均分为(2.875±0.785)分;职业获益感总分为(131.395±16.048)分,正向职业感知条目均分为(3.728±0.586)分,良好的护患关系条目均分为(4.297±0.593)分,团队归属感条目均分为(3.987±0.624)分,亲友认同条目均分为(3.802±0.645)分,自身成长条目均分为(4.169±0.545)分.精神科护士职业获益感与挑战性压力呈正相关(r=0.537,P＜0.01),与障碍性压力呈负相关(r=-0.526,P＜0.01).挑战性-障碍性压力解释了职业获益感总变异的30.7％(调整R2=0.307,P＜0.01).结论 挑战性-障碍性压力是职业获益感的重要影响因素,护理管理者需关注精神科护士的压力水平,并采取积极的干预措施,以提高精神科护士的职业获益感及工作积极性.

目的 了解湖北省5家三级甲等综合医院精神科护士知觉压力和职业倦怠与心理健康的现状及相关性.方法 选取2019年9-11月在湖北省5家三级甲等综合医院精神科病房的186名护士为研究对象,采用自制的一般情况调查表、知觉压力量表(PSS)、症状自评量表(SCL-90)和MASLACH职业倦怠量表-服务行业版(MBI-HSS)进行调查并分析精神科护士知觉压力、职业倦怠与心理健康的水平.结果 186名精神科护士PSS评分为39.48±7.43,MBI-HSS评分为68.11±12.95,情感衰竭、去人格化倾向和个人成就感都以中度为主,分别占51.1％、54.3％和43.0％.SCL-90)评分为149.61±41.27,所调查的精神科护士SCL-90量表躯体化、强迫、人际敏感、抑郁、焦虑、敌意、恐怖和偏执评分及总分均高于全国常模(t=9.591、7.601、5.282、4.611、11.215、11.399、6.325、3.925和7.451,均P＜0.01).Pearson相关分析结果显示,PSS量表评分与MBI-HSS量表情感衰竭、去人格化倾向维度评分及总分均呈正相关(r=0.641、0.540、0.608,均P＜0.01),与个人成就感维度评分呈负相关(r=-0.440,P＜0.01).PSS量表评分与SCL-90量表的各个维度评分及总分均呈正相关性(r=0.387、0.584、0.521、0.543、0.518、0.519、0.388、0.466、0.361和0.533,均P＜0.01),MBI-HSS量表情感衰竭维度评分与SCL-90量表的各个维度及总分均呈正相关(r=0.550、0.688、0.659、0.669、0.640、0.641、0.509、0.579、0.570和0.688,均P＜0.01),MBI-HSS量表去人格化倾向维度评分与SCL-90量表的各个维度及总分均呈明显正相关性(r=0.349、0.550、0.560、0.537、0.457、0.535、0.376、0.408、0.503和0.529,均P＜0.01),个人成就感评分与SCL-90量表各个维度及总分均呈明显的负相关性(r=-0.381、-0.468、-0.470、-0.467、-0.434、-0.367、-0.420、-0.358、-0.515和-0.486,均P＜0.01),职业倦怠总分与SCL-90量表的各个维度及总分均呈正相关(r=0.252、0.358、0.339、0.341、0.316、0.387、0.205、0.308、0.225和0.339,均P＜O.05).结论 湖北省5家三级甲等综合医院精神科护士普遍存在知觉压力、职业倦怠与心理健康问题,且三者存在着明显的相关性,降低精神科护士的知觉压力及职业倦怠感有助于提高护士的心理健康水平.

目的 探讨阿立哌唑联合利培酮对缓解精神分裂症患者暴力行为的影响.方法 前瞻性选取2018年3月至2019年12月武汉大学人民医院收治的176例精神分裂症患者为研究对象,根据随机数字表法将样本分为观察组与对照组,每组各88例.观察组予以阿立哌唑、利培酮联合治疗,对照组予以利培酮,2周为1个疗程,共治疗4个疗程.分别在治疗前、治疗后8周采用阳性症状和阴性症状量表(PANSS)评估患者症状改善情况,依据世界卫生组织生存质量测定量表简表(WHOQL-BREF)、韦氏成人智力量表评估生活质量改善情况及认知功能.于治疗前、治疗后2、8周采用《修订版外显攻击行为量表》(MOAS)评估2组患者攻击行为,统计治疗期间的不良反应.结果 治疗后8周,观察组阳性症状(12.6±2.7)分,阴性症状(13.5±2.4)分,一般精神病理(21.7±2.6)分,均显著高于对照组[(15.3±2.4)、(15.6±2.3)、(23.5±2.3)分],差异有统计学意义(P<0.05);治疗后8周,2组生活质量评分较治疗前显著提高,观察组心理、社会关系、环境评分依次为(53.2±4.8)、(63.6±5.1)、(56.5±3.4)分,均显著高于对照组[(44.6±3.7)、(58.2±4.6)、(48.4±3.2)分],差异有统计学意义(P<0.05),但2组生理评分比较,差异无统计学意义(P>0.05);治疗后8周,观察组认知功能中言语评分(103.5±14.6)分,与对照组[(99.7±6.5)分]比较,差异无统计学意义(P>0.05),但操作评分(102.7±9.4)分则显著高于对照组[(96.5±7.8)分],差异有统计学意义(P<0.05).治疗后2周,观察组财产、自身、体力等暴力攻击行为及总评分均显著低于对照组,差异有统计学意义(P<0.05),治疗后8周,观察组各项暴力攻击行为评分均显著低于对照组,差异有统计学意义(P<0.05).观察组不良反应发生率为2.27％,与对照组不良反应发生率(7.95％)比较,差异无统计学意义(P<0.05).结论 阿立哌唑联合利培酮治疗有助于提高精神分裂症患者生活质量及认知功能,改善其暴力攻击行为.

This article assesses the energy management of reconfigurable residential smart hybrid AC/DC microgrids considering the combined heat and power (CHP) loads as well as the electric vehicles charging/discharging behaviors. A holistic model is developed for the proton exchange membrane fuel cell to retrieve the unwanted thermal energy generated at the operation time. The proposed model makes use of the unoccupied capacity of the fuel cell for producing/storing hydrogen for the later usage and increasing its efficiency. A stochastic framework is designed using point estimate method (PEM) to capture the uncertainties of the photovoltaic and wind turbine forecast error, power company price, the operating temperature of the proton exchange membrane fuel cell, the price for natural gas, price for selling hydrogen, and the pressure of the H2 and O2 in the fuel cell stack. The PEM approach has shown superior advantages in terms of accuracy and running time. Considering the complex and nonlinear structure of the proposed framework, a proficient optimization technique based on the teacher learning algorithm (TLA) is devised. A two-phase modification method is proposed to increase the algorithm variety and help its convergence characteristics. The performance of the proposed algorithm is compared with the TLA, particle swarm optimization (PSO) algorithm and genetic algorithm (GA). For enhancing the security of the energy and data transaction within the system, a directed acyclic graph (DAG)-based security framework is introduced to guarantee the performance of the system against the subversive accesses. By using this scheme, the essential data of the units are recorded and secured in the form of public, private and transaction blockchains. The economic characteristics of the proposed method are assessed on a residential hybrid AC-DC microgrid test system.

Over the last few decades, the use of renewable and clean energy sources has been the core of attention of the researchers. Besides, utilization of the energy hubs as a great innovation for future multi-carrier energy systems is well perceived for integrating intermittent sources of energy into the energy systems, which is surged and bolded in recent years. In this regard, this paper proposes an effective distributed energy management framework for modeling and optimal operation management of clean smart islands based on primal-dual method of multipliers. The primal-dual method of multipliers approach has shown superior performance compared to the alternating method of multipliers for distributed optimization. In this study, two different agents including a smart energy hub and a microgrid comprises of renewable and clean energy sources are considered in the smart island. These two distinct energy systems are assumed to be equipped with communication apparatuses and are intended to negotiate over the energy they need in a proper and completely distributed manner. Results show the effectiveness, accuracy and applicability of the approach for energy communication.

In light of the problem that it is hard to analyze the non-linear and time-varying model in the traditional hydrogenerator system identification, based on the PID control parameters, this paper proposes a hydro-turbine governing system using the improved BFO-PSO algorithm, and introduces the sliding mode variable structure into the proposed improved governing system. The research results show that: the proposed BFO-PSO model has integrated the advantages of the two algorithms and has been successfully applied in the parameter optimization of the hydraulic turbine set. This paper also studies the selection of indices for optimization of PID parameters. Considering the deficiencies in the PID parameters in previous research, this paper proposes an improved fitness evaluation method, and also puts forward the concepts of stability and instability parameter sets and applies them in the stable search strategy, which effectively improves the local search capability of the model algorithm, and guarantees the stability and accuracy of the hydro-generator model. The design of multi-control-input hydro-turbine state equations can effectively solve the steady-state errors in the simulation process and explain the generation mechanism of such errors. The simulation results show that the optimization result of this algorithm significantly shortens the ITAE transition rising time of the hydro-turbine set and that the target population has been moving towards the global optimal solution, thus increasing the searching ability of the algorithm. The curve fluctuates slightly and reaches the steady state in a very short time.

Objective To evaluate the effect of doll intervention on the effect of clinical nursing of psychiatric patients. Methods Between April and October of 2017, a total of 61 female patients hospitalized in the Mental Health Center of Renmin Hospital of Wuhan University were recruited, and randomly divided into intervention group (n=30) and control group (n=31). The patients of the control group received routine nursing care, while the patients of the intervention group were given doll intervention on the basis of routine nursing for 3 weeks. Patients were rated using Nurses' Observation Scale for Inpatient Evaluation (NOSIE) and Kolcaba General Comfort Questionnaire (GCQ) for the effect of intervention. Results The result of NOSIE indicated that after 3 weeks' intervention, the scores of social interest, delayed and depressive of the intervention group were (20.67±5.81), (M=6) and (M=4) respectively, which were all improved than those of the control group (15.16±7.17), (M=2), and (M=2) (P＜0.05). The score of GCQ of the intervention group was (87.07±9.58), which was significantly higher than that of the control group (79.81±7.94), and the difference was statistically significant (P=0.002). Conclusions Doll intervention method is beneficial to the improvement of patient's comfort level and social interest, the reduction of the patient's delay and depression, and the effects of clinical nursing on the improvement of mental illness.

为提高新入职护士岗前培训的效果,对2017年7月新入职的127名护士在传统培训方法的基础上,采用在线学习平台进行岗前培训及考核,及时发现培训中存在的问题并改进.培训结束后对新入职护士的理论及临床操作进行考核,并调查护士对在线学习平台的评价.与传统培训方法相比,新入职护士的各项考核成绩均有所提高(P＜0.01),护士对在线学习平台的评价较好.通过在线学习平台可有效提高新入职护士的综合能力,是传统培训方法的重要补充.

Objective To understand the relationship between the current status and the relevant factors of patients with severe mental disorder in Wuchang District ,Wuhan City and provide a basis for effective management in community .Methods The relevant data of 3 358 patients with severe mental disorders from the national network management system of severe mental disorders were under descrip‐tive analysis .The influence factors of type and duration of the diseases were analysed by Logistic regres‐sion .Results Among all the patients ,59 .38% were single ,60 .18% were educated at or below junior high school level ,43 .33% were from poor families ,60 .76% were unemployed or laid off .Logistic re‐gression analysis showed that the influence factors of the duration in patients with severe mental diseases included financial status (OR = 0 .896) and education (OR = 1 .430) .The impact factors of the type of diseases included education (OR = 0 .549) ,financial status (OR = 1 .212) ,marital status (OR = 1 .183) and occupation (OR = 1 .215) .Conclusions Schizophrenia and mental retardation (with mental disor‐ders) should be viewed as the key point of community health service management ,especially for patients with no medication and poor compliance .

目的 了解湖北省精神卫生机构开展健康教育情况,为全省心理健康教育发展提供基础理论依据.方法 采用自制调查表对全省精神卫生机构心理健康教育开展形式、面向人群、开展内容、开展频率、效果自评等进行调查.结果 湖北省精神卫生机构健康教育开展形式主要为讲座、心理辅导和培训,面向人群主要为青少年和老年人,内容以精神疾病健康教育为主,50％以上的机构每月都开展健康教育,44.8％的机构自评达到“良好”.结论 目前湖北省精神卫生机构健康教育工作开展良好,可进一步开展多种教育方式,提升心理健康教育效果.

目的 分析湖北省严重精神障碍网络管理患者的基本情况,为研究制定湖北省严重精神障碍患者救助救治政策提供基础信息.方法 选取截止到2013年12月31日湖北省15岁以上常住人口中明确诊断为严重精神障碍的173 494例在管患者为研究对象,由湖北省各级精神卫生中心或疾病预防控制中心、严重精神障碍管理治疗工作领导小组和省级专家指导组提供医疗技术指导、培训、会诊等服务,以村委会或居委会为基本单位,由基层卫生医疗机构负责采集患者基础信息及随访情况,录入国家数据收集分析系统,按人口学特征和疾病特征进行统计分析.结果 18～44岁严重精神障碍患者占53.43％;严重精神障碍患者小学文化及以下占54.23％;98.03％的严重精神障碍患者为汉族;严重精神障碍患者未婚者占39.12％;离婚及丧偶者占6.72％;有严重精神障碍家族史者占4.35％;农村严重精神障碍患者占65.51％,城市下岗职工或无业人员占14.25％;经济状况处于当地贫困线以下的严重精神障碍患者占64.47％;精神分裂症患者占81.88％;不服药和间断服药患者占54.99％,随访病情不稳定占4.45％,近3年平均肇事肇祸率为1.19％.在纳入网络管理的173 494例患有严重精神障碍患者中,同意接受随访患者133 929例,接受治疗患者71 131例,随访管理率为77.19％,规范治疗率为53.11％.结论 应加强政府领导,完善协调机制,依法对贫困、肇事肇祸严重精神障碍患者免费开展救治救助工作,确保患者得到全程连续性管理治疗服务,促进公共安全和社会稳定.

目的：了解湖北省精神卫生机构和床位资源现状，为全省精神卫生机构设置及体系建设发展规划提供决策。方法采用自制调查表对全省精神卫生机构现状进行调查。结果截至2013年10月，全省17个市州及直管市设有精神卫生机构共119个，21个县级地区无精神卫生机构。机构数量以武汉市、襄阳市居多，神农架林区无精神卫生机构；全省精神科床位16654张（含心理科病床1739张），以武汉市、黄冈市居多；全省平均床位密度2．97张／万人，高于全国1．82张／万人平均水平，以鄂州市最高，其次为黄石市。各级精神卫生机构设置精神疾病防治科74家，占62．2％。结论初步建立了省－市－县精神卫生服务管理网络，全省精神卫生机构与床位资源可满足当前开展严重精神障碍患者服务需求，但主办部门多，资源缺乏有机结合，精神科床位资源地域分布不平衡，地区差异明显。

Objective To understand the development of psychological service in mental health in‐stitutions of Hubei Province ,and provide evidences for enacting appropriate policy .Methods A sampling survey of psychological service at mental health institutions of Hubei Province was made by the self -made questionnaire .Results More than 80% of mental health institutions had developed the psychological counseling and treatment services .The outpatient's amount was less than or equal to 150 times/month in 54 .1% of mental health institutions ,the outpatient's amount was less than or equal to 1000 times/year in 39 .3% of mental health institutions ,the psychological department that only had less than or equal to 30 beds ,accounted for 34 .8% of mental health institutions ,and 37 .0% of institutions'discharged pa‐tients were less than or equal to 250 times/year .The major of educational degree of psychiatrists and psychologists was bachelor degree (40 .9% ) , and the major of title was intermediate certificate (36.9% ) ,the working experience mainly was less than 5 years (32 .4% ) .The average hospital days of mental health institutions was 42 .6 days .The top 5 diseases in psychological department respectively were de‐pression ,anxiety ,schizophrenia ,bipolar disorder and obsessive compulsive disorder .Conclusions At pres‐ent ,the mental health needs of Hubei Province is great .However ,the psychological departments are lack of human resources and service ability ;the distribution of mental health resources is imbalance;and the quality of the people working on psychological department is low .Therefore ,we should provide tar‐geted support to improve .

目的 分析2011～2013年湖北省在管严重精神障碍患者的失访与死亡情况,为减少失访患者危险行为的发生提供依据.方法 对在管患者随访数据及失访(死亡)患者登记表进行整理,了解失访患者的失访原因、病种,以及死亡患者的死亡原因.结果 2013年较2012年失访与死亡患者增加1.17倍,除其他(37.3％)和死亡(13.3％)外,外出打工、迁居他处、连续3次失访和走失患者合计49.4％;精神分裂症占失访患者84.2％;躯体疾病所致死亡患者占53.6％.结论 加强对精神分裂症和躯体疾病患者的随访,及时流转患者随访信息是预防患者失访和死亡的有效方法.

The indicators and methods of the probabilistic stability analysis of interconnected power grid's low frequency oscillation are put forward in this paper, and the case study based on the real interconnected power grid is investigated. As the probabilistic distribution of various uncertain factors of power grid is known, the method of two-point-estimation is adopted to calculate the probabilities of low-frequency oscillation caused by these uncertain factors based on small perturbation calculation method. The theory of risk assessment is used to analyse the instability condition of power system's low frequency oscillation caused by multiple disturbances, and then the control cost and the risk of low frequency oscillation of power grid are given. The expenses between the risks the power grid companies have taken and the costs the transmission capacity has increased are obtained through comprehensive probability analysis of small disturbance and large disturbance, which can give insights for grid operators to address the economy and security issues.

目的 探讨理论授课与集体心理辅导对心理护理小组护士心理的影响.方法 对65名心理护理小组护士采取心理理论授课、心理干预、集体心理辅导等方法进行干预,采用总体幸福感量表和生活质量综合评定问卷对小组成员在心理护理小组活动前后进行调查.结果 干预后小组成员总体幸福感上升,生活质量总体评价提高,其中躯体功能(除进食功能、运动与感觉功能外)、心理功能、社会功能(除人际交往能力、工作与学习外)得分显著高于干预前(P＜0.05,P＜0.01).结论 通过心理理论授课及集体心理辅导后,小组成员的总体幸福感上升,生活质量提高,其对改善护理人员的心理状况有一定的帮助.

目的 了解湖北省精神卫生服务人员现状,为人力资源规划提供基本依据.方法 采用自制调查表对全省精神卫生机构人力资源现状进行调查.结果 全省有精神科医师1 398人(2.44/10万人);精神科护士3 175人(5.55 人/10万人);心理治疗师293人(0.51 人/10万人);全省21个县(市)无在岗精神科医护人员,37.8％机构未设置精神疾病预防科开展精神社区服务.结论 全省人力资源分布不均衡,区域差异明显;服务人员整体结构欠合理,专业种类不全;人员总体素质偏低,规范服务能力不足,难以满足社区精神卫生工作.