新形势下军队医院卫生技术人员的稳定与思考

目的 分析在新形势下军队医院卫生技术人员的稳定性及影响因素。方法 对某省5家军队医院现役卫生技术人员进行问卷调查,采用卡方检验进行统计学分析。结果 有21.4％的现役卫生技术人员有转业倾向,其中医疗岗位占93.5%。与地方比福利待遇偏低、职称晋升困难、改非现役文职人员的不确定性显著影响人员的稳定性。结论 通过组织谈心和政策约束,稳定医疗岗位人才。对于选择提前退休或自主择业人员,积极创造条件返聘,通过各种途径稳定卫生技术人员,确保军队医院稳步转型。     

Estimating the Global Burden of Endemic Canine Rabies

BackgroundRabies is a notoriously underreported and neglected disease of low-income countries. This study aims to estimate the public health and economic burden of rabies circulating in domestic dog populations, globally and on a country-by-country basis, allowing an objective assessment of how much this preventable disease costs endemic countries.Conclusions/SignificanceThis study demonstrates that investment in dog vaccination, the single most effective way of reducing the disease burden, has been inadequate and that the availability and affordability of PEP needs improving. Collaborative investments by medical and veterinary sectors could dramatically reduce the current large, and unnecessary, burden of rabies on affected communities. Improved surveillance is needed to reduce uncertainty in burden estimates and to monitor the impacts of control efforts.     

Community arts: (Re)contextualizing the narrative of teaching and learning

ABSTRACT

Education in the United States is often characterized by testing and standardized outcomes, and bears little relevance to the culture and the community that surrounds both students and teachers. Conversely, community arts connect the philosophies of art and education to the larger spheres of culture and community. The community thus becomes an educational space in which both the teachers and students are motivated to learn from each other through a reciprocal relationship that changes the dynamic of both teaching and learning. Consequently, the (re)contextualization of art and education within culture and community has distinct policy implications regarding both what we teach and the way we teach it. There is an opportunity to increase the significance of art education in a democratic society if we embrace practices that empower preservice teachers to analyze how artmaking practices shape their own sensibilities and those of the communities in which they live. This article suggests a field experience model for informing cross-cultural understandings of community-based pedagogy, participation, and collaboration that challenges existing educational policy while informing the values and beliefs of the preservice teacher. It presents the opportunity to develop socially relevant programs for use in the teaching of art that include community, social justice, democracy, collective responsibility, activism, and equity—among others—that confront established perceptions of both art and education.     

Allosteric activation of metabotropic glutamate receptor 5

Abstract

Metabotropic glutamate receptor 5 (mGluR5) is a class C G protein-coupled receptor (GPCR) with both an extracellular ligand binding site and an allosteric intrahelical chamber located similarly to the orthosteric ligand binding site of Class A GPCRs. Ligands binding to this ancestral site of mGluR5 can act as positive (PAM), negative (NAM) or silent (SAM) allosteric modulators, and their medicinal chemistry optimization is notoriously difficult, as subtle structural changes may cause significant variation in activity and switch in the functional response. Here we present all atom molecular dynamics simulations of NAM, SAM and PAM complexes formed by closely related ligands and analyse the structural differences of the complexes. Several residues involved in the activation are identified and the formation of a continuous water channel in the active complex but not in the inactive ones is recognized. Our results suggest that the mechanism of mGluR5 activation is similar to that of class A GPCRs.

Communicated by Ramaswamy H. Sarma     

住院医师规范化培训中的问题及国际经验启示

目的 梳理我国住院医师规范化培训存在的问题,借鉴国际经验,提出相关政策建议。方法 对现阶段我国住院医师规范化培训存在问题和典型国家住院医师培训开展文献调研和专家咨询。结果 我国 住院医师规范化培训存在管理制度不完善,培训过程和内容不合理,考核制度不健全,动员机制不顺畅等问题。结论 根据 国际经验,提出厘清各部门分工,充分发挥行业组织的桥梁和纽带作用;加强顶层设计和政策配套,保障培训制度的落实;拓宽培养内容,加强学员考核,提高培养质量等政策建议。     

基于医院管理者视角的医学新技术转化应用模式分析

目的 对医院管理者视角下,新技术的引进,引进后的使用与管理及使用后的综合评估与反馈进行综合分析。方法 通过对53名医院管理人员1~1.5小时的半结构式访谈收取定性资料,并进行属性归类分析。结果 研究发现新技术在引入过程中主要考虑的因素涉及新技术的特性及循证依据的情况、新技术引入可能对医生的影响、新技术引入可能为医院带来的影响、新技术引入过程中涉及的相关政策、新技术引入可能对医患关系的影响;明晰了新技术引入的程序、新技术的使用管理及使用后的评估。结论 二三级医院基本已经形成一整套新技术的引进及管理反馈机制,在医院层面新技术的引进及使用过程中,政策因素起到非常重要的作用。     

Spatial greenhouse gas emissions from US county corn production

Purpose

Stakeholders from across supply chains have been prompted to explore ways to reduce the environmental burdens of corn production. To effectively manage these environmental impacts, spatially explicit information accounting for the differences in growing conditions and production practices across the production landscape is essential, allowing for high impact intensity corn to be identified and prioritized for improvement. To support these sustainability efforts, this study examines the spatially explicit life cycle greenhouse gas emissions of US county corn production, providing the most comprehensive assessment to date.

Methods

A streamlined spatial life cycle assessment is conducted, focusing on the three key hotspots of corn production for spatial differentiation at the county scale across the contiguous USA, accounting for almost 60% of total average cradle-to-farm gate impacts. Variations in nitrogen fertilization types and rates, N₂O emission rates, and irrigation emission rates are specifically revealed. Spatially distinguished hotspot inputs and related emissions are combined with static national average emission estimates from all other inputs used in corn production to gain a full picture and understand the relative contributions to total cradle-to gate impacts.

Results and discussion

Results show significant variation across corn producing counties, states, and regions. High impact priority locations are highlighted and key contributors of impact for each location are illuminated, providing critical information on the spatially explicit levers to reduce impacts. Results increase the generalizability of emission estimates using expected yields to characterize emission intensity, enabling more practical integration into company supply chain sustainability assessments to align with the time horizons in which decisions are made.

Conclusions

Streamlined life cycle assessment methods are an effective way to characterize spatial heterogeneity around key contributors of impact, helping deliver the necessary information for companies, stakeholders, and policy makers to target their influence to reduce these emissions through various engagement efforts.

     

The New Teacher of Art

Because of education reform policy and misconceptions about artistry and artistic assessment, visual art education remains in the margins of high school education. One response to the lack of supportive arts education policy is the Advanced Placement (AP) Studio Art Program, a visual arts assessment at the high school level that engages large numbers of students in rigorous art experiences. This article reviews the structure and characteristics of the AP portfolio assessment as a basis for critique and policy analysis. At issue are the reliability of this assessment's measurements and its level of credibility with key constituencies. These concerns are especially relevant in a testing culture in which objective evaluations are highly regarded and art education programs are often threatened. The authors suggest possibilities for future research and policy recommendations for secondary art education.     

A cis-encoded sRNA,Hfq and mRNA secondary structure act independently to suppress IS200 transposition

IS200 is found throughout Enterobacteriaceae and transposes at a notoriously low frequency. In addition to the transposase protein (TnpA), IS200 encodes an uncharacterized Hfq-binding sRNA that is encoded opposite to the tnpA 5''UTR. In the current work we asked if this sRNA represses tnpA expression. We show here that the IS200 sRNA (named art200 for antisense regulator of transposase IS200) basepairs with tnpA to inhibit translation initiation. Unexpectedly, art200-tnpA pairing is limited to 40 bp, despite 90 nt of perfect complementarity. Additionally, we show that Hfq and RNA secondary structure in the tnpA 5''UTR each repress tnpA expression in an art200-independent manner. Finally, we show that disrupting translational control of tnpA expression leads to increased IS200 transposition in E. coli. The current work provides new mechanistic insight into why IS200 transposition is so strongly suppressed. The possibility of art200 acting in trans to regulate a yet-unidentified target is discussed as well as potential applications of the IS200 system for designing novel riboregulators.     

The Rock Art Of Western Montana

Abstract

Western Montana rock art comprises 29 pictograph sites scattered throughout the mountainousPacific-drained portion of the state. The sites, composed of panels of simple red, yellow or black pictographs, cluster along the major streams in the region. A variety of zoomorphic, anthropomorphic and geometric designs predominate. Traditionally Western Montana rock art has beenassumed to be related to the rock art of the Northwestern Plains, however, this study demonstrates that functionally and stylistically its closest relationships are with Columbia Plateau rock art. Two style zones, each reflecting a different cultural influence, are recognized in theregion. The majority of sites apparently served as vision quest sites for Salishan tribes that inhabited the area during the Late Prehistoric Period. A few sites in the extreme southern portion of the region are attributed to Shoshoneans, and relate most closely to the pictographsof central and southern Idaho.     

Anisotropic mechanical properties of magnetically aligned fibrin gels measured by magnetic resonance elastography

The anisotropic mechanical properties of magnetically aligned fibrin gels were measured by magnetic resonance elastography (MRE) and by a standard mechanical test: unconfined compression. Soft anisotropic biomaterials are notoriously difficult to characterize, especially in vivo. MRE is well-suited for efficient, non-invasive, and non-destructive assessment of shear modulus. Direction-dependent differences in shear modulus were found to be statistically significant for gels polymerized at magnetic fields of 11.7 and 4.7 T compared to control gels. Mechanical anisotropy was greater in the gels polymerized at the higher magnetic field. These observations were consistent with results from unconfined compression tests. Analysis of confocal microscopy images of gels showed measurable alignment of fibrils in gels polymerized at 11.7 T. This study provides direct, quantitative measurements of the anisotropy in mechanical properties that accompanies fibril alignment in fibrin gels.     

The role of DNA sequence in centromere formation

Centromeres are key to the correct segregation and inheritance of genetic information. Eukaryotic centromeres, which are located in large blocks of highly repetitive DNA, have been notoriously difficult to sequence. Several groups have recently succeeded in analyzing centromeric sequences in human, Drosophila and Arabidopsis, providing new insights into the importance of DNA sequence for centromere function.     

The transition from noncoded to coded protein synthesis: did coding mRNAs arise from stability-enhancing binding partners to tRNA?

Background  

Understanding the origin of protein synthesis has been notoriously difficult. We have taken as a starting premise Wolf and Koonin's view that "evolution of the translation system is envisaged to occur in a compartmentalized ensemble of replicating, co-selected RNA segments, i.e., in an RNA world containing ribozymes with versatile activities".     

Towards social life cycle assessment of mobility services: systematic literature review and the way forward

Purpose

The main purpose of this review is to describe the state of the art of social impact assessment with a focus on mobility services. Whereas the use phase plays an important role for the assessment of services in general, the evaluation of the use phase has been underrepresented in previous social life cycle assessment studies. For that reason, particular attention has been paid to indicators, which allow the assessment of social impacts during the use phase of mobility services.

Methods

Continuous efforts to mitigate climate change and to improve quality of life in cities result in new mobility solutions based on collective use. This will have a huge impact on our society transforming the use of vehicles. In order to better understand the implications for cities, society and the automotive industry, it is essential to evaluate the social impact generated along a product life cycle with particular attention to the use phase. To reach the goal, a systematic literature review was carried out with a focus on social indicators that allow assessing use phase impacts of mobility services. The indicators were analysed and allocated to stakeholder groups. Based on the analysis, a core set of indicators is proposed under consideration of data availability.

Results and discussion

Based on the selected search strings, 51 publications were selected for the literature review, including 579 social indicators. The analysis revealed a wide variety and diversity of indicators that are trying to measure the same aspect. The allocation to the respective stakeholder groups showed that most of the indicators (36%) evaluate impacts regarding the stakeholder group local community. The majority of analysed indicators are of quantitative nature (63%). Nevertheless, a clear assessment method was often missing in the respective publications. Therefore, for the core set of indicators, an assessment method is proposed for every indicator.

Conclusions

The results from this study can help practitioners as well as researchers in the field of urban mobility assessment as it systematically analyses social sustainability aspects. The presented data gives an overview of various indicators that are suggested in other publications, and the proposed core set of indicators can be used to evaluate different mobility services in further research.

     

“单独两孩”政策对上海市医疗卫生行业的影响研究

目的 了解单独两孩政策的出台对上海市医疗卫生行业的影响,并由此提出有关对策建议。方法 通过宏观层面分析、焦点组访谈、问卷调研等多形式的调查手段,综合分析评估单独两孩政策实施后对上海市医疗卫生系统的需求和影响。结果 单独两孩政策实施对上海市医疗卫生行业的分别产生了三大影响和挑战：（1）影响：未来几年上海市将增加至少10%的年分娩量,2016年可能面临一个生育小波峰; 妊娠风险增加,高风险、高技术含量的产科任务增加;儿科医疗服务量的增加将逐渐出现,呈叠加之势。（2）挑战：政策调整将加剧产科医疗资源使用的不均衡,首要受到冲击的是优质产科机构;妊娠风险增加将进一步考验上海高危产科的整体应对能力;出生人口的增加和不断叠加将使本已短缺的儿科医疗资源雪上加霜。结论 单独两孩政策的影响辐射结果提示了政府主导辅以市场机制调控的重要性和迫切性;需要尽快扭转孕妇自由选择分娩医院的无序状态,保证优质产科资源真正为高危孕产妇服务;整合区域内不同层次产儿科医疗资源,以提高对高危产科的整体应对水平。     

公立医院外部绩效评价的执行路径研究

目的 探索公立医院外部绩效评价在公立医院的有效执行路径。方法 访谈公立医院管理人员,调研不同执行情况的北京市属公立医院进行案例分析;构建公立医院外部绩效评价政策执行的分析框架;对公立医院外部绩效评价政策资料和研究文献进行分析。结果 构建公立医院外部绩效评价政策在公立医院的四种执行模式,归纳外部绩效评价执行的院科两级影响因素。结论 政府主管部门、公立医院、部门科室三层级的绩效评价融合是推进公立医院外部绩效评价政策在公立医院内有效执行的路径选择。     

Shape-shifting corals: Molecular markers show morphology is evolutionarily plastic in Porites

Background  

Corals are notoriously difficult to identify at the species-level due to few diagnostic characters and variable skeletal morphology. This 'coral species problem' is an impediment to understanding the evolution and biodiversity of this important and threatened group of organisms. We examined the evolution of the nuclear ribosomal internal transcribed spacer (ITS) and mitochondrial markers (COI, putative control region) in Porites, one of the most taxonomically challenging and ecologically important genera of reef-building corals.     

北京市单病种付费政策回顾性研究

目的 回顾分析北京市单病种政策执行情况，为付费制度改革提供建议。方法 通过对医院单病种运行指标分析，评价单病种运行现状；选择盈亏的典型病种对照临床路径，探究原因。结果 单病种政策有效降低了平均住院日、个人负担、次均费用，部分病种偏离率较高；病种盈亏与政策是否及时调整有关。结论 北京市执行单病种政策有效遏制医疗费用不合理增长，但政策长期不调整使医院执行政策走形。建议政府部门通过扩大病种范围、设立定额标准调整规则、配套监管措施，提高医疗质量和控费效果。     

基于FMEA和POSSUM评分的手术风险评估研究

??????? 目的 研究建立手术风险评估的架构,以正确决策手术时机。方法 采用用于计数死亡率和并发症发生率的生理学和手术严重性（POSSUM）评分原理进行分层计分,同时引用失效模式与效应分析方法对手术可能发生故障模式的严重度及发生可能性及风险因素的影响度3个维度进行评估。结果 建立了手术前风险预警机制及手术评估架构,利用评估架构对某综合医院2010年200例80岁高龄的手术病人进行了术前评估,结果手术后并发症的发生率较2009年同年龄的手术病人的并发症下降了10.45%。结论 在手术前对手术相关因素进行评估,可以为手术时机的选择提供参考。     

Impatiens maculifera sp. nov. (Balsaminaceae) Yunnan,China

Impatiens (Balsaminaceae) is a notoriously difficult genus to study for reasons that include small, remote and endemic areas of occurrence, and difficulty in obtaining well‐dried herbarium specimens and separating and reconstructing floral parts from available dried specimens. Impatiens has also been notoriously difficult when it comes to phylogenetic resolution at the infrageneric level, but a new system with two subgenera (Impatiens and Clavicarpa) was recently proposed by Yu et al. and it has made it easier to classify newly discovered species. Impatiens maculifera, a new species of Balsaminaceae from Malipo County, Yunnan, China described here, is similar to I. parvisepala S.X. Yu & Y.T. Hou in having racemose inflorescences, four lateral sepals, clavate capsules and ellipsoid seeds, but differs in having leaves narrowly oval or with elliptic–lanceolate blades (versus obovate or obovate–lanceolate), obvious petioles (versus leaves subsessile), racemose inflorescence with 8–12 flowers (versus 6–8 flowers), flowers greenish yellow (versus yellow), lateral united petals and lower sepal with dense red spots (versus red spots absent), and dorsal petal with apparent stalk at base (versus unapparent stalk). Morphological characters and molecular phylogenetic analyses of DNA sequences from both nuclear ribosomal and plastid genes show that the new species differs distinctively from I. parvisepala. Furthermore, I. maculifera is distinguished from other Impatiens species based on morphological, micromorphological and palynological evidence, and molecular data.