住院电子病历常见问题及解决方案

在医院住院电子病历使用过程中,问题主要出现在电子病历模板、与其他系统接口程序、系统管理3个方面。列举这3方面具有典型意义的案例并提出了解决方法,供系统使用、维护人员参考。     

Stereochemical Problems in Oligonucleotide Synthesis

Abstract

The phosphoramidites of protected cordycepin, thymidine and deoxyadenosine were prepared and the two isomers were well separated by medium-pressure chromatography. Condensations were performed in solution to dimers and on solid support to oligomers. The stereochemical consequences will be discussed.     

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。     

医疗卫生行业特点与医院内部分配问题与对策研究

目的 梳理医疗卫生行业特点,分析医院内部分配问题,并提出对策建议。方法 基于个人深访和选题小组访谈的访谈法、专家咨询法。结果 医疗卫生行业具有公益性且劳动价值高,社会和政府预期高,高风险,高强度,周期长（高投入）,专业性强,压力大,不计付出,对个人、家庭及周边人员影响大,待遇低等特点。医院内部分配存在薪酬与收入挂钩、内部分配系数差异大、岗位间不平衡等问题。结论 行业宏观政策宜确定医院员工工资和社会平均工资的倍差关系,增设专门津补贴;医院微观制度宜推行岗位评价,落实岗位绩效薪酬制,明确评价指标,增加透明度,调整薪酬系数,提高职工参与度。     

Growth of Filamentous Fungi in Submerged Culture: Problems and Possible Solutions

ABSTRACT:?

Filamentous fungi are important organisms industrially and continue to attract research interest as microbiologists attempt to overcome the problems associated with their behavior in submerged culture. This review critically examines the literature describing these problems and where available suggests possible solutions to them. The influence of the chemical and physical environment on culture morphology, the process engineering challenges presented by different fungal morphologies, and the relationship between fungal morphology and metabolite production are all discussed.     

Postnatal Environmental Tobacco Smoke Exposure Related to Behavioral Problems in Children

ObjectiveThe purpose of this study was to examine the association between pre and post environmental tobacco smoke (ETS) exposure and behavioral problems in schoolchildren.MethodsIn the cross-sectional 6 cities Study conducted in France, 5221 primary school children were investigated. Pre- and postnatal exposure to secondhand tobacco smoke at home was assessed using a parent questionnaire. Child’s behavioral outcomes (emotional symptoms and conduct problems) were evaluated by the Strengths and Difficulties Questionnaire (SDQ) completed by the parents.ResultsETS exposure during the postnatal period and during both pre- and postnatal periods was associated with behavioral problems in children. Abnormal emotional symptoms (internalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.72 (95% Confidence Interval (CI)= 1.36-2.17), whereas the OR was estimated to be 1.38 (95% CI= 1.12-1.69) in the case of postnatal exposure only. Abnormal conduct problems (externalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.94 (95% CI= 1.51-2.50), whereas the OR was estimated to be 1.47 (95% CI=1.17-1.84) in the case of postnatal exposure only. Effect estimates were adjusted for gender, study center, ethnic origin, child age, low parental education, current physician diagnosed asthma, siblings, preterm birth and single parenthood.ConclusionPostnatal ETS exposure, alone or in association with prenatal exposure, increases the risk of behavioral problems in school-age children.     

医疗损害赔偿立法存在的问题与完善建议

《中华人民共和国侵权责任法》虽然用专章规定医疗损害责任，但对医疗损害赔偿没有作出专门性规定，不能完全解决在司法实践中涌现的诸多医疗损害赔偿问题。拟从医学与法学理论及实践相结合角度，同时借鉴有关国家和地区医疗损害赔偿相关经验，对医疗损害赔偿立法存在的问题及完善进行分析、探讨。     

Diseases of tropical crops: Problems and controls

Summary

Tropical crops are diverse as to botanical origins and as to function; they have numerous diseases, some of them very damaging. A few characteristic crops and their diseases and causal agents are listed for purposes of illustration. There are several approaches to control of which the cultural, legal and chemical have some uses; by far the most important is by breeding ‘horizontal resistance’ (HR) which is cheapest and ‘environmentally friendly’. Sugarcane is specifically instanced as the best example in the world of outstandingly successful HR breeding programmes; vast areas of a clonal crop are grown in good health without the use of chemical controls.     

Female Adolescents with Severe Substance and Conduct Problems Have Substantially Less Brain Gray Matter Volume

ObjectiveStructural neuroimaging studies have demonstrated lower regional gray matter volume in adolescents with severe substance and conduct problems. These research studies, including ours, have generally focused on male-only or mixed-sex samples of adolescents with conduct and/or substance problems. Here we compare gray matter volume between female adolescents with severe substance and conduct problems and female healthy controls of similar ages. Hypotheses: Female adolescents with severe substance and conduct problems will show significantly less gray matter volume in frontal regions critical to inhibition (i.e. dorsolateral prefrontal cortex and ventrolateral prefrontal cortex), conflict processing (i.e., anterior cingulate), valuation of expected outcomes (i.e., medial orbitofrontal cortex) and the dopamine reward system (i.e. striatum).MethodsWe conducted whole-brain voxel-based morphometric comparison of structural MR images of 22 patients (14-18 years) with severe substance and conduct problems and 21 controls of similar age using statistical parametric mapping (SPM) and voxel-based morphometric (VBM8) toolbox. We tested group differences in regional gray matter volume with analyses of covariance, adjusting for age and IQ at p<0.05, corrected for multiple comparisons at whole-brain cluster-level threshold.ResultsFemale adolescents with severe substance and conduct problems compared to controls showed significantly less gray matter volume in right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, medial orbitofrontal cortex, anterior cingulate, bilateral somatosensory cortex, left supramarginal gyrus, and bilateral angular gyrus. Considering the entire brain, patients had 9.5% less overall gray matter volume compared to controls.ConclusionsFemale adolescents with severe substance and conduct problems in comparison to similarly aged female healthy controls showed substantially lower gray matter volume in brain regions involved in inhibition, conflict processing, valuation of outcomes, decision-making, reward, risk-taking, and rule-breaking antisocial behavior.     

Glycemic Control and Outcomes of Hospitalization in Noncritically Ill Patients With Type 2 Diabetes Admitted With Cardiac Problems or Infections

ObjectiveAlthough the importance of glycemic control is well established for patients with diabetes hospitalized for surgical problems, it has not been supported by clinical studies for patients with diabetes hospitalized on the medical floors.MethodsWe conducted a retrospective study of 378 patients with type 2 diabetes admitted for cardiac or infectious disease (ID) diagnosis between September 1, 2011, and August 1, 2012. Exclusion criteria included type 1 diabetes, admission to the intensive care unit (ICU), hospital stay shorter than 3 days, and daily glucocorticoid dose > 20 mg of methylprednisolone. The primary composite outcome included death during hospitalization, ICU transfer, initiation of enteral or parenteral nutrition, line infection, deep vein thrombosis, pulmonary embolism, rise in plasma creatinine by 1 or > 2 mg/dL, new infection, an infection lasting for more than 20 days, and readmission within 30 days and between 1 and 10 months after discharge.ResultsPatients were stratified by mean blood glucose (BG) level: group 1 had mean BG of < 180 mg/dL (n = 286; mean BG, 142 ± 23 mg/dL), whereas group 2 had mean BG levels > 181 mg/dL (n = 92; mean BG, 218 ± 34 mg/dL; P < .0001). Group 2 had a 46% higher occurrence of the primary outcome (P < .0004). The rate of unfavorable events was greater in cardiac and ID patients with worse glycemic control (group 2).ConclusionOur data strongly support a positive influence of better glycemic control (average glycemia < 180 mg/dL or 10 mmol/L) on outcomes of hospitaliza-tion in patients with type 2 diabetes. (Endocr Pract. 2014; 20:1303-1308)     

Mental Health Problems and Educational Attainment in Adolescence: 9-Year Follow-Up of the TRAILS Study

BackgroundThis study examines if mental health problems at age 11 and changes in mental health problems between age 11 and 16 predict educational attainment of adolescents at age 19, overall and stratified by gender.MethodsData from 1711 adolescents (76.8% from initial cohort) of the Tracking Adolescents'' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 9year follow-up, were used. Mental health problems (externalizing, internalizing and attention problems) were measured by the Youth Self Report and the Child Behavior Checklist at ages 11 and 16. Difference scores for mental health problems between age 11 and 16 were calculated. Educational attainment was assessed at age 19.ResultsExternalizing, internalizing and attention problems at age 11 were significantly associated with low educational attainment at age 19 (crude model). When adjusted for demographic variables and the other mental health problems, only the association for attention problems remained significant (odds ratio (OR), 95% confidence interval: 3.19, 2.11–4.83). Increasing externalizing problems between age 11 and 16 also predicted low educational attainment at age 19 (OR 3.12, 1.83–5.32). Among girls, increasing internalizing problems between age 11 and 16 predicted low educational attainment (OR 2.21, 1.25–3.94). For boys, no significant association was found for increasing internalizing problems and low educational attainment. For increasing attention problems between age 11 and 16 no significant association with low educational attainment was found.ConclusionsExternalizing, internalizing and attention problems at age 11 and an increase of these problems during adolescence predicted low educational attainment at age 19. Early treatment of these mental health problems may improve educational attainment, and reduce socioeconomic health differences in adulthood.     

Notes on Chronological Problems on the Northwestern Plains and Adjacent Country

Abstract

A methodology is presented for the analyses of cultural chronologies covering the last 7300 years. With this we can isolate problem areas within the local sequences. No sequence in any of the six subareas discussed here has a chronology that is not marked by one or more significant time gaps in absolute dates over this temporal interval. These breaks include ones during the later Altithermal, during the time period assignable to the McKean Technocomplex, and even more recently. This being the case, no hypothesis which assumes occupational (or population or ethnic) continuity is supportable by refering to the stratigraphic record of the last 7300 years in any of the six subareas.     

Problems with the statistical testing of panbiogeographic hypotheses

Abstract

Croizat regarded generalised tracks as having a statistical basis, their degree of justification being directly related to the number of individual tracks consistent with them. In order to be logically valid, however, such an approach needs to have an explicit statistical basis. Page (1987) attempts to provide this, proposing the following protocol. Tracks are treated as geographic minimum-spanning trees which in turn are represented numerically as binary connectivity matrices. The statistical significance of similarities between two connectivity matrices is assessed using a permutation-test of association, a test that was developed for comparing distancematrices. The null hypothesis for this test is defined by the set of alternative connectivity matrices corresponding to all possible permutations of the track-vertices. There are however, a number of problems with this statistical test when applied to connectivity matrices derived from panbiogeographic tracks, and these render invalid the procedure advocated by Page.     

The Mechanical Basis Of Stone Flaking: Problems And Prospects

Abstract

A variety of quite different theories and models concerning the fracture of solids and the behavior of solids under stress have been developed by physical scientists. On the basis of their work, 19 variables are identified that are likely to be important in studying the mechanics of stone flaking. These variables fall into three classes: (1) properties of the material being fractured; (2) properties of the flaking device; and (3) variables relating to the experimental situation. A lack of knowledge concerning the physical properties of many common stone tool materials seriously hinders the direct application of theories of stress and fracture to practical archaeological problems. However, the work of physical scientists may still suggest approaches to problems in lithic technology and variables which may be worth examining.     

Nelson Lee and the Green Corn Dance: Data Selection Problems with Wallace And Hoebel’S Study Of the Comanches

Abstract

This paper shows that Wallace and Hoebelˊ s erroneous report of a Comanche Green Corn Dance resulted from misuse of source material. Consideration of their methodology suggests that critical reanalysis of the corpus of Comanche ethnohistoric sources might be fruitful     

Bioassays and Field Studies for Allelopathy in Terrestrial Plants: Progress and Problems

Bioassays are an integral part of allelopathy research. The unsuitability of laboratory bioassays to explain field situations is discussed previously. In this article, we discuss progress in bioassay experimental design and several unresolved problems associated with research on allelopathy. The objectives of this article are to discuss problems related to (1) collection of allelopathic material for bioassay, (2) allelochemical quantification in bioassays, (3) selection of concentration of allelochemicals in bioassay, (4) selection of appropriate control, (5) interaction between allelochemicals and other substances, and (6) in situ allelochemical bioassays. We concluded that new experimental designs for in situ bioassay are needed that can account for the large number of confounding factors in a complex field environment, and can be linked to physiological monitoring of target species and biochemical monitoring of the growth medium. Referee: Dr. Stella Elakovich, Dept. of Chemistry and Biochemistry, University of Southern Mississippi, Hattiesburg, MS 390406-5043     

Ecology of the North Sea: Problems,successes, failures,future needs

After defining ‘ecology’, outlining the basic categories of ecological research and listing examples of modern ecological investigations, this introductory paper focusses on basic considerations; it is, in essence, a programmatic contribution. Research details on the ecology of the North Sea are the subject of the following papers. Theproblems of ecological North Sea research are formidable. Hydrological and biological fluctuations and variabilities are pronounced. Exchange patterns with the Atlantic are complex, and the inputs of rivers and rain defy exact measurement and prediction. Season, weather, climate—and as yet insufficiently known and controlled human-caused impacts—further complicate the situation. All this results in an unusually high degree of uncertainty. New questions and problems arise before the old ones can be answered or solved. Nevertheless, ecological North Sea research has achieved manysuccesses. The North Sea is the most intensively investigated sea area on our planet. Generations of zoologists, botanists and hydrographers — and more recently microbiologists, meteorologists, climatologists, chemists, pathologists and toxicologists — have produced an impressive body of knowledge. Slowly we are beginning to understand the forces that govern energy budgets and balances, material fluxes, and the factors that control and direct ecosystem dynamics. Essential driving forces of ecosystem dynamics result from microbial, especially bacterial, activities. Ecological modelling has paved the way for new theories and insights, and holds promise for progress towards a predictive ecology.Failures and shortcomings include insufficient long-term research, inadequately designed experiments, and misconceptions in environmental protection. Net changes in ecological processes of an heterogeneous and intensely varying environment such as the North Sea can only be comprehended adequately against the background of sustained measurements over decades.Future needs include: more long-term research; and new patterns of management, institutional organization and financial support. Essential breakthroughs in field-work demand more teamwork, in-situ experimentation and surveys from space. Studies on the health status of organisms and ecosystems should receive more attention. Finally, there is need for changes in human behaviour: we must use our insight and willpower to meet the deadly consequences of our self-made scientific-technological evolution by an equally self-made ethical evolution aimed at achieving a re-harmonization with nature.